理学療法ジャーナル53巻6号

2019年06月発行

特集 上肢運動器疾患—若年者と中高年者の特徴

上腕骨外側上顆炎—若年者と中高年者の違い

著者： 坂田淳¹²

所属機関： ¹トヨタ自動車株式会社 ²トヨタ記念病院リハビリテーション科

ページ範囲：P.569 - P.576

はじめに

　上腕骨外側上顆炎は，一般からスポーツ選手まで発症する，よく知られた疾患である．上腕骨外側上顆に起始をもつ手関節および指伸筋群のうち，特に短橈側手根伸筋（extensor carpi radialis brevis muscle：ECRB）の腱付着部症であるとされる^1）．付着部周囲には，症候の要因となり得る豊富な血管，神経組織，滑膜組織を含む滑液包や脂肪性結合組織などがみられる．腱付着部にストレスが加わり，周辺組織に炎症が波及することで，疼痛が発生すると考えられている．腱の退行性変性がみられること^2）が共通認識として得られている一方で，その発生メカニズムについては諸説あり，コンセンサスが得られていない．本稿では，外側上顆炎の疫学，肘関節外側を中心とした解剖，関連するバイオメカニクスに関する知見を整理し，現在考えられている外側上顆炎の病態について，そのストレスの種類から分類して紹介する．最後に，これまで筆者が経験した臨床的見地から，外側上顆炎における若年者と中高年者の違いについて私見を述べる．

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