Hand Tremors

For some people, trembling of the hands is a part of life. Let's understand why this happens and how to avoid it

Hands trying to put a thread in the eye of a needleSometimes when you are in fear, your hands shake so much that you find it difficult to hold even a pen. Well, that’s an extreme emotion. But for some people, such trembling [medically known as tremors] is frequent. It hinders their day-to-day activities. The movement is rhythmic and involuntary, which means you can’t stop the part of your body from shaking. Rhythmicity implies that the movement reappears at regular intervals of time, usually several times per second. We have all experienced tremors and this is a normal occurrence from a neurological point of view. But it warrants concern and a visit to a neurologist when the tremors become persistent or disabling.

Tremors usually affect the upper limbs, but are also common in the lower limbs, neck, tongue, lips and voice box. For some, tremors might just be an unrelated occurrence not connected to any other disease, while for others they might represent the first signs and symptoms of a serious, underlying, neurological disorder.

Types of tremors

Enhanced physiological tremor: Each one of us is capable of manifesting this type of tremor when subject to certain conditions. It affects both limbs equally, tends to be subtle and is most marked when a sustained posture is attempted [such as keeping hands outstretched for long]. Anxiety, fear, and fatigue, high levels of thyroid hormones and low blood glucose levels could cause this type of tremor. When the underlying cause is treated, the tremors disappear.

Essential tremor: This runs in families and is fairly common. So if either of your parents experiences this type of tremor, there’s a 50 per cent chance that you might too. Usually, the tendency becomes evident in the middle years of life. It affects the hands, neck and voice box. The tremors are coarser in character and are also more marked when sustained posture is attempted. They may be quite prominent on attempting to perform fine, coordinated movements such as threading a needle. Essential tremor responds moderately well to medication and shows a tendency to deteriorate gradually, as the years pass.

Parkinson’s disease-related tremor: Tremor is one of the most important diagnostic features of Parkinson’s disease [PD] along with other cluster of symptoms. The tremor of PD is coarse and produces a characteristic back and forth movement called the ‘pill rolling’ movement. It is more marked at rest and when the person is relaxed and tends to ease on movement. The tremor classically starts in one or another extremity and involves other limbs sequentially. What is strikingly different in patients with tremor of PD is the coexistence of the other signs and features of PD, which include rigidity, slowing of movements, a mask-like face and sometimes, a sense of poor balance and a tendency to falling. The medications for PD also treat associated tremors.

Other tremors: These are seen in those who suffer from disorders of the motor coordination system in the brain [represented by the cerebellum]. These tremors are characteristically slower and the most coarse of the tremor variants. They are maximal while performing fine, skilled movements and tend to increase as the fine movement is brought to completion. Based on the location of the disease process in the brain, the tremors may affect one or more limbs.

Rarely, a movement resembling tremors may actually be a type of epileptic seizure [convulsion]. This condition, which persists for days to weeks, continues unabated during sleep and does not change its character and intensity with change in position [rest, sustained posture or fine skilled movement] of the affected limb. It arises due to focal damage with irritation to a part of the brain that directs movements of the affected limb.

When you first experience tremors, a volley of questions come to mind. But don’t draw conclusions about the diagnosis, consult a neurologist, who will perform a thorough analysis of the symptoms to zero down on the exact cause.

The tests that might be ordered in course of such an evaluation would include, but may not be restricted to, MRI of the brain and spine, electrophysiological sampling of nerves and muscles and blood tests to assess function of vital organs and to detect the presence of metabolic disorders such as diabetes. In select cases, the urine and blood may be screened for toxins.

In summary, tremors are a common problem. A majority of tremors are usually due to factors that are easily remediable, yet one must never ignore the symptom as it might sometimes represent the harbinger of more ominous neurological disorders. Early diagnosis and timely, appropriate treatment go a long way in avoiding untoward instances.

Try This

  • Try relaxation techniques such as meditation and deep breathing to ease tremors caused by fear, anxiety or stress.
  • Eliminate coffee from your diet as it aggravates tremors, irrespective of the cause.
  • Certain medications too cause tremors. If you’ve noticed that you’re having uncontrolled shaking of the hands or legs after starting a medication, speak to your physician. However, don’t discontinue medication without your physician’s advice.
  • Seek treatment if your tremor is associated with alcohol intake.
  • Keep your blood pressure in control as a rise in it worsens tremors.
  • If you experience severe tremors, avoid performing tasks that put you at risk such as lifting vessels full of hot food or beverages or handling fire-crackers or sharp objects.
  • Use a bib to avoid food from spilling on your clothes in case your hands shake when having food. When the episode is at its worst, it’s best to avoid consuming food, which you find difficult eat, or for which you need assistance.
  • Buy clothes/shoes with Velcro fasteners rather than buttons or laces as the shaking may make it difficult to use buttons.
  • Use utensils and cutlery with large handles to give you a firm grip and avoid spilling.
  • Rather than drinking liquids from a glass, use a straw.
  • Ask your doctor for hand exercises to make the tremors less pronounced and improve your grip.
  • Assign speed dial for numbers that you use frequently.
  • Use a phone with a large keypad. And use text message templates for frequently sent messages.

— Team Complete Wellbeing

This was first published in the February 2012 issue of Complete Wellbeing.

Girish Nair
Dr Girish Nair is a consulting neurologist at Fortis Hospital, Mulund.


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