Hand tremors are unintentional rhythmic movements of the hand that occur either at rest or with motion.
Tremors are unintentional, rhythmic movements of a part of the body that occur in a back-and-forth pattern. They are the most common of all involuntary movements and can affect the hands, arms, head, face, voice, trunk and legs. Tremors may occur at any age but are most common in middle-aged and older persons.
Several neurological disorders like multiple sclerosis, stroke, brain injury or neurodegenerative diseases that damage brain and nerve cells cause hand tremors. Other medical conditions like alcohol withdrawal, thyroid disorders, liver failure and lithium poisoning are also associated with tremors. Fatigue, anxiety, stress, aging, low blood sugar, some prescription medicines like amphetamine, corticosteroids and over use of caffeinated drinks can also cause hand tremors.
Tremors are generally caused by improper functioning of the part of brain that controls muscle movement throughout the body or in particular areas such as hands.
Hand tremors may occur:
- At rest
- During action
Depending on the tremor characteristics and the associated symptoms, the underlying cause of the tremor can be diagnosed. For example:
- Tremors at rest associated with rigid muscles and slow movements could suggest Parkinsonism.
- Tremors associated with a high pulse rate and weight loss may be due to high thyroid hormone levels.
- Tremors that appear within a reasonable time frame following drug ingestion may be induced by medications.
- Tremors that appear at the end of purposeful movements may be due to a problem in the cerebellum.
- Tremors in a diabetes patient may be due to excessive medication resulting in low blood sugar levels.
The cause of hand tremors vary from anxiety to lesions in the brain.
The various causes of hand tremors are listed below:
Resting Tremors: Resting hand tremors appear when the hand is resting, and go away or becomes less noticeable with movement. The tremor worsens in stressful conditions. Conditions that result in resting tremors include:
- Parkinsonism: Parkinsonism is a condition characterized by low levels of a chemical called dopamine in the brain. The hand tremor usually appears at rest and disappears with movement. The hand moves in a typical pill-rolling fashion. The tremor increases tremendously with stress and emotions. The chin, lips, legs and trunk can also be affected by Parkinson tremor. In addition, the patient shows other symptoms like a shuffling gait, rigidity of muscles and slowness of movements. Antiparkinsonism medications are usually effective in controlling the tremor.
- Drug-induced Tremors: Drugs like neuroleptics, metoclopramide and prochlorperazine can cause resting tremors similar to those observed in Parkinsonism.
- Vascular Midbrain Lesions: Holmes tremor is also known as rubral tremor or midbrain tremor. This rare tremor is associated with a vascular lesion in the central nervous system and is characterized by combination of slow rest and intention tremor.
Action Tremors: Action tremors are tremors associated with movement. These include:
- Intentional Tremor: This type of tremor occurs at the end of purposeful movement such as writing, pressing a button or reaching out for an object
- Cerebellar tremor: The cerebellum is an important part of the central nervous system responsible for movements and balance. Conditions like stroke, tumor and multiple sclerosis that damage the cerebellum result in intentional tremors. Cerebellar tremor is a slow tremor that occurs at the end of purposeful movement such as trying to press a button or touching a finger to the tip of one’s nose. Overuse of drugs like phenytoin, sodium valproate and amiodarone, and chronic alcoholism can also cause cerebellar tremor. The tremor is often irregular and jerky. The patient shows an abnormal gait, incoordination of the limbs, rapid and involuntary movement of eyeballs, and alteration in speech
- Wilson’s disease: Wilson’s disease is a condition where the patient suffers from abnormal copper metabolism. The tremors appear as flapping movements, most commonly in ‘wing-beating’ posture. Additional symptoms include increased muscle tone, rigidity and slow movements, Kayser-Fleischer rings in the eyes. Liver functions are abnormal in these patients.
- Simple Kinetic Tremor: Simple kinetic tremor occurs during any voluntary non-target directed movements, like flexing or extending.
- Postural Tremor: This type of tremor occurs when arm, leg or hand is held in one position for a period of time against gravity such as while writing, holding a cap and holding the arms out.
- Benign essential tremor: Benign essential tremor is the most common form of tremor and generally affects people over the age of 40 years. It usually affects hands but the head, voice, tongue, and trunk may also be involved. Although the tremor may be mild and non progressive over a long period of time, it may progress within a few years in some individuals. The condition usually runs in families. It is triggered or worsened by stress, fever, fatigue, heightened emotions and low blood sugar, and reduces with alcohol intake. It is treated with medications and in some cases with electrode placement and deep brain stimulation.
