為什麼網球肘總是好不了？談網球肘病因 (by 尤稚凱復健科醫師)
網球肘正式名稱為「肱骨外上髁炎」。首先並不是因為打網球才會有網球肘，但打網球是比較容易有網球肘沒錯。網球肘常常是因為過度使用「手腕」才手肘疼痛！但也有些情況是過度使用手肘造成的傷害。
很多人對於網球肘的認知是手肘關節外側的疼痛，但大部分比較少知道的是，網球肘的病因有四種可能性，包括肌腱、韌帶、軟骨、神經。大約有70%的網球肘病患有兩種以上的病因，只有30%是單一病因引起網球肘。
如果沒有找出真正的原因，對症下藥的話，有可能長期治療還是無法達到預期的成效。
肌腱發炎造成的網球肘
因為過度使用手腕、手指造成的肌腱發炎，導致手肘外側疼痛，是最常見的網球肘原因。
很多網友會問：「奇怪，我是手肘痛，怎麼會和手腕有關係呢？」其實許多手指手腕的活動，都是靠上臂的肌肉在拉動唷，肌肉一邊的肌腱在手肘、一邊的肌腱在手腕與手指。所以說手腕與手指的活動是會影響到手肘的！
手指、手腕、前臂、手肘的肌肉、肌腱、韌帶圖，圖片來源：https://homesecurity.press
其中最常見的是手腕伸展肌因為過度使用電腦、搬重物、抱小孩、做家事、不當的健身與重量訓練，造成這條肌肉靠近手肘那側的肌腱發炎。
手肘外側的韌帶與軟骨受損導致網球肘
韌帶以及軟骨問題是第二和第三常見的病因。長期過度使用、外傷有可能造成這兩種病因。另外就是喜愛運動的人，如果長期用不正確的姿勢做伏地挺身，有可能讓手肘壓力過大而損害到軟骨。常見的錯誤包括手臂外展太開，意思是手肘打太開離身體太遠；另一個常見問題錯誤姿勢是手掌離胸線太遠。一般來說我們會希望伏地挺身的過程前臂不會左右動作。
神經造成的網球肘
這個病因是容易被忽略掉的一種。後臂皮神經會穿梭在上臂的肌肉與筋膜之間。如果過度使用上臂肌肉，也就是過度使用手腕、手指的話，肌肉容易因此變得緊繃，緊繃就可能夾擠到神經，造成神經發炎。
神經造成的網球肘容易發生在重量訓練族群、還有工作時需要長時間高舉手臂的人。
圖片提供：菁英診所
如何確定網球肘的真正病因？
基本上因為上述四種病因造成的症狀都是相同的，都是手肘外側有明顯疼痛。所以需要透過軟組織超音波、甚至核磁共振來檢查。軟組織超音波可以透過聲波反射來看你的肌肉、肌腱、韌帶、滑液囊、神經等組織的狀況，是現代醫學非常實用的儀器。現在許多復健科診所裡都有軟組織超音波儀器來輔助診斷。
而核磁共振就需要到醫院去安排檢查，一般的診所不會有核磁共振的機器。
網球肘的治療
一般來說健保部分會做的治療方式包括熱敷、電療、超音波治療(不是檢查用的軟組織超音波)、低能量雷射等等。有時候會合併使用止痛藥或注射類固醇。
通常如果一般的治療有效的話，三個月之內會好轉。假如超過三個月沒有改善，或是持續反覆發作，可能是因為沒有治療到真正的病因，或是你使用手臂的壞習慣一直沒有改。
假如是前者的話，因為我的專長是超音波導引注射，意思是在軟組織超音波的掃描之下，做非常精準的針劑注射。針對肌腱、韌帶或軟骨的問題，我會將高濃度葡萄糖或是自體血小板注射到受損的地方，刺激重新生長。但是假如肌腱或韌帶撕裂超過一公分，或是軟骨磨損面積超過一半，就不適合這個治療方式。會建議手術或合併其他治療方式。
那如果是神經受到夾擠的問題，我可能會採取低濃度葡萄糖做神經解套注射，意思是精準注射液體來撐開神經周邊的軟組織，讓神經能有夠有好的空間。關於神經解套注射，我也常使用在腕隧道症候群的治療上。
除了針劑注射治療之外，我都會建議病患要有好的營養攝取，才能夠幫助肌腱、韌帶、軟骨恢復。另外運動治療也是非常重要的。不過說到底，要從根本來改善的話，一定還是要改變生活與工作的方式，否則網球肘有天還是可能再次找上門。例如做家事可以分兩次做，不一定要一次把全部的工作做完。對於大量使用手腕的工作，可以每半小時活動與伸展一下。如果是運動族群，可以和教練一起改善動作模式、比賽的戰略等等。這些都是為了不要讓肌肉、肌腱一次承受過大的工作量。
以下有我之前錄製的網球肘伸展與運動的影片：
合作撰寫：
好痛痛(粉絲頁)、尤稚凱復健科醫師(專欄連結) (診所官網)
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