手麻就醫指南、診斷與治療 (by 林杏青醫師 & 李冠頡物理治療師)
手麻麻的有點痛，感覺怪怪的有點難描述。一開始是運動時的某些姿勢才麻，但後來卻變成無時無刻不麻。手麻的同時也覺得力氣變弱，甚至肌肉變小，之前的重訓都白練的。
這樣的症狀很有可能是神經痛的問題，他可能是老化間接造成的，可能是長期姿勢不良間接造成的，也可能是運動傷害或是車禍之類造成的神經受傷、神經壓迫。
這篇文章會告訴你：
手麻、神經痛要如何看醫生？
手麻、神經痛你可以選擇復健科或是神經內外科。以下是你可以跟醫生說的一些重點項目，協助他幫你找到手麻的原因：
- 哪些地方麻？哪些地方痛？
- 這個症狀從多久以前開始的？
- 每次發作會持續多久時間？
- 它如何麻如何痛？哪些姿勢不舒服？哪些姿勢比較舒服？
- 有沒有伴隨無力的情形？
- 你有沒有哪些內科疾病？是否手術過？是否吃藥？
- 你的生活習慣。
這些其實很符合常見的What、Where、When、How，建議可以經常記錄自己的身體狀態，比起憑記憶印象來和醫生溝通會好很多。
但是切記訴說病情的時候可以不用從盤古開天闢地、爺爺奶奶打拚種田開始講，時間是寶貴的。
簡介一下你的神經系統
在講醫生如何檢查與診斷神經痛之前，我們先簡介一下神經。神經系統的老大是你的大腦，神經從大腦出發，經過脊髓分散到身體各部位，離開脊髓後是周邊神經，分成自律神經、運動神經、感覺神經。(延伸閱讀：和本篇較無關的自律神經)
如果這個長長的神經有一個地方受傷、或是受到壓迫、或是受了委屈，就會形成神經痛。神經密密麻麻又長長的，要如何檢查起呢？除了上一段的問診以外，下面告訴你可能的診斷方式和檢查儀器。
手麻、神經痛可能的診斷
從上面的圖可以知道神經像樹的分支走下來，越走越細也越多分叉，而且每一條神經的分叉支配的感覺區域和動作都不一樣。
大體上來說，出問題的地方越上游(越靠近大腦)，通常那個地方的下游都會問題。例如：
- 如果你兩隻手全都麻麻的，那出問題的地方很可能是脊髓。
- 如果是一隻手從上麻到下，那可能是脊髓分支出去的地方被壓迫到了。
- 如果是手腕以下，手掌側前三支手指頭麻，那可能是正中神經的壓迫。
- 如果是手腳末端麻，那可能是糖尿病的多發性神經病變。
- 如果是手臂上舉會麻，放下來就好了，那可能是胸廓出口症候群，是因為頸部肌肉暫時壓迫到了神經或血管。
另外藥物、酒精、腎病、腫瘤等等都有可能引發不同的手麻，養成良好的生活習慣是非常重要的。如果你只是每次趴在桌上睡覺起來會手麻，過一下就好了，那我想應該不用太擔心，單純是壓到手太久。
接下來我們要講一些醫學儀器，它們可以幫助醫生抽絲剝繭找出問題的根源。
X 光與核磁共振 (MRI)
X光可以拿來看脊椎有沒有不正常的排列、骨刺，或是椎間盤是不是變窄變薄了影響到神經的孔洞、你脊椎的韌帶是否鈣化、是否有腫瘤等等。更嚴重的時候會使用 MRI 去看結構上的問題，例如看神經是否被擠出來的椎間盤壓迫到。
但是照出來的這些影像，無論是 X光或 MRI ，也不能完全確定問題就是那樣造成的。就像壯的人不定力氣比較大，只是可能性比較高。就像宅的人不一定都是金城武，但是機率可能高那麼一點點XD
軟組織超音波
如果我們懷疑你的手麻是因為手腕裡的正中神經被壓迫到，或是發炎；那軟組織超音波就是一個不錯的檢查儀器。大部分有在做軟組織超音波的醫師都有能力去看到手腕的正中神經，雖然超音波對是否是壓迫或發炎腫的檢查還沒有強到替代肌電圖，但可用來排除結構性問題壓迫、注射時定位、幫助診斷。
電學診斷
通常醫院才會有電學檢查，例如肌電圖、神經傳導速度、肌肉電刺激。
肌電圖簡單說就是看看哪個地方在亂放電，神經受傷到什麼程度，是否急性受傷，有沒有在恢復等等。透過肌電圖檢查，可以知道你的神經哪一段傳導比較慢，或是看電的波型來知道你那一段的神經是在變爛還是在生長。
BUT，凡事總有個罷特，電學檢查也無法百分之百準確，一來它很依賴操作者的技術，二方面如果你的手麻有多重原因一同發生也很難檢查，三來如果你的麻沒有超過三個禮拜也很難檢查。
手麻、神經痛、神經壓迫的治療方法
治療方法可以分成開刀與不開刀(保守治療)。
開刀：
基本上是由醫生來判斷是否需要開刀。
一般來說如果肌肉無力萎縮、有不自主動作出現、三到六個月保守治療後，追蹤肌電圖或影像神經狀況依然變差或有急性神經壞死的證據，建議開刀，但是這個建議不是一種指引，只是一個專家意見。
不開刀(保守治療)：
假如醫生判斷不是很嚴重，還沒到神經急性損傷、壞死的話，一般而言會先執行保守治療。
1, 保守治療最常見的就是健保部分的物理治療，例如牽引(ex拉脖子)對症狀有效果。
但是拜託不要自己亂拉，會受傷的。(圖片來自爆廢公社)
2, 證據等級較高的方法是注射類固醇加上副木固定來緩解周邊神經壓迫。
假如是正中神經壓迫，例如腕隧道症候群，我們可以嘗試對正中神經注射麻醉、抗發炎藥物，或做神經解套。
3, 自費物理治療的部分包含：
肌力訓練，把穩定脊椎、支撐脊椎的小肌肉練起來，可以騰出更多空間給神經。
神經鬆動術是一種常見的徒手治療手法，藉由一拉一放的特殊技巧以及幫浦效應，來增加神經供血，同時降低身經張力。可作為注射與副木的附加治療方法。 (神經鬆動術影片在下面)
切記這樣的治療應該要由專業物理治療師來評估與執行，以免在某些狀況下反而惡化，例如腕隧道症候群要特別小心。未來我們獨立一篇文章介紹神經鬆動術。
這邊就先這樣啦～
祝大家麻麻愉快～
延伸閱讀：
1, 如何預防手麻？
合作撰寫：
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。
手指痲，酸。
如何就醫？
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