肩夾擠症候群，常見舉手肩膀痛原因之一 (by 姚斯元物理治療師)
肩夾擠症候群是常見肩膀疼痛、活動問題之一，症狀通常是舉手、抬手會痛；或是用手去摸另一邊肩膀同時抬高時會痛；運動是有揮臂動作時會痛。而痛了比較久的病患，則會有旋轉肌的激痛點轉移，而會感覺到手臂甚至手腕的疼痛。
為什麼肩夾擠會痛？
肩夾擠症候群顧名思義就是有東西被夾到了所以會痛，那是什麼被什麼夾到呢？
是軟組織(棘上肌、二頭肌長頭肌腱、肩峰下滑液囊)在你做動作的時候被肱骨和肩胛骨(肩峰、肩峰韌帶、喙突)夾到了。想像成火車通過山洞的時候，山洞變小壓到火車了。
或許你會問，人體的設計是有其道理的，如果肌肉那樣長、骨頭那樣長，理論上平常做那些動作不應該被夾到才對。
正常的時候，當你往外抬起上臂，你的肌肉應該是有順序的合作協助拉起你的骨頭，同時肩胛骨也要配合移動。(延伸閱讀：肩胛活動障礙)
粗略來說，你的棘上肌會先動作把肱骨上緣往內側拉；手臂往上抬更多時，主要負責抬手的肌肉會變成三角肌，也就是肩膀外側很性感的那條肌肉。如果肌肉沒有按照順序正確運作，例如太慢動、或不動、或萎縮，就有可能造成夾擠。
肩夾擠症候群常見原因
常見原因主要分成兩大類，一類是和肌肉的運作有關，一類是和天生肩胛骨構造有關。
- 假如你的棘上肌在抬手的過程中太慢出力，隨著抬手的過程肩峰下的空間變小，棘上肌卻未收縮就被夾到了。打個譬喻：火車要通過山洞山洞才會開始關閉，而火車太慢動，所以被山洞夾到。
- 承上，棘上肌萎縮、失能也會造成類似的狀況，意思是火車根本沒在動。曾有前輩物理治療師表示棘上肌失能其實是更常見的狀況。
- 肩胛骨活動問題：當我們在舉手或是肩膀外展的時候，肩胛骨要跟著肩膀的動作一起移動來完成肩膀的動作，但如果因為肌肉過度緊繃(如胸小肌，提肩胛肌)，或是肩胛肌肉控制不良(如下斜方肌，前鋸肌)，則在肩膀移動的時候，肩胛骨動的太慢，或是動的方向完全不對。那肩胛骨就會跟肱骨上緣一起把火車夾住。
- 天生肩胛骨和肱骨中間的隧道(肩峰下空腔)比較小，所以夾到的機率比較高。
那哪些人比較容易遇到肩胛擠症候群呢？
如果你從事的運動有大量揮手臂的動作，例如棒球、游泳、排球等等，都是比較容易發生的。另外如果你長時間姿勢不良、圓肩，也有可能引發肩夾擠症候群。
肩夾擠症候群的治療
從上面的夾擠原因可以發現，這一切都是肌肉造成的，然後被夾的也是肌肉。犯人和被害人都是同一個人或是肌肉自己人(控制肩胛骨的肌肉有很多)，這時候法官會說：「肌肉哩北七喔～」喔不是啦，是我們要從喚醒肌肉、鍛鍊肌肉這個方向來做治療。
首先要找出山洞夾火車的原因在哪，並且針對這個原因作處理。運動治療中我個人認為肩胛骨的穩定訓練是最好的，Redcord 紅繩懸吊系統、彼拉提斯都有不錯的效果。
順帶一提滑液囊被夾到急性發炎的時候，有些醫師認為注射也是頗有效的作法。
除了肩胛穩定訓練，也有物理治療師會去喚醒與訓練旋轉肌(棘上肌)，這邊也分享給各位一個訓練棘上肌的小運動：站直，拿一個彈力帶把自己手肘上方套一圈，雙臂對外出力，這時候三角肌還無法出力，你的大腦會去叫棘上肌出力，對於喚醒與訓練棘上肌有一點效果。但這個出力角度其實很微妙，如果做了一段時間沒效，或是發現你的三角肌一直有在用力，那可能做錯了，請去找物理治療師來幫助你。
好，先這樣，姚斯元(ATX)物理治療師祝大家肩胛骨棘上肌都好壯壯，ㄅㄅ～
延伸閱讀：
合作撰寫：
協助：
好痛痛復健科、骨科、物理治療、運動訓練搜尋器
註：本部落格文章是以科普、衛教為出發點，不代表任何人的生理狀況。每個人的身體皆不相同，有任何疑問請詢問自己的醫師、物理治療師、專業教練。
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