March 27, 2008

Hand Hurts While Crying

Stupid Question ™
March 25, 1999
By John Ruch
© 1999

Q: My hand aches when I cry. Am I the only one, or is there a medical explanation?
—Jennifer L. McCormick

A: Most doctors I spoke to wanted to start by getting you into an examining room. Until then, it’s going to be impossible to explain specifically why your hand hurts during crying.

In any case, all of them—a hospital general practitioner, a neurologist and an expert in the physiology of crying—could find no record of an ailment like yours.

Before this starts sounding like another bad HMO experience, however, let me add that they had some bright ideas.

Sadness or other strong emotions can of course result in crying—a complicated nervous system function ranging from tear-shedding to raised blood pressure.

According to Dr. Harrison Weed of the Ohio State University (OSU) Medical Center, there is one recognized form of crying-related pain: SUNCT Syndrome.

Cranial Nerve 7 sends the pulses that produce tears in your eyes. On its way up, a portion of the nerve passes through a complex of other nerves that hook up to Cranial Nerve 5—the one that controls facial pain.

In some people, probably with a tiny biological defect, the Nerve 7 stimulus short-circuits and jumps over to Nerve 5, causing facial pain during crying.
But the nerves to the hand are too far away for such a short-circuit.

Dr. Weed also suggested that the rise in blood pressure during crying may cause a blood vessel in your hand to expand and squeeze a nearby nerve.
J. Layne Moore, an OSU professor of neurology, suggested something similar: Thoracic Outlet Syndrome.

The thoracic outlet is a space near your shoulder through which the arteries, veins and nerves for your arms run. The space is between the collarbone and the first rib.

In the syndrome, the blood vessels and/or nerves get pinched between the two bones. The cause can be posture problems, an old collarbone fracture, even a freak extra rib. It’s also been associated with repetitive motion.

When the nerve is pinched, it causes pain in the shoulder, arm and/or hand. Hand pain is usually worse in the ring and pinkie fingers.

You may be experiencing thoracic outlet pinching by hunching and tensing during crying. Bra straps can also aggravate the condition.

But Thoracic Outlet Syndrome is a trendy diagnosis these days, and it’s usually a chronic problem.

Pain without an organic cause is rare. But pain is partially subjective. Sometimes, minor pain can set off a hypersensitive reaction in the brain that magnifies the small stimulus. Mental states such as anxiety can lower the pain threshold and increase its sensation.

So it’s possible you always experience minor thoracic outlet pain, but only notice it while crying.

All these suggestions are only suggestions. If you decide to see a doctor, you may be given the dubious distinction of having a medical disorder named after you.

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