Shaking of Hands: Causes, Symptoms, Treatment of Hand Tremor

Tremor or uncontrollable shaking is an involuntary movement or shaking of any body part such as hands, arms, eyes, face, head, trunk, legs and even voice.¹ Shaking or tremor is more obvious in hands. Older people commonly suffer from an essential tremor, although it rarely is noticeable if the hands are at rest and but hand shaking or hand tremor is apparent when the affected individual is trying to do some activity like writing or lifting something. Essential tremors are not caused by any underlying disease.

The reason for hand shaking or hand tremor in some people is an underlying neurological disorder; whereas, some individuals may have tremors due to excitement or fear. Some diseases such as Parkinson’s disease or multiple sclerosis cause uncontrollable shaking of hands or hand tremor as there is destruction of the nerve tissue. Stroke, head injury, excessive stress, strong emotions, physical exhaustion may also cause uncontrollable shaking of hands or hand tremor. Shaking of Hands or Hand Tremors can be perfectly normal in an old person and may not indicate any underlying disorder; however, it is better to eliminate other medical reasons for the tremors.

Slight shaking of our hands is normal, as the tiny muscle fibers in our hands and arms are continuously contracting and relaxing. When the shaking of hands or hand tremor starts to interfere with our daily activities such as writing, holding a pen, or using a fork and knife then it becomes a cause for concern. Rigid muscles or muscle stiffness commonly affects the limbs and neck. If the stiffness is severe, then it can also cause pain and limit a person’s movements. The signs and symptoms of alcohol withdrawal such as shaking of the hands and legs or tremors of the hands and legs, mild headaches, vomiting, cold sweat, loss of appetite, restlessness, insomnia, rapid pulse, anxiety and auditory hallucinations appear around six to 48 hours after the patient has stopped drinking alcohol. Testing should be done to rule out other causes of shaking of hands or hand tremors, such as excessive caffeine or tobacco use, using certain medications like those given for asthma, lithium, some antidepressants and medications given for seizures.

There are many causes for shaking of hands or hand tremor. Some of the reasons for shaking hands are:

• Shaking of Hands or Hand Tremor Caused by Anxiety, Stress, Anger etc. Some of the events that lead to anxiety stress or anger will cause us to tremble (‘shaking with nerves’) or the hands may also shake when we are very tired.
• Low blood sugar level also causes hand tremor as the required amount of fuel is not supplied to the nerves and muscles which leads to the adrenaline system responding by worsening of the shakiness of hands. A low blood sugar commonly occurs if one consumes a lot of sugary snacks/foods or after excessive exercise.
• Excessive tea and coffee intake also causes shaking of the hands or hand tremor especially in conjunction with low blood sugar. So, reducing the amount of tea and coffee and sugary snack ‘meals’ helps a lot with the hand tremors.
• Environmental factors such as unusual exposure to herbicides and pesticides increase the risk of developing Parkinson’s disease which can cause shaking of hands or hand tremor.
• Some vitamin deficiency.
• Neurological disorders or conditions like traumatic brain injury, chronic kidney disease, multiple sclerosis and stroke can cause shaking of hands or hand tremor.
• Brain tumor.
• Various drugs and prescription medicines are known to cause hand shaking or hand tremor.
• Excessive alcohol consumption or alcohol withdrawal leads to shakiness of hands or hand tremor.
• An essential tremor is one of the most common types of shakiness.²
• Medications like those given for asthma, some antidepressants, lithium, tranquilizer etc. can also cause shakiness of hands if stopped abruptly. Likewise, an alcoholic may get shakiness of the hands in the morning after a binge.
• Parkinson’s disease also causes shaking of hands, but is less common than essential tremor.³ The difference between essential tremor and Parkinson’s disease is that shaking of hands is worse upon resting in Parkinson’s. The shaking of hands in Parkinson’s disease is termed as ‘pill rolling’ because the sensation is like rolling a small pill between the thumb and the index finger.
• Overactive thyroid is also one of the causes for shaking of hands or hand tremor. Women and people in their 20s and 30s are more commonly affected by this.

• Blood draws
• CT
• MRI

Treatment for shaking of hands or hand tremor is dependent on cause and degree of tremors of the hands and it includes medications, lifestyle changes and sometimes surgery for a severe and persistent tremor.

• Medications for parkinsonian tremors causing hands to shake include: Levodopa, ropinirole, pramipexole, anticholinergic and amantadine hydrochloride.
• Propranolol or other beta blockers are beneficial in treating essential tremors that causes shaking of hands or hand tremor.
• Anticonvulsants like primidone can also be prescribed to treat hand tremors.
• Dystonic tremors may benefit from drugs such as clonazepam, anticholinergic drugs, and injections of botulinum toxin can be given intramuscularly. Botulinum toxin may also be prescribed for treating head and other movement disorders.
• Orthostatic tremors can be treated with medicines such as primidone and clonazepam.
• Medical treatment is not beneficial for cerebellar tremors.

Modifying one’s lifestyle helps tremendously in decreasing the severity of the problem of hand shaking or hand tremor. Triggers such as caffeine and other stimulants should be avoided. Patient should take adequate rest and sleep (7 to 8 hours). If stress is the cause for shaking of hands or hand tremor, then patient should practice relaxation techniques such as breathing exercises, meditation or deep relaxation. Physical therapy may also be done to improve strength and muscle control thereby decreasing the extent of the uncontrollable shaking of hands or hand tremor.

In case of severe shaking of hands or hand tremors which are beyond control and do not respond to drugs or exercises, surgery may be recommended by the doctor. Surgical procedures such as thalamotomy and Deep Brain Stimulation (DBS) have shown a very good response and are extremely effective in treating serious tremors.

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