Tremor
Shaking; Tremor - hand; Hand tremor; Tremor - arms; Kinetic tremor; Intention tremor; Postural tremor; Essential tremor
A tremor is a type of shaking movement. A tremor is most often noticed in the hands and arms. It may affect any body part, including the head or vocal cords.
Considerations
Tremors can happen at any age. They are more common in older people. Everyone has some tremor when they move their hands. Stress, fatigue, anger, fear, caffeine, and smoking may make this type of tremor worse.
A tremor that does not go away over time may be a sign of a medical problem and should be checked by your health care provider.
Essential tremor is the most common tremor. The shaking most often involves small, rapid movements. It usually occurs when you are trying to do something, such as reaching for an object or writing. This type of tremor may also run in families.
Essential tremor
Essential tremor (ET) is a type of involuntary shaking movement. It has no identified cause. Involuntary means you shake without trying to do so an...
Causes
Tremor may be caused by:
-
Certain medicines
Certain medicines
Drug-induced tremor is involuntary shaking due to the use of medicines. Involuntary means you shake without trying to do so and can't stop when you ...
-
Brain, nerve, or movement disorders, including uncontrolled muscle movements (
dystonia
)
Dystonia
Uncontrolled or slow movement is a problem with muscle tone, usually in the large muscle groups. The problem leads to slow, uncontrollable jerky mov...
-
Brain tumor
Brain tumor
A primary brain tumor is a group (mass) of abnormal cells that start in the brain.
-
Alcohol use
or
alcohol withdrawal
Alcohol use
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to f...
Alcohol withdrawal
Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking ...
-
Multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).
- Muscle tiredness or weakness
- Normal aging
-
Overactive thyroid
Overactive thyroid
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
-
Parkinson disease
Parkinson disease
Parkinson disease causes certain brain cells to die. These are the cells that help control movement and coordination. The disease leads to shaking ...
- Stress, anxiety, or fatigue
-
Stroke
Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
- Too much coffee or other caffeinated drink
Home Care
Your provider will likely suggest self-care measures to help with daily life.
Self-care measures
Shaking - self-care; Essential tremor - self-care; Familial tremor - self-care
For tremors caused by stress, try ways to relax, such as meditation or breathing exercises. For tremors of any cause, avoid caffeine and get enough sleep.
For tremors caused by a medicine, talk to your provider about stopping the drug, reducing the dosage, or switching to another medicine. Do not change or stop medicines on your own.
For tremors caused by alcohol use, seek treatment to help you stop drinking alcohol .
Stop drinking alcohol
Alcohol use disorder - quitting drinking; Alcohol abuse - quitting drinking; Quitting drinking; Quitting alcohol; Alcoholism - deciding to quit...
Severe tremors may make it hard to do daily activities. You may need help with these activities.
Devices that may help include:
- Buying clothes with Velcro fasteners or using button hooks
- Cooking or eating with utensils that have a larger handle
- Using a sippy cup to drink
- Wearing slip-on shoes and using shoehorns
When to Contact a Medical Professional
Call your provider if your tremor:
- Is worse at rest and gets better with movement such as when you reach for something
- Is prolonged, severe, or interferes with your life
- Occurs with other symptoms, such as headache, weakness, abnormal tongue movements, muscle tightening, or other movements that you cannot control
What to Expect at Your Office Visit
Your doctor will perform a physical exam, including a detailed brain and nervous system (neurologic) examination. You may be asked questions to help your doctor find the cause of your tremors:
The following tests may be ordered:
-
Blood tests such as
CBC
,
blood differential
,
thyroid function tests
, and
glucose test
CBC
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
Blood differential
The blood differential test measures the percentage of each type of white blood cell (WBC) that you have in your blood. It also reveals if there are...
Thyroid function tests
Thyroid function tests are used to tell whether your thyroid is working normally. The most common thyroid function tests are:Total, or free T4 (the m...
Glucose test
A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of t...
-
EMG
or
nerve conduction studies
to check the functions of the muscles and nerves
EMG
Electromyography (EMG) is a test that checks the health of the muscles and the nerves that control the muscles.
Nerve conduction studies
Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve.
-
Head CT scan
Head CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
-
MRI of the head
MRI of the head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
- Urine tests
Once a cause of the tremor has been determined, treatment 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.
You may be prescribed medicines to help relieve symptoms. How well medicines work depends on your overall health and the cause of the tremor.
In some cases, surgery is done to relieve the tremors.
References
Fasano A, Deuschl G. Therapeutic advances in tremor. Mov Disord . 2015;30:1557-1565. PMID: 26293405. www.ncbi.nlm.nih.gov/pubmed/26293405 .
Jankovic J, Lang AE. Diagnosis and assessment of Parkinson disease and other movement disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice . 7th ed. Philadelphia, PA: Elsevier; 2016:chap 23.
Raftery AT, Lim E, Ostor AJK. Tremor. In: Raftery AT, Lim E, Ostor AJK, eds. Churchill's Pocketbook of Differential Diagnosis . 4th ed. Philadelphia, PA: Elsevier; 2014:468-470.
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Muscular atrophy - illustration
Muscular atrophy is the decrease in size and wasting of muscle tissue. Muscles that lose their nerve supply can atrophy and simply waste away.
Muscular atrophy
illustration
Review Date: 5/30/2016
Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.