Hand tremor in adults
Trembling in the hands is familiar to many of us. There are quite a few reasons for it, ranging from excitement or temperature to Parkinson’s disease and multiple sclerosis. Discuss the main causes of hand tremors with doctors

Every adult has experienced hand tremors in one way or another. Hands may tremble due to excitement, hypothermia, after taking certain medications and drinking a lot of coffee. If trembling bothers you regularly and appears for no apparent reason, this may be an independent disease or a sign of neurological disorders.

We talked to our experts about the most common causes of hand tremors in adults. We learned about harmless and more dangerous types of hand tremors. We also found out what diagnostic and treatment methods are used for complaints of trembling in the upper limbs.

Causes of hand tremor in adults

Hand tremor is physiological and pathological. Physiological trembling in the hands occurs during stress, high temperature, physical exertion, as well as in people who smoke a lot, abuse tea and coffee. Sometimes physiological tremor appears on the background of taking medications: neuroleptics, antidepressants, antiepileptic drugs. Physiological trembling goes away if you eliminate what causes it.

Pathological tremor is primary and secondary. Primary is an independent neurological disease, which is most often inherited. Secondary tremor develops against the background of diseases: stroke, multiple sclerosis, Parkinson’s disease, thyroid diseases. Diagnosis and treatment are required only for pathological hand tremor.

Essential tremor

Essential hand tremor in adults is one of the most common neurological diseases (for comparison, Parkinson’s disease is 10 times less common)1. With essential tremor, trembling of the upper extremities is the first and almost the only symptom of the disease.1. Trembling occurs when the hands are in motion, and is almost not observed at rest.1. Most often, the tremor is symmetrical and affects the hands and forearms of both hands.2. In some cases, ET is accompanied by shaking of the head and vocal cords.1. Essential hand tremor is often diagnosed at a young age, but the onset of the disease can occur in children and the elderly.1.

Essential tremor has a characteristic that doctors call the alcohol test. After taking small doses of alcohol, trembling in the hands completely disappears. This sometimes leads people with ET to be treated with alcohol and become chronic alcoholics.

Parkinson’s disease

In people with Parkinson’s disease, hand tremors most often begin at rest. Sometimes legs, chin and lips tremble along with the upper limbs3. Hand tremor in Parkinson’s disease is unilateral, that is, the right or left hand trembles3. As the disease progresses, shivering becomes bilateral. In addition to trembling limbs, people with this diagnosis also have other signs of the disease: muscle rigidity and hypokinesia, or slowness of movement.3.

Thyrotoxicosis

One of the causes of hand tremor in adults is thyrotoxicosis. This condition occurs when the thyroid gland produces an excessive amount of thyroid hormones – thyroxine and triiodothyronine.4. In 70-80% of cases, thyrotoxicosis develops against the background of Graves’ disease and nodular toxic goiter.4. Patients with thyrotoxicosis also complain of muscle weakness, sweating, weight loss, irritability, heart palpitations, impaired memory and attention.4.

Focal pathology of the central nervous system

This term refers to a whole group of diseases of the central nervous system, which are accompanied by damage to the cerebellum and brain stem. Focal pathologies develop in people with stroke, dyscirculatory encephalopathy, traumatic brain injury, encephalitis. Patients suffer from large tremors in the upper extremities, which occur at the beginning of the movement and increase when approaching the target. Therefore, it is difficult for people with such pathologies to touch the tip of their nose with their index finger.

Wilson’s disease

Wilson’s disease is a hereditary disease in which copper metabolism in the body is disrupted. Copper accumulates in the liver, kidneys, cornea and brain and causes intoxication of these organs. The disease can take different forms. One of the forms of the disease is accompanied by a tremor of the upper extremities.

Polyneuropathies

This is a whole group of diseases in which the functions of peripheral nerves are impaired. Polyneuropathies are observed in people with diabetes mellitus, chronic alcoholism, paraneoplastic syndrome, uremia and dysproteinemia. Neuropathic tremor is often accompanied by muscle weakness and sensory disturbances (for example, the hands “go numb” or vice versa, feel pain and discomfort with light touch).

Treatment of hand tremor in adults

Physiological tremor does not require treatment, and in other cases, the therapeutic regimen depends on the pathology that provoked trembling in the hands. The goal of treatment for hand tremors in adults is to reduce or stop the symptoms and, if possible, eliminate their cause. Any therapy begins with a diagnosis.

