Tremor

Definition

A tremor is a type of involuntary shaking movement. Involuntary means you shake without trying to do so. A tremor is often most noticeable in your hands and arms, but it may affect any body part (even your head or voice).

There are three main types of tremors:

• Resting (or static) tremors: These tremors are present when your muscles are resting. The tremor may go away or become less noticeable when you move muscles that are involved.
• Intention (or kinetic): These tremors occur at the end of a purposeful (intended) movement, such as writing, pressing a button, or reaching for an object. The tremor will usually disappear while the affected body part is at rest.
• Postural or action tremors occur when you are holding your arm or leg in one position for a period of time against gravity. This may happen when you are writing, holding a cup, holding your arms out, or when you stand up straight.

See also: Essential tremor

Alternative Names

Tremor - hand; Hand tremor; Tremor - arms; Kinetic tremor; Intention tremor; Postural tremor

Considerations

Tremors can happen at any age but tend to be more common in older people. Everyone has some tremor when they move their hands. Stress, fatigue, anger, fear, caffeine, and cigarettes may temporarily make this type of tremor worse.

However, a tremor that does not go away over time may be a sign of an underlying medical problem and should be evaluated. You may learn that your tremor is perfectly normal, but eliminating medical reasons for the shaking is important.

Essential tremor is the most common tremor. It is rarely seen when the hands are not being used. It becomes most apparent when you are trying to do something, such as reaching for an object or writing. It is not caused by an underlying disease. This type of tremor may also run in families.

Common Causes

Tremor may be caused by:

• A variety of drugs and prescription medicines
• Brain, nerve, or movement disorders, including dystonia and certain inherited peripheral neuropathies (such as Charcot-Marie-Tooth disease)
• Brain tumor
• Excessive alcohol consumption, alcoholism, or alcohol withdrawal
• Low blood sugar
• Multiple sclerosis -- can cause an intention tremor
• Muscle tiredness or weakness
• Normal aging
• Overactive thyroid -- can cause a postural tremor
• Parkinson's disease -- a classic cause of a resting tremor that is often accompanied by slowness of movement, muscle rigidity, and an abnormal gait
• Stress, anxiety, or fatigue can cause a postural tremor
• Stroke
• Too much coffee or other caffeinated drink

Home Care

For tremors caused by stress, try relaxation techniques like meditation, deep relaxation, or breathing exercises. For tremors of any cause, avoid caffeine and get enough sleep.

For tremors caused by a medication, talk to your doctor about stopping the drug, reducing the dosage, or switching medications. Do NOT change or stop medications on your own.

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

Severe tremors may interfere with your ability to perform daily activities. You may need assistance with these activities. Take precautions to avoid injury during activities such as walking or eating.

Assistive devices may help with everyday activities, including:

• Buying clothes with Velcro fasteners, using button hooks
• Cooking or eating with utensils that have a larger handle
• Using straws to drink
• Wearing slip-on shoes and using shoehorns

Call your health care provider if

Call your doctor if:

• Your tremor is worse at rest and gets better with movement, like when you reach for something.
• Your tremor is prolonged, severe, or interferes with your life.
• Your tremor occurs with other symptoms, such as headache, weakness, abnormal tongue motion, muscle tightening or contractions, or other movements that you cannot easily control.

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a detailed brain and nervous system (neurologic) examination. The following medical history questions may help your doctor evaluate the cause of your tremors:

• Is your tremor regular or irregular?
• Does it occur with activity, at rest, or when you have been holding your hand (or other body part) in a particular position for a long time?
• Are the movements small (fine) or large (coarse)?
• Is the movement fast or slow?
• Are both hands affected? To the same degree on both sides?
• Are other body parts affected, including your voice or head?
• Does the tremor impair your ability to use your hands or other body parts?
• Does emotional stress or excitement make it worse?
• Does drinking an alcoholic beverage make the tremor better or worse?
• Do you have any other symptoms?

The following tests may be performed:

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

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

You may not need treatment unless the tremor interferes with your daily activities or causes embarrassment.

Treatment depends on the cause. Tremor caused by a medical condition, such as hyperthyroidism, will likely get better when the condition is treated.

If the tremor is caused by a certain medicine, stopping the drug will usually help it go away. Never stop taking any medicine without first talking to your doctor. See: Drug-induced tremor

Medicines may help relieve symptoms. How well medicines work depends on the patient and the cause of the tremor.

See also:

• Essential tremor
• Parkinson's disease

Prevention

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References

Fahn S. Hypokinesia and hyperkinesia. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. St. Louis, Mo: WB Saunders; 2007:chap 34.