Alternate Names: Shaking of the hands; Tremor - arms or hands

Considerations: 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, anger, or rage. However, constant tremor that is not associated with altered emotional states may be a sign of disease or 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 people older people. Essential tremor is rarely present when the hands are not being used and becomes most apparent when 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, an important fact in making the diagnosis, but alcohol is NOT a desirable treatment.

Common Causes:

• Too much coffee or other caffeine-containing drink
• Excessive alcohol consumption, alcoholism, or alcohol withdrawal
• Stress
• Normal aging
• Cocaine use
• Essential tremor
• Drugs such as amphetamines, antipsychotics, and lithium toxicity, phenothiazines, or phenytoin, valproic acid, and cyclosporine
• Insulin overdose in diabetics (hypoglycemia)
• Wilson's disease
• Disease causing parkinsonism
• Parkinson’s disease
  • Characterized by shaking that is constant at rest and improves when the person reaches out for something
  • Parkinson’s disease is often accompanied by slowness of movement, muscle rigidity, and abnormal gait

Home Care: 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 MEDICATIONS WITHOUT CONSULTING YOUR HEALTH CARE PROVIDER.

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

For hand tremor caused by alcohol abuse, avoid alcohol.

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

Call If:

• 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.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting hand tremor in detail may include:

• 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 (e.g., holding arms extended horizontally) make the tremor worse? Which postures?

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

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