Understanding Hand Tremors: Normal vs. Concerning Signs and Triggers

02.10.2023 posted by Admin

Do hand tremors indicate a problem?

Q: Lately, I've noticed that my hands are shaking more. Should I be concerned?

A: If your hand tremors aren't causing problems in your daily life, there's likely no need to worry.

We all experience a slight, fast trembling in our hands, which is considered normal. To see this for yourself, try placing a piece of paper on your outstretched palm, facing upward.

However, as we age, this normal hand tremor tends to slow down and may become more noticeable during everyday tasks. Approximately one in four people over the age of 70 develop some form of visible tremor.

Certain factors can make this baseline tremor more pronounced and visible. These factors include:
  • Intense fear, anxiety, or fatigue.
  • Conditions like fever, hyperthyroidism, or low blood sugar.
  • Vigorous physical activity.
  • Withdrawal from alcohol or opioids.
  • Certain medications, such as SSRIs or SNRIs (antidepressants), albuterol, prednisone, nicotine, and caffeine.

  • Addressing these triggers can often alleviate the visible tremor.

    However, there are crucial instances when a tremor may indicate an underlying condition like Parkinson's disease or multiple sclerosis. If you have an unexplained tremor, it's advisable to consult your doctor.

    Root Causes of Tremors

    Tremors are involuntary movements typically caused by rapid, alternating contractions of opposing muscle groups—like your biceps and triceps. In these movements, one muscle relaxes while the other contracts to move a part of your body.

    Beyond what we know about the role of the brain and muscles in tremors, there's longstanding evidence suggesting that the gut plays a significant role in various neurological disorders. Recent research has shown unique microbiome changes and correlations with specific short-chain fatty acids in people with Parkinson's disease and essential tremor, indicating a potential link.

    When assessing your tremor, a physician will first inquire whether it occurs at rest, such as when your arm is comfortably supported on a chair, or during voluntary activities. In cases where the cause is unclear, doctors may order specialized head scans.

    Possible Causes of Tremors

    Essential Tremor

    If your tremor mainly occurs during actions or while writing (known as a primary writing tremor), you might have essential tremor, a very common condition.

    People with essential tremor often describe difficulties like repeatedly hitting the same key while typing, trouble keeping their hands steady for shaving, or frustration with food slipping off their forks before reaching their mouths.

    Essential tremors can run in families and typically affect both hands symmetrically. Alcohol may temporarily alleviate the tremor due to its effect on certain brain receptors, but it often leads to a rebound effect with increased tremor amplitude. Prolonged alcohol use may also worsen the tremor.

    Fortunately, there are several treatment options for essential tremor, including medications like propranolol and primidone, weighted gloves, or deep brain stimulation. While essential tremor isn't inherently dangerous, some individuals may be at higher risk of developing Parkinson's disease, so keeping your doctor informed about any health changes is crucial.

    Parkinson's Disease

    Tremors are often the initial symptom in about three out of four people with Parkinson's disease. In Parkinson's, the tremor typically starts in one hand while at rest, resembling the thumb and forefinger rolling a pill back and forth. However, it can also affect the leg or foot.

    This tremor is associated with a dopamine deficiency in a brain region called the substantia nigra. Medications like levodopa, which boost dopamine levels, can be beneficial for Parkinson's patients.

    Multiple Sclerosis

    Tremors are common in individuals with multiple sclerosis, an immune-related central nervous system disease. People with multiple sclerosis may experience neurological symptom "attacks," such as sudden loss of sensation on one side or vision problems, which may improve before another episode begins.

    Wilson's Disease

    A less common cause of tremor, Wilson's disease, typically affects younger individuals and arises from a genetic defect leading to copper accumulation in various body parts, including the liver, joints, and brain.

    What I Want You to Know

    Many people find their tremors embarrassing and disruptive to everyday tasks like brushing teeth or eating, not to mention their work and hobbies. Those with movement disorders may benefit from a comprehensive healthcare team, including physical and occupational therapists, psychologists, or dietitians, beyond just their doctor. Don't hesitate to inquire about connecting with these specialists to improve your overall health and well-being.
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