Unlike many Who songs from the 1960s, "Mary Anne with the Shaky Hand" recalls the typical pop song convention of praising a pretty girl[4] but does not provide any description of her appearance,[4] focusing instead on Mary Anne's hand tremor.

[4][5][6] The reason for the shaking is not clear:[4][5] Mary Anne may have some affliction[5] and/or the song may be, as Chris Charlesworth describes it, the Who's "second great song about masturbation" (after the band's 1967 single "Pictures of Lily"):[5][7] Steve Grantley and Alan Parker suggest that the reason can be inferred from the line "What they do to a man, those shaky hands."

[8] Townshend has also introduced the song with "This next one's written in very bad taste", as on Live at the Royal Albert Hall.

The song has a melody described by AllMusic's Mark Deming as "charming" and "a tune you couldn't forget even if you tried".

[6] The acoustic guitar version on The Who Sell Out album was recorded at De Lane Lea Studios on 24 October 1967.

In 2021 the Who released a "Super Deluxe" edition of The Who Sell Out that contained a previously unreleased 1967 Townshend home demo of the song.