Nail Clinic: Wrestling With Wrist Pain

After a few hectic days in a row servicing nail clients, Kim Chi Nguyen, owner of Ultimate Nails in Delray Beach, Florida, says her wrist pain can start creeping back.

“I have experienced recurring wrist pain on and off over the years,” says Nguyen, who had to have surgery to remove a cyst from her wrist 15 years ago. “Wrist pain is common among nail technicians due to the repetitive nature of the job. You are making small, detailed movements all day and multiple times per client. During a busy season or after long days, these movements take a toll on you.”

If you are experiencing some pain or even swelling in your wrists, it could be one of a few different things. Persistent wrist pain is frequently caused by an inflamed tendon, aka tendonitis, but not always, says Phillip Ross, M.D., a hand and upper extremity surgeon and assistant clinical professor of orthopedic surgery at the University of Cincinnati College of Medicine. Other common causes of wrist pain include carpal tunnel syndrome, arthritis, ligament and cartilage tears and wrist instability.

Although repetitive stress can cause nail techs wrist pain, it is unlikely the underlying problem is a “stress fracture,” which is very rare in the hand and upper extremity, Ross says. Fractures in the hand are more likely the result of falls, car crashes and other higher energy events.

7 Ergonomic Tips to Protect Your Wrists at the Salon*

• Adjust your chair so your feet are flat on the floor; use a footrest if needed.
• Make sure you have bright, adjustable light over your table so you do not have to lean in to peer at your client’s hands.
• To minimize pressure points that constrict circulation, put pads on the edge of your table to help keep arms and wrists in a neutral position, and consider putting soft pads on tools, when possible, so they are easier to hold.
• Bend at your elbows and shoulders rather than your wrists to avoid repetitive stress.
• Do your best to avoid rushing through services, which naturally makes the body tense up.
• Do gentle stretching exercises between clients to keep muscles and joints moving.
• Do not overapply artificial nail products, which increases the number of times you will need to file nails.

*Sources:

U.S. Department of Labor Occupational Safety and Health Administration (OSHA), https://www.osha.gov/nail-salons/positions-motions, and a handout by the Nail Manufacturers Council of the Professional Beauty Association and International Nail Technicians Association, https://beautyimages.bobitstudios.com/upload/_migratednails/files/Handouts/INTA_NMC_ErgonomicBasics.pdf

Wrist Risks for Nail Techs

The combination of hunching over nails with the amount of finger and wrist flexing it takes to attend to clients’ nails can put pressure on wrists, says Jacob Hascalovici, M.D., Ph.D., founder and chief medical officer of telehealth company Clearing.com. “Poor lighting and trying to stay within clients’ comfort range can lead to techs having awkward posture, cutting off circulation to their fingers or causing tissue inflammation.”

The physical demands of nail service have led many nail techs to see Ross about their wrist pain.

“They tend to be hardworking, and most in my practice are female, which in itself makes certain hand conditions more likely,” Ross says. “That is, conditions like De Quervain’s tenosynovitis and basilar thumb arthritis are more common in women than in men.”

In general, nail techs frequently develop tendonitis and carpal tunnel syndrome, he says. Those who are older often develop arthritis at the base of their thumbs. Tendonitis can occur anywhere on the body where tendons are attached to bones, such as elbows. It happens when the lining around the tendon that helps them move becomes irritated, inflamed and swollen. This condition is often persistently painful and can affect almost any tendon in the hand and wrist, Ross says.

De Quervain’s tendonitis is when the tendons of the thumb become irritated at the level of the wrist, a very common cause of pain related to repetitive stress, says Andrea Halim, M.D., Yale Medicine orthopedic wrist and hand surgeon and assistant professor at Yale School of Medicine in New Haven, Connecticut.

Performing nail services requires techs to pinch clients’ hands and instruments, which can absolutely contribute to wrist and hand pain, Halim says.

Common Symptoms and Diagnosis

“Carpal tunnel is usually experienced as a burning or painful numbness into the hand, index and middle finger,” Halim explains. “When it is severe, it wakes patients up at night and can even cause weakness in the hand. Some patients do describe pain in the wrist and forearm [that is] related to carpal tunnel.”

There are several thumb tendons that help give the thumb its wide range of motion.

“These two specific tendons (called the APL and EPB) get irritated as they course over the radius bone at the edge of the wrist, where they are held to the bone by a tight band of tissue,” Ross says. “The tight band, the shape of the radius bone and constant thumb motion cause these two tendons to be irritated and inflamed frequently.”

A thorough history and physical examination by a provider experienced in hand and wrist injuries is usually the easiest and most effective method to diagnose tendonitis, Ross says. An examination combined with an X-ray of the wrist can determine if arthritis may be the cause of pain.

“I would encourage patients to advocate for themselves to get tests when appropriate and get to a hand specialist early if their symptoms are not improving,” Halim says, adding, “General practitioners can often be helpful with initial diagnoses and can order nerve tests, X-rays or other imaging studies.”

Keeping Wrist Pain at Bay

After surgery to remove the cyst, Nguyen is still able to work, but she says her wrist is not as strong as it once was. Cysts can be related to tendonitis, Ross says, and cysts on the top of the wrist are very common. Now, Nguyen is vigilant about prevention: She does wrist and hand stretches to help keep her joints flexible and combat the stiffness that comes with doing nails. And at the first sign of pain, Nguyen applies a topical CBD cream, wears a wrist brace while servicing clients and takes ibuprofen.

“CBD cream is an exciting new treatment that may help a lot of people with pain. I believe it to be safe within the prescribed doses and have recommended that some patients try it,” Ross says. “There are not yet, however, many good studies on how well it works.”

Ross also recommends regular stretching of the wrists and fingers, backward and forward, to keep the joints limber and help prevent injury. You can also try doing so with 1-to-3-pound weights to strengthen the muscles of the forearm that act on the wrist.

At the salon, he advises working with the wrists straight or in a neutral position. (See sidebar for more tips.) Yen says taking breaks between clients helps and recommends elevating the nail table to the height of the tech so they can rest their hands comfortably for leverage while they work.

“Wrist pain is part of the job and definitely is a concern,” Nguyen says. “But as with any profession where you work with your hands (like writers, painters, mechanics, musicians), it does not stop me from loving what I do.”

About the Author

Virginia Pelley is a freelance writer and editor based in Tampa, Florida.

Sources:

1. hopkinsmedicine.org/health/conditions-and-diseases/tendonitis#:~:text=Tendonitis%20is%20when%20a%20tendon,tendon%20sheath%20around%20a%20tendon
2. my.clevelandclinic.org/health/diseases/22289-tendinopathy

This article was originally published in the June 2022 issue of Nailpro magazine.