Diagnostics

Hand tremors are usually treated by a neurologist. At the initial examination, he collects an anamnesis and conducts neurological tests: he asks the patient to touch the tip of his nose with his index finger or stretch his hands in front of him and hold them for several minutes.

A preliminary diagnosis can be made based on the results of the examination and questioning of the patient. For example, with tremor at rest, Parkinson’s disease and Wilson’s disease are primarily suspected.

To clarify the diagnosis, laboratory and instrumental methods are used:

  • MRI or CT of the brain – to determine or exclude tumors, strokes, hematomas, cerebellar atrophy;
  • MRI of the vessels of the brain – to assess the condition and structure of the vessels, to identify inflammation, compression, hemorrhage;
  • electroneuromyography – to assess the frequency and strength of muscle contractions with tremor;
  • Ultrasound of the thyroid gland and a blood test for thyroid and corticosteroid hormones in case of suspected endocrine pathology.

Comprehensive diagnostics for hand tremor allows you to differentiate the disease, that is, to distinguish it from other pathologies with similar symptoms. In addition to the neurologist, other narrow specialists, such as endocrinologists, oncologists and surgeons, can join the diagnostics.

Modern treatments

In most cases, conservative methods are used to treat hand tremors – taking medications and physiotherapy. Surgical intervention is indicated for urgent and severe conditions: traumatic brain injuries and tumors.

Therapy is selected by the doctor, taking into account the clinical picture of the disease. For the treatment of hand tremors, drugs from the following groups can be used:

  • antiparkinsonian drugs – levodopa, dopa-decarboxylase inhibitors, catechol-O-methyltransferase inhibitors3;
  • non-selective beta-blockers – propranolol, sotalol;
  • antiepileptic drugs – topiramate, clonazepam, carbamazepine.

In diseases of the thyroid gland, surgery, treatment with drugs and radioactive iodine are indicated.4. Specific therapy is required for stroke and other focal lesions of the central nervous system.

An MRI-guided bloodless neurosurgery can be used to treat essential tremor. During the operation, the surgeon, using ultrasound, “turns off” the neurons that provoke trembling of the limbs.

An important role in the treatment of hand tremor is played by kinesiotherapy, physiotherapy exercises, relaxing massage. Rehabilitation measures that help change motor skills and improve the quality of life of the patient give good results.

Prevention of hand tremor in adults

There are non-specific, but quite effective measures to prevent hand tremors in adults. Quitting smoking and alcohol, a stable daily routine, regular exercise, and reducing the amount of coffee and tea in the diet will help reduce the risk of developing tremor.

Popular questions and answers

Trembling in the hands can occur at any age and in people who consider themselves healthy. At the same time, even relatively harmless essential tremor brings a lot of anxiety and worsens the quality of life. Our experts told what causes trembling in the hands of young and old people, and in which cases it is necessary to consult a doctor.

What can cause hand tremors at a young age?

In young people, physiological and essential tremors are most common. With a strong sudden trembling in the hands, thyroid pathologies and Wilson’s disease should be excluded.

Why does hand tremor occur in older people?

The most common cause of hand tremor in the elderly is neurological diseases: Parkinson’s disease, Alzheimer’s disease, dyscirculatory encephalopathy.

When to See a Doctor for Hand Tremors?

A doctor is consulted if the tremor appeared suddenly for no apparent reason, if the hands tremble regularly, or if the tremor intensifies over time. Primary diagnosis is performed by a therapist or neurologist.

Is it possible to cure hand tremor with folk remedies?

With physiological tremor, folk remedies that have a calming and relaxing effect can help. In all other cases, it is better to use traditional medicine methods.

Sources of

  1. Tremor: differential diagnosis and choice of therapy. Department of Neurology, Center for Clinical Neurosciences, Faculty of Medicine, Charles University (Prague, Czech Republic). https://clck.ru/af55p
  2. Essential tremor. International Medical Journal, No. 3, 2014.  
  3. Parkinson’s disease, secondary parkinsonism. Clinical guidelines. All-Russian Society of Neurologists, National Society for the Study of Parkinson’s Disease, Association of Neurosurgeons of Russia. https://clck.ru/af6uA
  4. Clinical guidelines for the diagnosis and treatment of patients with diffuse toxic and nodular goiter. Russian Association of Endocrinologists, 2021.
  5. Encephalopathy. Textbook for doctors. Irkutsk ISMU 2017.

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