Hands shake for a reason: why tremors occur and what to do

Parkinson's disease is a common neurodystrophic pathology, ranking second in frequency after senile Alzheimer's psychosis. The disease occurs in older people, but in some cases juvenile forms are observed (the development of Parkinson's symptoms in adolescents and young adults). Diagnosis is based on the clinical picture; tremor in Parkinson's disease is included in the triad of characteristic symptoms. An accurate diagnosis allows the patient to be given timely treatment, which makes it possible to delay as much as possible the period of complete dependence on others due to immobility.

Types of tremor

Tremor may be;

• normal (physiological);
• abnormal (pathological) caused by disorders or medications.

The usual classification of tremors is based on when the shaking occurs:​

• Resting tremor: occurs primarily at rest.
• Action tremor: occurs during voluntary movements of a specific part of the body. Action tremor includes: Intentional: increases when approaching a goal (for example, when reaching for a glass).
• Kinetic: occurs at the end of movement towards the target.
• Postural: occurs when maintaining a posture (for example, with a limb extended in one position).

In addition, tremor is classified according to the causes that cause it, namely:

• Physiological (usual mild tremor, found in all people).
• Essential (common disorder, other symptoms are rare).
• Cerebellar (results from damage to the part of the brain called the cerebellum)
• Secondary (manifestation of an underlying disorder or caused by the effect of a drug).
• Psychogenic (caused by psychological factors).

Other important characteristics of tremor:

• Jitter frequency: slow to fast.
• Range of movements: from fine to coarse.
• Frequency of occurrence of jitter: periodically or continuously.
• How strong is the shaking?
• How quickly does it develop: suddenly or gradually?

— Physiological tremor.

Everyone, including healthy people, has physiological tremor to one degree or another. For example, most people's arms outstretched in front of them shake slightly. This quick and mild tremor occurs as a result of the constant correction of the hand's position by the nerves that send signals to the muscles. For most people, this type of tremor is almost unnoticeable. However, normal tremors can become more noticeable and cause concern under certain conditions. Trembling becomes more noticeable, for example, if a person:

• experiencing stress or anxiety;
• abstains from alcohol, sedatives (such as benzodiazepines), or opioids;
• consumes caffeine;
• takes certain medications, including theophylline and albuterol (used to treat asthma and chronic obstructive pulmonary disease, or COPD), corticosteroids, and recreational drugs (such as cocaine or amphetamines);
• has certain medical conditions, such as an overactive thyroid gland (hyperthyroidism), that cause other symptoms/

- Essential tremor.

Essential tremor occurs as a result of a problem with the nervous system, but people with essential tremor rarely have other symptoms associated with the problem (neurological symptoms). The cause of this tremor is unclear, but the condition often runs in families.

Essential tremor can begin at any age, but it usually occurs in young adulthood. Tremors slowly get worse and become more noticeable with age. This is associated with another, incorrect name, “senile (senile) tremor.” Trembling of the arms and legs, and in some cases of the head, is usually observed. If the tremor spreads to the head, it makes involuntary oscillatory movements “yes-yes”, “no-no”. The tremor usually intensifies when the patient holds the limb in weight or makes movements with it.

The essential form of the disorder usually remains mild. Despite this, it can be annoying and awkward. It can make writing and cooking and eating difficult. For some people, the gradual increase in shaking can be disabling. Symptoms may resemble those of Parkinson's disease. Sometimes doctors actually confuse essential tremor with Parkinson's disease. In rare cases, people with Parkinson's disease also have essential tremor.

General clinical picture

Symptoms associated with hand tremors:

• for an essential type of disorder it is typical that in the later stages of the disease mild cerebellar dysfunctions appear: ataxia, disturbances in coordination of movement, balance when walking;
• the parkinsonian type is accompanied by hypokinesia (limited mobility), postural instability (impaired balance), rigidity (a sharp increase in the tone of anatomical structures);
• the dystonic type is accompanied by a pathological posture in the affected part of the body;
• Holmes tremor is characterized by additional symptoms: rigidity, poor coordination, imbalance, other brainstem symptoms (dizziness, difficulty swallowing, floating movements of the eyeballs);
• cerebellar tremor accompanies coordination impairment, dysmetria (a person cannot hit the target), adiadochokinesis (difficulty performing alternating movements at a fast pace).

Causes and risk factors

Tremor develops in many diseases.

Most often the condition occurs as a result of the following:

• physiological tremor (the most common, everyone has it);
• disorders of the nervous system;
• Parkinson's disease;
• multiple sclerosis as a result of damage to the areas of the brain responsible for controlling movement.
• liver disease;
• due to alcohol withdrawal;
• overactive thyroid gland (hyperthyroidism)
• due to hereditary disorders affecting the cerebellum; these may be, for example, Friedreich's ataxia and spinocerebellar ataxias
• use of certain medications or exposure to certain toxic substances
• psychogenic tremor (caused by psychological factors)

Sometimes there is more than one cause of tremors.

