Hand Tremor: Causes of Shaky Hands, Essential Tremor and When to Be Seen

What it involves

MedlinePlus defines a tremor as a type of shaking movement, most often noticed in the hands and arms but able to affect the head, tongue or vocal cords. It adds that everyone has a small tremor when they move their hands, and that tremors are more common in older people.

Who this is for

• Patients whose hands shake when they write, eat, drink or reach for objects
• Patients with a new tremor, or one that has slowly worsened over months
• Patients with a family member who has shaky hands and wonder if it is inherited
• Patients who also have a racing pulse, weight loss or heat intolerance with the shaking

What to expect

• Questions about when the tremor appears, whether it is worse at rest or with movement and who else in the family has it
• A physical exam, including a nervous system check, as MedlinePlus describes for this symptom
• Blood work such as thyroid function and glucose, since the practice lists blood work among its services
• A plan that may include a medicine review, home strategies or referral to a neurologist

Everyday shake versus tremor worth checking

MedlinePlus says stress, fatigue, anger, fear, caffeine and smoking can make an ordinary tremor stronger. After a night of poor sleep and three coffees, steady hands are not guaranteed. A tremor that does not go away over time, though, may be a sign of a medical problem and should be checked by a provider. A useful habit is to note whether the shaking appears while the hands are resting, while holding a posture or only during a task such as writing, because the pattern points the provider toward likely causes.

Essential tremor

The encyclopedia calls essential tremor the most common type. It involves small, rapid movements, usually when you are trying to do something such as reach for an object or write, and it may run in families. MedlinePlus says it is most common in people older than 65, can also affect the head, voice and eyelids, and may come and go. It often worsens with stress, caffeine, lack of sleep or certain medicines, and it rarely affects the legs. It also states plainly that essential tremor is not a dangerous problem, though it can be embarrassing.

Other causes on MedlinePlus's list

A tremor may come from certain medicines, alcohol use or alcohol withdrawal, too much coffee or caffeinated food, muscle tiredness or weakness, and normal aging. An overactive thyroid is on the list, and the thyroid care page explains how it is followed. Brain, nerve or movement disorders such as Parkinson disease, multiple sclerosis, stroke and brain tumor are also named. Most shaky hands turn out to have a common cause, but the list is why a provider asks careful questions and checks the nervous system.

What a visit may include

Your provider performs a physical exam that includes a detailed nervous system check. MedlinePlus says tests that may be ordered include blood tests such as a complete blood count, thyroid function tests and glucose, as well as nerve and muscle studies, a head CT scan and an MRI. Those scans and studies are referrals, not services listed by this practice. The thyroid blood tests guide explains the blood tests most likely to come first when the thyroid is a possible cause.

Easing daily tasks at home

For tremors from stress, MedlinePlus suggests relaxation methods such as meditation or breathing exercises, and for any tremor it advises avoiding caffeine and getting enough sleep. It also lists everyday aids: clothes with Velcro in place of buttons, utensils with larger, weighted handles, half-filled cups or sippy cups, straws, slip-on shoes with a shoehorn and a heavier bracelet or watch, which may reduce a hand or arm tremor. If a medicine causes the shake, talk to your provider; do not stop it yourself.

When to be seen sooner

MedlinePlus says to contact a provider if the tremor is worse at rest and better with movement, is prolonged or severe, interferes with your life, or comes with other symptoms such as headache, weakness, abnormal tongue movements, muscle tightening or other uncontrolled movements. For essential tremor specifically, it says to call about a new tremor and about side effects from medicines used to treat it. Sudden weakness, trouble speaking or facial droop is an emergency; call 911 instead of waiting for an appointment.

Sources

• MedlinePlus — Tremor
• MedlinePlus — Essential tremor