- By Hope Willis Sheehan -
In this story, read about the most common cause of hand pain for women, and how to fix it.
“I don’t want that doctor cutting on me,” she states defiantly. “He wants me to have that surgery and I keep telling him no.”
Pain has put Natalie in a tough spot. Working at her beauty shop has been a trial lately with sharp pains jabbing across her thumb and wrist. Each day of snipping and clipping seems to worsen the pain. She needs her hands to earn a living but the surgery seems scary. She fears being unable to work. Despite her current stress, Natalie is very becoming, with lovely red hair, skillfully applied makeup and pink lipstick to match her long acrylic nails. She enjoys expressing her femininity. She loves to laugh and enjoys doting on her clientele, helping them to feel more confident and beautiful.
I say, “Tell me more about your pain, Natalie. To fix your problem, I need to determine how your daily work causes discomfort. Where does it hurt and when?”
To show me, Natalie takes up various imaginary tools and mimes her work: she pinches hair clips, grips a drying brush, and cuts with a scissors. She soon grimaces though, because working even imaginary tools brings on the burning pain. She stops and strokes the outside of her thumb and across the wrist.
“It hurts here too,” she adds, rubbing the inside base of her thumb. [1]
“Rest your hand on this beanbag, Natalie. The support will feel better.”
She lays her hand over the mound and we wait for the pain to ease.
She asks, “So what do you think, Hope? Can you help me?”
“Well, I’m confident we can have you feeling a lot better. There is one thing I notice especially, Natalie, and that is when you pinch, your thumb tip is always curved backward. That thumb action is called hyper extension. Not everyone can curve their thumb back like that, but for those of us who can, the pulpy pad of the thumb offers a nice large surface for pinching against - like pushing in a thumb tack or pressing closed a zipper-lock bag.”
“So what’s wrong with that, Hope?”
“Well, when you use your thumb all the time in that curved back position, the strongest muscle for thumb gripping is left out of the action. That powerful muscle adds its leverage only when the thumb curls into flexion, curling the thumb tip toward the fingers - for instance when you pinch onto a tiny sliver and then pull it out. If this strong muscle does not routinely move the thumb like this, the hand will suffer. Wear and tear and then pain often follows.”
“Well, maybe I could just learn to curl my thumb the right way. Wouldn’t that fix it?”
“That is a good idea, Natalie. Pinching your tools with your thumb curled into flexion is a lot better. But as it stands in your hand, the thumb nail is in the way because it is too long. If you were to use the better thumb power pinch against the other fingers, that poky nail risks jabbing into the fingers."
“Now to be honest, Natalie, most patients tell me they don’t feel any of this nail jabbing. And sadly, this is probably true, because their hands have learned over time to move in an unhealthy way to prevent that poky irritation. The thumb learns to move without that strong muscle, being careful to either jut the nail out straight or they pinch as you do, by curving the thumb back into hyper extension. [2]
“Both adaptations prevent the nail from poking into the fingers, but these alternatives also force the thumb to pinch without the leverage of the strongest muscle - which is why you are in pain. May I ask you? Have you always worn your nails long?”
“Since high school,” she says. “I like the way they make me feel - more feminine somehow. Most of my customers and friends have nails like mine, even longer for some. I‘d feel kind of naked without them. I never heard that wearing long nails could be a problem.”
“Neither did I, Natalie. I wore my nails long for years, just like yours - I loved the length and the feeling of them. My job at the time was to greet customers in a fancy restaurant. I started having my nails done, partly because I wasn’t as slender and trim as the other hostesses. I depended on my nails for a feeling of elegance. I remember how attractive and confident I felt wearing them long. The job paid well and I was putting myself through school at the time.”
Natalie nods and agrees, smiling. Then a quizzical look appears and a slight frown, and she asks, “But your nails are really short now.”
“That’s right.”
“So why did you cut them?”
“Well, it wasn’t easy and it’s a long story. You see, in college I was taking classes such as anatomy, right? I was learning about how the hands work and I was becoming more aware of my own. At the same time, on my hostess job, I could feel my fingers and wrist moving differently, you know? I began to notice that my fingertips were typically more straight than curled; kind of in display mode, I guess. That sense of displayed straightness became constant because having long nails changes how you hold onto things, doesn’t? You can’t bend your fingertips or really grip with your fingertips or else the nails get in the way. Still, I was enjoying my new sense of femininity. I loved how pretty I felt with my nails and I didn’t see any harm in using my hands differently.”
