Can C5-T1 Nerve Root Compression Cause Hand Swelling?
Nerve root compression of C5-T1 does not typically cause hand swelling as a direct manifestation of radiculopathy. The characteristic presentation of cervical radiculopathy involves neuropathic pain, dysesthesia, sensory loss, motor weakness, and reflex changes in specific dermatomal distributions—but not edema or swelling 1, 2.
Why Hand Swelling is Not a Typical Feature
The C5-T1 nerve roots form the brachial plexus and provide motor and sensory innervation to the upper extremity 1. When these roots are compressed, the expected clinical findings include:
- Neuropathic pain with an "electric" quality radiating in dermatomal distributions 2
- Motor weakness affecting specific muscle groups (shoulder abduction/external rotation from C5-C6, elbow flexion/extension, wrist and finger extensors from C5-C8) 3, 4
- Sensory deficits in corresponding dermatomes 1, 5
- Reflex changes (diminished or absent deep tendon reflexes) 2
- Muscle atrophy in chronic cases 1
Swelling or edema is not part of the typical radiculopathy syndrome because nerve root compression primarily affects motor and sensory nerve fibers, not the autonomic or vascular systems that would produce edema 1, 6.
When to Consider Alternative Diagnoses
If hand swelling is present alongside symptoms suggesting C5-T1 involvement, you should consider:
Plexopathy Rather Than Radiculopathy
- Brachial plexopathy can present with more complex symptoms than simple radiculopathy and may involve regional soft-tissue changes 1
- Post-traumatic complications such as regional hematoma or scarring can accompany plexopathy 1
- MRI of the brachial plexus (not just cervical spine) is the preferred imaging modality to differentiate plexopathy from radiculopathy 1
Vascular or Lymphatic Compromise
- Thoracic outlet syndrome affecting both neurovascular structures
- Venous thrombosis or lymphedema from other causes
- These conditions may coexist with cervical pathology but are separate entities
Complex Regional Pain Syndrome (CRPS)
- Can develop after nerve injury and presents with swelling, color changes, and temperature alterations
- This is a complication rather than a direct effect of nerve root compression
Inflammatory or Infectious Processes
- Infection or inflammation affecting the plexus can cause regional soft-tissue changes 1
- MRI with contrast may be helpful when infection or inflammation is suspected 1
Diagnostic Approach When Swelling is Present
Order MRI of the brachial plexus rather than just cervical spine imaging if the clinical picture includes hand swelling with neurological symptoms 1. The brachial plexus MRI protocol differs from routine cervical spine imaging and includes:
- Orthogonal views through the oblique planes of the plexus
- T1-weighted, T2-weighted, and fat-saturated sequences 1
- Better visualization of postganglionic plexus and soft-tissue complications 1
Consider electrodiagnostic studies to confirm the diagnosis and differentiate radiculopathy from plexopathy 1.
Critical Clinical Pitfall
Do not attribute hand swelling to cervical radiculopathy without investigating other causes. The presence of swelling should prompt you to look beyond simple nerve root compression and consider:
- Vascular evaluation (venous Doppler if thrombosis suspected)
- Assessment for thoracic outlet syndrome
- Evaluation for CRPS if there is a history of trauma
- Inflammatory or infectious workup if systemic symptoms are present
The inflammatory response from nerve root compression affects pain generation and neurologic deficits but does not produce peripheral edema 6.