I will try and have my daughter take some pictures tomorrow. It shouldn't hurt your hand, it is much like writing, your using the same muscles. I don't use a hoop, I hold the fabric with my left hand and use the tip of my left index finger as a guide. When pushing the needle through with my right hand I "hit" my index and that guids my needle back up. While doing this your not holding the needle with your right index and thumb. You at first poise the needle with your rt index and thumb, but use your thumb to tell the needle where to go. It is a combined effort of both hands. once you get good at it, you will pretty much just wiggle the needle up and down pushing in with your thumb, and letting the left index determine the stitches. Getting used to it does cause muscle fatigue, You have to find a comfortable sitting position, find a way to rest and relax your arms, then get good enough at stiching that you only use your hands. it takes practice, you need to just run with it. not pay attention to stich size or straight lines, just find a comfort zone, I think you will enjoy it more.
Edit: as far as which direction, since I am right handed I prefer working right to left, or upwards (away) from me, but on a big quilt, that could mean a LOT of turning the quilt, which I don't want to do. So you do kinda learn to go in many directions.