“When I graduated as an Occupational Therapist, my job was to work with patients with hand pain. They came to see me with all kinds of problems. Lots of them had tendinitis, especially in the wrist - like you. There were other patients with thumb pain, carpal tunnel pain or elbow problems. Still others had neck or shoulder pain. Over time, I realized that so many of my patients had long fingernails. And these were the hardest patients to heal.”
“So to answer your question, Natalie, it was really hard, but I finally accepted that it is risky to wear long nails. After treating all kinds of hand problems for many years I am even more convinced of the connection between the length of fingernails and my patients’ pain. When I suggested that my patients cut their nails, it didn’t seem fair to them to keep mine long. So now my nails are really short.”
Natalie looks dubious as she studies me. “I understand your explanation about the fingernails, but it’s my wrist that hurts,” she responds. “I don’t see how my nails have anything to do with making my wrist hurt.”
“Well it’s because everything is connected, Natalie. It’s just like the old song says, ‘The finger bone’s connected to the hand bone. The hand bone’s connected to the wrist bone, the wrist bone’s connected to the arm bone, the same for you and me.' Have you heard that song? Well, it’s true. Everything is connected. For most people, it is simply unbelievable that the length of a person’s fingernails can hurt the fingers, let alone damage the workings of the wrist or the arm and neck. But the truth is that every extra millimeter of fingernail length changes how we move, just as wearing high heels alters how we walk."
“Long nails change the hand because the extra length prevents the hands’ strongest muscles from working. These tip-of-the-finger muscles travel from there all the way to your elbow. It is these powerful muscles that should be relied upon for your pinching and grabbing work. When these muscles are doing your gripping - and this is critical to understand, Natalie - they keep the entire arm and shoulder fit and vigorous. You and I are fortunate that your problem is just wrist pain. I have patients with long nails sitting right there as you are with even more serious diagnoses: thumb arthritis, wrist ligament damage, even fractures. So I am grateful for the chance to help you before you suffer more damage."
“My job is to make you well and strong again, Natalie, and I intend to do so. So let’s get started. I have an exercise for you that will spark those tip-of-the-finger muscles back into working. I call it the Claw. We do this because the fingertips tend to stiffen when they’re not being used so we must exercise the fingertips back to being flexible and ‘grabby' again. I’ll show you how to do this but of course the exercise will be easier and work better as soon as you shorten your nails."
“Shall we start?”
Pain has put Natalie in a tough spot. Working at her beauty shop has been a trial lately with sharp pains jabbing across her thumb and wrist. Each day of snipping and clipping seems to worsen the pain. She needs her hands to earn a living but the surgery seems scary. She fears being unable to work. Despite her current stress, Natalie is very becoming, with lovely red hair, skillfully applied makeup and pink lipstick to match her long acrylic nails. She enjoys expressing her femininity. She loves to laugh and enjoys doting on her clientele, helping them to feel more confident and beautiful.
I say, “Tell me more about your pain, Natalie. To fix your problem, I need to determine how your daily work causes discomfort. Where does it hurt and when?”
To show me, Natalie takes up various imaginary tools and mimes her work: she pinches hair clips, grips a drying brush, and cuts with a scissors. She soon grimaces though, because working even imaginary tools brings on the burning pain. She stops and strokes the outside of her thumb and across the wrist.
“It hurts here too,” she adds, rubbing the inside base of her thumb. [1]
“Rest your hand on this beanbag, Natalie. The support will feel better.”
She lays her hand over the mound and we wait for the pain to ease.
She asks, “So what do you think, Hope? Can you help me?”
“Well, I’m confident we can have you feeling a lot better. There is one thing I notice especially, Natalie, and that is when you pinch, your thumb tip is always curved backward. That thumb action is called hyper extension. Not everyone can curve their thumb back like that, but for those of us who can, the pulpy pad of the thumb offers a nice large surface for pinching against - like pushing in a thumb tack or pressing closed a zipper-lock bag.”
“So what’s wrong with that, Hope?”
“Well, when you use your thumb all the time in that curved back position, the strongest muscle for thumb gripping is left out of the action. That powerful muscle adds its leverage only when the thumb curls into flexion, curling the thumb tip toward the fingers - for instance when you pinch onto a tiny sliver and then pull it out. If this strong muscle does not routinely move the thumb like this, the hand will suffer. Wear and tear and then pain often follows.”
“Well, maybe I could just learn to curl my thumb the right way. Wouldn’t that fix it?”
“That is a good idea, Natalie. Pinching your tools with your thumb curled into flexion is a lot better. But as it stands in your hand, the thumb nail is in the way because it is too long. If you were to use the better thumb power pinch against the other fingers, that poky nail risks jabbing into the fingers."
