C5-T1 Nerve Root Compression and Hand Swelling

Clinical Presentation

The American College of Radiology suggests that nerve root compression of C5-T1 does not typically cause hand swelling as a direct manifestation of radiculopathy, with characteristic presentation involving neuropathic pain, dysesthesia, sensory loss, motor weakness, and reflex changes in specific dermatomal distributions 1, 2
The C5-T1 nerve roots form the brachial plexus and provide motor and sensory innervation to the upper extremity, with expected clinical findings including neuropathic pain, motor weakness, sensory deficits, reflex changes, and muscle atrophy in chronic cases 1, 2, 3

The American College of Radiology recommends MRI of the brachial plexus rather than just cervical spine imaging if the clinical picture includes hand swelling with neurological symptoms, with a protocol that includes orthogonal views, T1-weighted, T2-weighted, and fat-saturated sequences 1, 3, 4, 5
Electrodiagnostic studies should be considered to confirm the diagnosis and differentiate radiculopathy from plexopathy 1

Brachial plexopathy can present with more complex symptoms than simple radiculopathy and may involve regional soft-tissue changes, with post-traumatic complications such as regional hematoma or scarring accompanying plexopathy 1, 3, 4
Vascular or lymphatic compromise, such as thoracic outlet syndrome or venous thrombosis, may coexist with cervical pathology but are separate entities 2, 4
Complex Regional Pain Syndrome (CRPS) can develop after nerve injury and presents with swelling, color changes, and temperature alterations, as a complication rather than a direct effect of nerve root compression 2
Inflammatory or infectious processes, such as infection or inflammation affecting the plexus, can cause regional soft-tissue changes and may require MRI with contrast for diagnosis 2, 5