神經壓迫會造成手麻、腳麻、刺痛、跛腳
/ 李安物理治療研究室 (李冠頡、楊庭安)

為什麼神經會被壓迫？ (by 李冠頡物理治療師)

我們前陣子花了一些時間聊各種神經壓迫造成的手麻，例如頸椎壓迫、正中神經壓迫(腕隧道症候群)，但是你會不會很好奇，為什麼神經會被壓迫？

如果你有手麻、腳麻、無力等問題，請你一定要好好看這篇！

神經的構造

在講神經壓迫之前，我們要先知道神經長什麼樣子，才會知道為何被壓迫之後會有那些刺麻與無力的症狀。

神經從你的大腦出發蔓延全身，神經其實也是一捆一捆、一圈一圈包起來的組織。你可以把它們想像成是柔軟、有彈性的、可滑動的網路線。(如果你是只知道 Wifi 的年輕朋友那就當我沒說)

神經系統，以及三層膜，神經外膜、神經周膜、神經內膜

基本上神經有三層膜包住，分別是神經外膜、神經周膜、神經內膜。我們由內而外做簡單講解：

神經內膜包覆一根或一捆軸突，軸突就是神經細胞的凸起，是神經訊號主要的傳遞通道。

神經周膜則包住一捆神經內膜束，周膜有很好的抗拉特性，避免神經被拉斷，內層的周膜會形成血神經障壁，為神經訊號傳導提供一個良好不被干擾的環境。

神經外膜的作用是分散神經所受到的壓力，保護神經避免受到壓迫。

 

神經壓迫與缺血

神經細胞是柔軟有彈性的，而且抗拉也抗壓，所以你才不會因為身體活動拉扯而斷訊，所以其實神經被東西壓迫到並不會有「立即」的影響，意思是如果你看到 MRI 脊椎有碰觸到脊神經，也不代表你就一定會有症狀。

神經細胞如同其他細胞一樣是需要血液供應養分的，事實上神經系統是非常需要血液的系統，周邊神經只佔身體質量的2%，卻耗掉20%的氧氣，他非常需要血液，簡直就是吸血鬼 (誤)。

為了供應氧氣，血管也必須從外面通過神經外膜、神經周膜、神經內膜來抵達神經細胞。假設今天因為某個原因讓神經細胞缺血了，缺血會讓剛剛提到神經外面的三層膜變緊繃，三層膜變緊繃就更不利血液傳送進來，血液更進不來他就越緊繃，惡性循環。

這種壞狀況我們稱作神經張力過高。可能會有痛、麻的感覺。假如長期壓迫缺血的話，神經就會壞死GG。

 

那什麼狀況會造成神經張力過高呢？

常見的原因是因為外力壓迫到神經，阻礙血液循環。例如骨頭夾到神經、骨刺壓到神經、椎間盤突出、軟組織發炎腫脹壓迫到神經等等。

另一個常見原因是神經可動性降低，什麼意思呢？

我們全身的神經是一個相連、連續的系統，這樣才能完整的互相傳遞訊息，不會說你的左手自己在那邊單機不受大腦控制。因次如同剛剛所說，神經必須要有彈性且可以滑動，才能適應身體的各種姿勢與活動。
如果無法適應各種姿勢活動的話神經就會被拉扯到，會非常痛，像是被電到一樣，或是覺得酸、軟、無力。

那為什麼神經會被拉扯到，常見的原因有組織沾黏、骨頭間縫隙變小、神經過度緊繃無法順利滑動等等。

 

常見神經壓迫病症

好的，講完了神經壓迫的原理與機制後，我們來談談哪些是常見的神經壓迫問題：

1, 坐骨神經痛

鼎鼎有名的坐骨神經痛會讓你腿麻、刺痛、力氣變弱、肌肉萎縮，可能會有間歇性跛行的問題。

常見原因之一是梨狀肌無力或過度緊繃壓迫到坐骨神經，因為坐骨神經會從梨狀肌下面穿出來，太緊繃的話會夾到神經，太無力會無法給予足夠的支撐。其他常見壓迫坐骨神經的原因還有椎間盤突出、椎孔狹窄之類的問題。

很多時候你腳麻去不專業或非政府認可的單位做治療，他們說你坐骨神經痛，但有可能是腰椎部分神經受到壓迫，但症狀出現在小腿或腳，嚴格上不能說坐骨神經痛。感謝很多廣告亂教，我們才能寫更多東西衝字數XD(?)

Piriformis_muscle

梨狀肌位置 (gif來源) (CC BY SA 2.1 JP 授權)

2, 腕隧道症候群

因為正中神經通過手腕中間的腕隧道時被壓迫了，造成拇指、食指、中指和無名指的一半麻。腕隧道症候群好發於會過度使用手腕的人，例如家庭主婦、職業電競選手、廚師等等。

更詳細的腕隧道症候群可以看這篇文章。(點此連結)

3, 肘隧道症候群

前臂尺側、內側發麻，可能一路麻到手腕，但不會麻到手指。主要原因是手肘的尺神經被壓迫到，尺神經可能被壓迫的位置，由肘關節以上 10 公分至以下 5 公分都有可能，最常見的位置是在當尺神經通過肱骨內上踝後面的肘隧道。

肘隧道症候群我們未來會專文細說。

4, 胸闊出口症候群

這是一個很常見造成手麻的症候群，常見原因是斜角肌或是胸小肌太緊繃，把通過的神經夾住了，或是被第一節肋骨卡住了神經與血管。

推薦一篇寫得不錯的胸闊出口症候群介紹文章 (點此連結)。

 

所以如果有神經壓迫問題造成麻痛，可以找誰幫助我？

你可以找神經內外科醫師、復健科醫師、物理治療師。

神經內外科醫師和復健科醫師可能會使用藥物、注射的方式來解決神經壓迫的問題，再加上常見的健保物理治療，而神經外科會比較傾向開刀。自費的物理治療師則會先想辦法解除壓迫，例如肌肉張力問題，再用神經鬆動術來改善張力與沾黏問題，最後再介入運動治療來避免復發。

如果你想要知道更多神經與血液的知識，非常推薦蔡永裕老師的影片：

 

合作撰寫：

好痛痛 (粉絲頁連結)

李冠頡物理治療師 (專欄連結)

 

好痛痛的醫療、運動搜尋器 (點此連結)

 

向你推薦一個很棒的神經肌肉再教育 Redcord N1 課程

 

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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