“Now to be honest, Natalie, most patients tell me they don’t feel any of this nail jabbing. And sadly, this is probably true, because their hands have learned over time to move in an unhealthy way to prevent that poky irritation. The thumb learns to move without that strong muscle, being careful to either jut the nail out straight or they pinch as you do, by curving the thumb back into hyper extension. [2]
“Both adaptations prevent the nail from poking into the fingers, but these alternatives also force the thumb to pinch without the leverage of the strongest muscle - which is why you are in pain. May I ask you? Have you always worn your nails long?”
“Since high school,” she says. “I like the way they make me feel - more feminine somehow. Most of my customers and friends have nails like mine, even longer for some. I‘d feel kind of naked without them. I never heard that wearing long nails could be a problem.”
“Neither did I, Natalie. I wore my nails long for years, just like yours - I loved the length and the feeling of them. My job at the time was to greet customers in a fancy restaurant. I started having my nails done, partly because I wasn’t as slender and trim as the other hostesses. I depended on my nails for a feeling of elegance. I remember how attractive and confident I felt wearing them long. The job paid well and I was putting myself through school at the time.”
Natalie nods and agrees, smiling. Then a quizzical look appears and a slight frown, and she asks, “But your nails are really short now.”
“That’s right.”
“So why did you cut them?”
“Well, it wasn’t easy and it’s a long story. You see, in college I was taking classes such as anatomy, right? I was learning about how the hands work and I was becoming more aware of my own. At the same time, on my hostess job, I could feel my fingers and wrist moving differently, you know? I began to notice that my fingertips were typically more straight than curled; kind of in display mode, I guess. That sense of displayed straightness became constant because having long nails changes how you hold onto things, doesn’t? You can’t bend your fingertips or really grip with your fingertips or else the nails get in the way. Still, I was enjoying my new sense of femininity. I loved how pretty I felt with my nails and I didn’t see any harm in using my hands differently.”
“When I graduated as an Occupational Therapist, my job was to work with patients with hand pain. They came to see me with all kinds of problems. Lots of them had tendinitis, especially in the wrist - like you. There were other patients with thumb pain, carpal tunnel pain or elbow problems. Still others had neck or shoulder pain. Over time, I realized that so many of my patients had long fingernails. And these were the hardest patients to heal.”
“So to answer your question, Natalie, it was really hard, but I finally accepted that it is risky to wear long nails. After treating all kinds of hand problems for many years I am even more convinced of the connection between the length of fingernails and my patients’ pain. When I suggested that my patients cut their nails, it didn’t seem fair to them to keep mine long. So now my nails are really short.”
Natalie looks dubious as she studies me. “I understand your explanation about the fingernails, but it’s my wrist that hurts,” she responds. “I don’t see how my nails have anything to do with making my wrist hurt.”
“Well it’s because everything is connected, Natalie. It’s just like the old song says, ‘The finger bone’s connected to the hand bone. The hand bone’s connected to the wrist bone, the wrist bone’s connected to the arm bone, the same for you and me.' Have you heard that song? Well, it’s true. Everything is connected. For most people, it is simply unbelievable that the length of a person’s fingernails can hurt the fingers, let alone damage the workings of the wrist or the arm and neck. But the truth is that every extra millimeter of fingernail length changes how we move, just as wearing high heels alters how we walk."
“Long nails change the hand because the extra length prevents the hands’ strongest muscles from working. These tip-of-the-finger muscles travel from there all the way to your elbow. It is these powerful muscles that should be relied upon for your pinching and grabbing work. When these muscles are doing your gripping - and this is critical to understand, Natalie - they keep the entire arm and shoulder fit and vigorous. You and I are fortunate that your problem is just wrist pain. I have patients with long nails sitting right there as you are with even more serious diagnoses: thumb arthritis, wrist ligament damage, even fractures. So I am grateful for the chance to help you before you suffer more damage."
“My job is to make you well and strong again, Natalie, and I intend to do so. So let’s get started. I have an exercise for you that will spark those tip-of-the-finger muscles back into working. I call it the Claw. We do this because the fingertips tend to stiffen when they’re not being used so we must exercise the fingertips back to being flexible and ‘grabby' again. I’ll show you how to do this but of course the exercise will be easier and work better as soon as you shorten your nails."
“Shall we start?”
In the book you will read about how after several more weeks of re-learning how to use her hands, Natalie left the pain behind and indeed recovered.
[1] This region of pain implies CMC thumb problems. See the case-study, “Making Thumbs Last” for an exploration of this related orthopedic discomfort.
[2] In this position, the thumb tip/IP joint is in neutral, (0 degrees).
[2] In this position, the thumb tip/IP joint is in neutral, (0 degrees).