- Physiological tremor: This type of tremor occurs in every normal individual and is rarely visible to the eye. Severity of the tremor increases with strong emotions such as anxiety or fear. All voluntary muscle groups are affected by physiological tremor and can be detected by extending the arms and placing a piece of paper on top of the hands. Physiological tremors may be increased with drugs like sympathomimetics and antidepressants.
- Dystonic tremor: Dystonic tremors occur in individuals of all ages and in any body part affected by dystonia i.e. abnormal posturing due to altered muscle tone. They are jerky, irregular and variable depending upon the posture and activity and are relieved with complete rest or by touching the affected body part.
- Thyrotoxicosis: Thyrotoxicosis is a condition where the patient suffers from high thyroid hormone levels. Tremors are evident when the hands are held out. Other associated features include a rapid pulse, weight loss, and sometimes the presence of goiter and bulging of eyeballs. The condition is diagnosed using thyroid function tests.
- Hypoglycemia: Low blood sugar levels can result in hand tremors, which usually disappear once the condition is treated. The patient may also have symptoms of sweating and convulsions in some cases.
- Cushing’s syndrome: Cushing’s syndrome results in increase adrenaline levels in the blood, which could stimulate hand tremors.
- Alcohol withdrawal: Alcohol withdrawal after prolonged intake can result in hand tremors. Other symptoms include sweating, anxiety, nausea and vomiting, headache and insomnia. Some patients may experience hallucinations and seizures.
- Peripheral Neuropathy: Conditions that affect peripheral nerves like dysgammaglobulinemia cause postural and kinetic tremors.
- Drugs: Overdosage of certain medications as well as sudden withdrawal can precipitate hand tremors. Drugs that are associated with postural tremors include amiodarone, amphetamine, beta adrenergic agonists, caffeine, cyclosporine, corticosteroids, sodium valproate, theophylline, thyroid hormone and tricyclic antidepressants.
- Anxiety: Anxiety and panic attacks commonly cause postural tremors especially in younger individuals. The patients may also complain of palpitations, chest discomfort and a feeling of suffocation.
- Isometric Tremor: Isometric tremor is a type of tremor that occurs during the contraction of a voluntary muscle in the absence of any movement. Essential tremor, enhanced physiological tremor, dystonic tremor, and tremor in Parkinson’s disease can manifest as this type of tremor.
- Task-specific tremor: Tremors that appear with certain tasks are referred to as task- specific tremor. These tremors include primary writing tremor and musician’s tremor
In addition to the above tremors, psychogenic tremors i.e. tremors due to a psychological cause, can manifest as any type of tremor. The tremors may appear, resolve or change direction suddenly. They decrease or completely stop when the individual is distracted.
FAQs1. Which doctor should I visit in case I suffer from hand tremors?
You should visit a neurologist in case you suffer from hand tremors.
2. Can hand tremors be completely cured?
There is no specific cure for hand tremors. Some medicines like propranolol are used in treating hand tremors. If hand tremors are due to Parkinson’s disease, antiparkinson medications are effective up to a certain extent. If tremors are caused by certain lifestyle factors like heightened emotions, stress, fatigue and excess alcohol or caffeine intake, removal of these factors is helpful in treating hand tremors.
3. What are general characteristics of hand tremors?
A patient with hand tremors shows a rhythmic shaking of the fingers and hands. He/she may also experience difficulty with writing or drawing, or problems holding utensils and cutlery. Some tremors may be triggered by or become exaggerated during times of stress or strong emotions, fatigue or with certain postures or movements.
4. Are hand tremors hereditary?
Some forms of tremors like essential tremors are hereditary and run in families.
5. Are hand tremors life-threatening?
Generally, tremors are not life threatening but can be embarrassing and interfere in daily activities.
- Sirisena D. My hands shake Classification and treatment of tremor. Australian Family Physician 2009;38 (9): 678-683
- Tremor Fact Sheet - (http://www.ninds.nih.gov/disorders/tremor/detail_tremor.htm)
Latest Publications and Research on Hand Tremor Symptom EvaluationCervical spinal cord stimulation for the treatment of essential tremor. - Published by PubMed
Botulinum Toxin for the Treatment of Hand Tremor. - Published by PubMed
Robotic versus laparoscopic gastrectomy with lymph node dissection for gastric cancer: study protocol for a randomized controlled trial. - Published by PubMed
Combined OCT distance and FBG force sensing cannulation needle for retinal vein cannulation: in vivo animal validation. - Published by PubMed
Characterization of Parkinsonian Hand Tremor and Validation of a High-Order Tremor Estimator. - Published by PubMed