Working Healthy

Stop Hand Pain

Stop Hand Pain Before It Stops You

The ulnar nerve (yellow) is one of three nerves that run from the neck to the hand. As the ulnar nerve travels through the elbow (as depicted in this cartoon illustration), it runs through the cubital tunnel, which is made from muscle, ligament, and bone (red). If the cubital tunnel is irritated, it can swell.

April 14 is one anniversary Marti Preuss has no plans to celebrate: It marks the last day she worked as a nail technician. After ignoring pain in her hands and wrists for more than six months because she was the sole nail technician in a busy salon, finally a sharp pain in her thumbs and a loss of feeling in her ring and pinkie fingers forced her to see a doctor. The diagnosis? Tensoynovitis, carpal tunnel syndrome, cubital tunnel syndrome, and a lesion of the ulnar nerve in her shoulder. Her doctor restricted her from working because of the extent of her symptoms.

“I can't even open my hand wide enough anymore to pick up a can of Coke,” Preuss says. “There's so much damage to my hands that I won't ever be able to do nails.” She remembers that the pain built up so gradually that it took awhile to realize just how bad it had gotten.

“It started with pain in my left thumb, though there was no tingling sensation,” she recounts. “Then a few times I couldn't let go of a client's hand because the tendons locked up. Then my wrist started hurting and tingling and my ring and pinkie fingers would go numb. The pain started in my right thumb and wrist and after that, both elbows and shoulders started aching and stinging.”

Fortunately for Preuss, she was employee of the salon where she worked and was covered by workers' compensation insurance. Still, she says, the financial impact has been devastating. “I was making more than $40,00 a year doing nails and hair. Now I get less than half that through workers' comp. When the doctor says I've recovered as much as I ever will, workers' comp will stop, and what I collect from social security disability will depend on how impaired they decide I am.”

Money aside, the former NAHA winner misses her work. “I also was a manufacturer’s educator, but now I can't even do a demo nail,” she laments. “I've probably improved about 30% over where I was last April, but they're not expecting my hands to get much better.” To help, she takes various medications, follows an exercises regimen prescribed by a physical therapist, and wears hand and arm splints every night at a various times throughout the day, but she says even simple chores like vacuuming or dusting hurt her hands and arms.

To help others visualize the extent of her disability, Preuss suggests taking the following test: Lay your hand on its side on a flat surface, thumb pointing to the sky. Raise the thumb as high as it will go, keeping the fingers together. Measure the angle between the index finger and thumb. “Normal range for a female is 85-90 degrees,” says Preuss. “Mine is 40 degrees in my right hand and 35 degrees in the left. This, despite all the exercises prescribed by my therapist, is the best it will get.”

In retrospect, Preuss says she wishes she had paid more attention to the pain and gone to the doctor as soon as her left thumb started hurting because, as she's since learned, she probably could have written a different ending to her story. Instead she shares it freely now,hoping to encourage her peers to prevent injuries to themselves in the first place and, failing that, to take immediate action at the first hint of pain.

Please, seek medical attention at the first sign of distress,” says Preuss. “Healing can be faster, and you will be able to return to work after treatment with braces and physical therapy. I waited much too long!”


Why Nail Techs Are at Risk

Discomfort in the fingers hands, or wrists—including pain, numbness, tingling, burning, and stiffness—is your body's way of telling you “too much”. Musculoskeletal disorders (also called repetitive strain injuries, repetitive motion injuries, repetitive motion injuries, and cumulative trauma disorders) are caused by repetitive, forceful, or prolonged exertions of the hands, frequent or heavy lifting, pushing or pulling, poor posture, and insufficient rest periods. While even one of these factors can cause injury, a combination of one or more of them greatly increases the risk.

Due to the nature of their work, nail technicians are susceptible to all these types of injuries. “Flexing the below more than 90 degrees and gripping files and brushes with the thumb, index, and middle fingers, plus having their wrists flexed put nail technicians at risk for these injuries,” explains Dr. Sidney Blair, professor emeritus of the department of orthopedics at Loyola University Medical Center (Maywood, Ill.).

“Hunching over the workstation adds another dimension of problems to the hands because carpal and cubital tunnel syndromes are nerve compression injuries. Slumping puts tension on these nerves around the neck and above the collarbone, which makes the nerves in the hands more sensitive because you've irritated them up above. That's called a 'double crush', where you've got two levels of compression. The compression at the end of the extremity is where the injury occurs.”

Dr. Jim McGlothlin, senior research ergonomist at the National Institutes of Occupation Safety and Health, observed nail technicians performing their work and what he saw were a number of postural issues that put nail technicians at risk for injury. “One risk factor is the size of the workstation,” he notes. “When the nail technician tries to work within the customer's comfort zone (12 inches or less in front of the customer), the nail tech tends to pretend her arms, causing fatigue. She also tends to lean over the workstation. The other strain is when she bends her neck down more than 30 degrees for extended periods over the client's hands.

“Then they have the detailed postures like a pinch posture for cleaning and filing the nails and applying product. They also may use their hand as a clamp to hold the client's hand. When the clamp posture is held over time, it restricts blood flow, causing fatigue that may result in symptoms leading to tendonitis and carpal tunnel syndrome.”


