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2007.03.25

手足のしびれ

1081
日常の外来で患者さんが症状を訴える時に「しびれる」という表現を使うことは数多くあります。患者さんの「しびれる」という言葉から医師が連想する病気は脳・脊髄および末梢神経疾患による運動や感覚障害です。
ところが実際は
セラミド不足などによる乾燥肌や角質成分の障害による皮膚に由来する場合
振動や立ち仕事また手を握る労働などによる手足の筋肉に由来する場合
動脈閉塞や静脈炎など血管の血流障害がある場合
糖尿病、ビタミン欠乏、膠原病などの内科疾患に由来する場合
などの様々な疾患が背景にあることがあります。
整形外科に関わる疾患の中で多い病気は頚椎症といわれるくびの病気
胸郭出口症候群といわれる鎖骨周囲の病気、肘部管症候群といわれる肘の病気
手根管症候群といわれる手のひらの病気。以上の4つの病気がしびれを引き起こす代表的なものと考えられます。
どこの診療科にかかるべきか迷った時には、首、肘、手首に痛みを伴うかどうかということがポイントになります。しびれる感覚以外に痛みを伴う場合はまず整形外科を受診することが勧められます。また両手のしびれを脳卒中の始まりではないかと心配して受診する患者さんがいらっしゃいますが、脳神経障害による手足のしびれはほとんどの場合に右か左かの片方に症状が発症します。
いずれにせよ、しびれを自覚して医療機関を訪れる時は、これまでの自分の既往歴、たとえば高血圧や糖尿病などの治療状況、また現在服用している薬などの情報をある程度把握して、問診の際にはしっかりと答えられるようにしておくことが大切です。

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