Post ambulatory swollen hands (POTASH): a case report

Post ambulatory swollen hands (POTASH) is an acquired condition that presents as asymptomatic swelling of the hands and their digits during ambulatory activities such as walking, hiking, and running. Affected individuals cannot clench their fingers into their palm to make a fist and thereby have a positive fist sign. The benign condition typically resolves spontaneously within 2 hours with complete resolution of the swelling; the individual can make a tight fist and has a negative fist sign.

A 65-year-old man developed POTASH, when he was rapidly walking during a 13.1-mile half marathon race, that presented as asymptomatic swelling of his fingers and hands. His hands and their digits began to swell after the first hour of running and continued to progressively become larger during the remainder of the race. In addition, he had a positive fist sign demonstrated by being unable to clench his fingers to his palm and make a fist. Within 2 hours after he stopped ambulating, the swelling spontaneously resolved completely, and he had a negative fist sign by being able to make a tight fist by clenching his fingers into his palm.

POTASH is an idiopathic recurrent condition whose pathogenesis remains to be determined. A report of occurrence in a brother and sister raises the possibility that in some individuals, genetic factors may have a contributory role in the etiology of the condition. There is a paucity of papers on POTASH in the medical literature which suggests a lack of awareness of this condition. It is important that healthcare providers are aware of this recurrent and benign condition and can appropriately counsel affected individuals.