An Ounce of Prevention

According to both Drs. Blair and McGlothlin, musculoskeletal disorders are much easier prevented than cured. “The key is to recognize what you're doing,” Dr. McGlothlin ways. “There are solutions: It's a combination for recognizing and adjusting your postures to neutral comfortable positions and taking frequent, mini-breaks throughout the course of a service and then longer breaks between. This allows the muscles to relax and for blood flow to return, preventing a buildup of fatigue.”

Neutral positions come at 0 degrees and 90 degrees angles for the body, he explains. The back should be straight, the head up, and the wrists flat, while elbows, thighs, knees, and feet should be at a 90 degree angle at the bone above the joint.

The next step is to work with the customer,” he says. “Talk with the customer and ask her to be comfortable but have her scoot her chair as close as possible to the workstation so that she's within your functional range of motion.”

Like Preuss, nail technician Barb Wetzel of Nail Splash in LaGrange, Ill., has tendonitis in her right hand and carpal tunnel in her left, but has kept both conditions at bay for several years by having good working posture and other work habits. She agrees that clients play an important role in her health. “the carpal tunnel I my left hand is from fighting with clients for control of their hand,” she says with a laugh. “I tell them that if they can see their hands then I can't, and they're paying me to look at them. I find it's easier to make sure their elbows are one the table and realized, which tends to give them a limp wrist.”

“Lighting can be another issue,” Dr. McGlothlin adds. “Nail technicians tend to work where th light is best, so make sure your lighting is aligned with your comfortable, neutral positions.” Nail technician Aymee Hodges, who has cubital tunnel syndrome, agrees, saying she never even realized this until she went recently to have her own nails done and saw the nail technician pull her desk lamp right down over her nails. “Now I'm doing it and it's been an immediate help,” she says.

Nail technicians also tend to rest their elbows on the edge of the table, which Dr. Blair says gives the shoulders a much needed occasional rest, but which can compress the nerve in the elbow. Hodges says she is living proof of this injury, having suffered from numbness and tingling in her pinkie and ring fingers for over a year now. “Looking back, I wish I had listened to my teacher in beauty school, who kept telling me to get my elbow off the table,” she says. To prevent his type of injury, Dr. McGlothlin recommends a padded arm rest (a couple of computer mouse pads for each elbow are simple, inexpensive options to occasionally rest the arms).

Next, he recommends examining your workstation. While an adjustable-height workstation is idea, he acknowledges most nail technicians can't afford to replace their table. “But if you have an adjustable-height chair, you can eliminate many problems,” he says. “The more features it has, the better.”


A Pound of Cure

According to Dr. Blair, the first signs of musculoskeltetal disorders are fatigue and a generalized achiness. “If you're tired or your neck is bothering you or your arms feel tired and it continues to the next day, something is going on,” he says. “Next comes the symptoms of pain or numbness and tingling in a specific area. You don't want to get to that point. If you feel fatigue or tiredness in an area, look at what you're doing now.”

Even with specific symptoms, however, Dr. Blair says you don't always need to rush off t the doctor because there is no magical pill and it's likely your doctor will recommend home remedies.

“First, modify your activity,” Dr. Blair says. “While it's not easy to back off, you should cut back your workload a little and rest your arms during your time off. While you're working, try to divide up your time more with breaks.”

During those breaks, many doctors recommend treating the pain and inflammation with alternating hot and cold soaks in water. Soaking the affected area for three minutes in 100-110 degree water followed by 20 seconds in ice cold water will ease the pain, reduce the swelling, and allow for better blood flow through the area. Alternate the hot and cold treatments at least three times, ending with a cold treatment. (If you have diabetes or a circulatory disorder, consult your doctor before applying heat to any part of your body.)

Even as you work, you can alleviate some symptoms or at lease prevent further injury by modifying your work tasks somewhat. For example, Wetzel says she analyzed how she was holding her files and realized she was doing it improperly. “I also invested in a better drill because I was concerned about the vibration from my old one.” She also switched to using a one-cut slicer to shorten the nails.

Other recommended treatments often include wearing hand splints during rest periods to immobilize the wrist in a natural, neutral position, and anti-inflammatory medications like Ibuprofen. If your symptoms worsen or don't clear up within two weeks, Dr. Blair recommends seeing your doctor to rule out other causes and explore treatment options. He emphasizes that I the early stages most musculoskeletal orders are reversible.

Wetzel agrees. “It's more of an inconvenience when it flares up,” she says. “I immediately start taking an anti-inflammatory and I wear the braces at night to sleep if I sense even the slightest bit of flareup. Then I analyze my work and usually find I'm doing something wrong.” Just the other day, she says she noticed she was working with her wrist bent palm down and had to correct herself.



How Common Are Musculoskeletal Disorders?

According to the Bureau of Labor Statistics, 62% of the 308,000 reported to work-place illnesses were due to disorders associated with repeated trauma. This figure does not include back injuries. Ore than $2 billion in workers' compensation costs are spent on musculoskeletal disorders.

Between 1972 and 1994, reported cases of these injuries rose from 23,800 to 332,000. In 1995, the number decreased to 308,000. While researchers will look for long-term decreases before declaring a victory, they hope the decrease can be attributed to heightened workplace awareness and improved ergonomics.



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