Table 5. Conditions with a positive fist sign.

^a A fist is created when there is clenching of the fingers and the fingertips are in direct contact with the palm of the hand with the thumb lying on top of the fingers between the proximal and distal interphalangeal joints. A positive fist sign is defined as the inability of the individual to make a fist; it, therefore, occurs when the fingertips are not able to contact the ipsilateral palm when the person attempts to clench their fingers. Therefore, a negative fist sign is observed when the individual can make an intact fist when they clench their fingers.

^b It is likely several, if not all, of the etiologies of acute hand swelling or chronic hand swelling are associated with a positive fist sign. However, most of the reports of patients with swollen hands do not describe whether the individual was not able to make a fist.

^c Resolution depends on the etiology of the hand swelling and appropriate initiation of intervention which often requires surgery such as an emergency fasciotomy.

CR: current report; POTASH: post ambulatory swollen hands; Refs: references; RS3PE: remitting seronegative symmetrical synovitis with pitting edema.

Conditiona,b	Resolves	Mechanism	Refs
Acromegaly	No	Soft tissue and bone overgrowth	Harada et al., 2019 [12]
Compartment syndrome	Post-surgery	Edema, hemorrhage, infection, and/or traumac	Oak and Abrams, 2016 [5]
Giant lipoma-associated carpal tunnel syndrome	Post-surgery	Space occupying lesion and nerve compression	Jalan et al., 2011 [13]
POTASH	Spontaneously	Edema	Ravaglia, et al., 2011 [1], CR
Puffy hand syndrome	No	Lymphatic obstruction and fibrosis	Studdiford and Stonehouse, 2009 [3], Chatterjee, 2021 [18]
RS3PE	Post-corticosteroids	Edema	Joshi et al., 2009 [10]