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This doctor's indulgence in rigorous physical activity led to the realisation of a novel clinical entity. As an active sportsman and ex-ice hockey player, currently living in a hot climate, I have had to sublimate my sporting activities to infrequent inline roller skate street journeys. Recently, on a day of a very pressed schedule, I attempted to concentrate a week's exercise into one concise session. After an hour and fifteen minutes of intense exertion, rapidly skating up and down hills and valleys, over good and not so good paved surfaces, I experienced an unexpected heaviness and tightness in the tips of my fingers. Later I noticed that the simple task of clenching my fists was not fully possible, and this was more accentuated in the right hand (the more dominant of the two). Within the course of a couple of hours the whole condition spontaneously subsided.
I had never previously suffered such events, no concurrent pathology existed in any body system, and I have remained healthy since. The working hypothesis to explain this phenomenon must be that the rhythmic swaying and waving of the outstretched arms in a circular arc resulted in increased centripetal force of hydrostatic pressure in the distal parts of the upper limbs. This overwhelming pressure overcame the compensation mechanism of the lymphatic system to drain the hands. Axillary pressure from the straps of a small backpack carried during the whole journey may have compounded the effect, although all it contained was a mobile telephone and a small bottle of water.
Bizarre and not always innocent diagnoses have been made in the pathogenesis of limb oedema.1,2 The resulting hydrostatic effects of physical exertion of the lower limbs are well documented.3–5 Possible reasons why this problem does not occur during ice skating are the fact that long distances without any stops are uncommon and the cold environment may provide protection through peripheral vasoconstriction.
Thus heavy roller skating is a thought to entertain a doctor's mind when confronted with a patient with acute unexplained bilateral hand oedema.
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