Tremor - arms or hands

A tremor is a symptom that may be present in otherwise healthy people, as well as in people with medical disorders.

Tremor or shaking can be associated with fatigue, stress, anxiety, or rage. However, constant tremor that is not associated with altered emotional states may be a sign of an abnormal condition and should be evaluated.

Tremor that is associated with involuntary movement of other parts of the body, such as the tongue and head, is always abnormal and should be evaluated.

Essential tremor, which is usually hereditary, is common in older people. Essential tremor is rarely present when the hands are not being used and becomes most apparent when the affected person is trying to do something like reaching for an object or writing. It is not caused by an underlying disease.

Essential tremor is commonly suppressed by alcohol consumption. This is a useful fact for making the diagnosis, but alcohol is not a desirable treatment.

• Too much coffee or other caffeinated drink
• Excessive alcohol consumption, alcoholism, or alcohol withdrawal
• Stress
• Normal aging
• Essential tremor
• Drugs
  • Cocaine
  • Amphetamines
  • Antipsychotics
  • Lithium
  • Phenothiazines
  • Phenytoin
  • Valproic acid
  • Cyclosporine
• Hypoglycemia
• Wilson disease
• Parkinson's disease
  • Characterized by shaking that is constant at rest and improves when the person reaches out for something
  • Often accompanied by slowness of movement, muscle rigidity, and abnormal gait
• Other disease that causes parkinsonism

Severe tremors may interfere with ability to perform daily activities. Assistance with these activities (as necessary) is recommended, and precaution should be taken to avoid injury during activities (such as walking or eating).

For hand tremor caused by stress, try to relax.

For hand tremor caused by reaction to drugs, consult with the doctor about discontinuing, reducing the dosage, or switching medications. Do not change or stop medications without first consulting your health care provider. Many conditions can be made worse by discontinuing or altering treatment, and certain medications may produce withdrawal symptoms if stopped suddenly.

For hand tremor caused by essential tremor, there are numerous medications that may be effective in controlling symptoms. These include beta-blockers, gabapentin, primidone, and others. If the tremors are severe and not responsive to medications, surgery may be an option.

For hand tremor caused by alcohol abuse, seek treatment and support to help you avoid alcohol.

For hand tremor caused by other conditions, see the doctor.

• The shakes are worst at rest and least intensive when reaching for something.
• There are prolonged and severe tremors that interfere with lifestyle.
• The tremors are associated with other symptoms.

Your health care provider will obtain your medical history and will perform a physical examination, including a detailed neurologic examination.

Medical history questions documenting hand tremor may include the following:

• Type
  • Is the tremor regular or irregular?
  • Are the movements small (fine) or large (coarse)?
• Distribution
  • Are both hands affected?
  • Is it the same on both sides?
• Quality
  • Does the tremor impair the ability to use the hands?
  • Is it a rapid and rhythmic tremor?
• Aggravating factors
  • Is it worse after emotional stress?
  • Does excitement make it worse?
  • Is it worse when you try to use your hand (action tremor)?
  • Do specific postures (such as extending your arms horizontally) make the tremor worse? Which postures?

• Relieving factors
  • Is the tremor better after you rest? After you sleep?
  • Does drinking an alcoholic beverage make the tremor less?
  • Does the medication L-dopa (levodopa) lessen the severity of the tremor?
• What other symptoms are present?

• Blood tests such as CBC, blood differential, thyroid function tests, and glucose test
• Urine tests
• Head CT scan
• MRI of the head
• EMG or nerve conduction studies

Once a cause of the tremor has been determined, the appropriate treatment for the disease will be prescribed.