Tremor in other brain diseases

Trembling of the limbs, head, tongue, and eyelids of the lower jaw can occur not only with Parkinson's disease, but also with other diseases of the nervous system. Overdiagnosis of Parkinson's is associated with the identification of tremors as the main characteristic of this pathology. Trembling as part of the clinical picture can occur in the following pathological conditions:

• essential tremor;
• Parkinsonism syndrome against the background of the development of encephalopathy (traumatic, toxic, atherosclerotic) or Economo's encephalitis;
• pathological processes in the cerebellum (tumors or circulatory disorders in the form of a stroke);
• functional disorders of the nervous system such as neurotic conditions;
• alcohol dependence with damage to the nervous system.

Important! The greatest difficulties for diagnosis are essential tremor and Parkinson's disease, since these conditions are often not distinguished during a clinical examination of the patient.

Progressive forms of Parkinson's disease in most cases are characterized by a decrease in tremor, despite the fact that degeneration covers large areas of the subcortical structures of the brain.

Features of diagnosing parkinsonian syndrome

With parkinsonian syndrome, it is always possible to establish a connection between trembling and hypokinesia and the cause of the pathology. During the collection of anamnesis, it turns out that the patient suffered a stroke, brain injury, and encephalitis. Atherosclerosis of the brain is accompanied by changes in basic mental functions (thinking, memory, attention, emotions).

Diagnosis of tumors and strokes

Muscle vibration with cerebellar lesions is accompanied by the development of other focal neurological symptoms. The diagnosis is confirmed using neuroimaging methods (computed tomography, magnetic resonance imaging).

Diagnosis of chronic alcoholism

Alcohol addiction is accompanied by trembling of the limbs, which intensifies against the background of withdrawal symptoms. After drinking small doses of alcohol, trembling decreases.

Functional disorders of the nervous system.

Neurotic conditions and hyperfunction of the thyroid gland can cause severe trembling of the limbs. The pathological condition is accompanied by a uniform increase in tendon reflexes, emotional excitability and irritability.

Signs and symptoms

The information below will help you decide when to see a doctor and what will happen during the examination.

The following symptoms are cause for concern:

• Tremor that started suddenly
• Tremor in people under 50 years of age who have no relatives with essential tremor
• Tremor is accompanied by other neurological symptoms, such as changes in mental status, muscle weakness, changes in gait, and difficulty speaking.
• Excitement and rapid heartbeat.

— When to see a doctor?

If alarming signs appear, you should immediately consult a doctor.

If there are no warning signs, you should consult a doctor as soon as possible.

Diagnostics

Doctors first ask about symptoms and take a medical history, and then perform a physical examination. Doctors' findings from a history and physical examination often indicate the cause of the disorder and tests that may be needed.

Doctors ask the following questions about tremors:

• Did it start suddenly or gradually?
• What parts of the body are affected?
• What triggers the tremor (such as movement, rest, or standing)?
• What makes shaking worse or worse (alcohol, caffeine, stress or anxiety)?

Do you know that…

Drinking small amounts of alcohol helps some types of tremors, but chronic alcoholism can cause brain damage, leading to tremors.

If the condition begins suddenly, the doctor will try to find out what may have triggered it (for example, a recent injury or a new drug).

To identify disorders associated with tremor, the doctor examines the patient's medical history. The doctor asks if close relatives have ever had tremor. The doctor checks what medications the patient is taking and finds out whether the patient drinks coffee, alcohol, or takes other drugs (including whether he has stopped taking them).

During the physical examination, the doctor conducts a neurological examination (including paying attention to the patient's gait). The doctor notes which part of the body is trembling, and in which situations the frequency of tremor is higher:

• A part of the body is at rest and fully supported by something (for example, hands on knees in a sitting position).

• Maintaining a certain posture (for example, arms extended forward).
• Walking or performing activities with a shaking part of the body.

To find out whether the patient's voice has changed, the doctor may ask the patient to make a long sound.

Typically, a doctor can determine the type of disorder based on its characteristics, medical history, and physical examination findings. For example

• Tremor that develops gradually: usually physiological or essential.
• Postural tremor that begins suddenly: Possible psychological factors, poisoning, illness (such as hyperthyroidism), stopping drinking or stopping a drug (this could be a sedative) or being treated with a drug known to cause tremors.

— Carrying out analyses.

Brain imaging using magnetic resonance imaging (MRI) or computed tomography (CT) is performed in the following cases:

• The patient has other neurological symptoms that indicate a brain disease, such as stroke, tumor and multiple sclerosis.
• The trembling began suddenly or progressed rapidly.

Blood tests may be done to identify possible causes when the cause is unclear. Examinations may include:

• Determination of blood sugar levels.
• Tests to evaluate how the thyroid and parathyroid glands, liver and kidneys are working.

In rare cases, electromyography (recording the electrical activity of muscles when they are stimulated). However, it may be performed when nerve damage is suspected as the cause.

Diagnosis and therapy

Making an accurate diagnosis of hand tremors is not easy; this requires a comprehensive study, which may consist of tests, samples, blood tests, fundus examination, blood pressure measurements, thermography, filming, and MRI.

Physiological tremor can occur in any person and be almost unnoticeable to others. Mild and physiological forms usually do not require treatment.

To overcome an unpleasant state, it is enough to know how to relieve stress and drink soothing herbs: lemon balm, chamomile, mint, motherwort, etc.

Treatment of pathological forms of hand tremor is aimed at reducing the intensity of trembling. In the first stages, medications are not prescribed in most cases.

Beta blockers: Propranolol, Obzidan and Anaprilin will help reduce the amplitude of hand tremors in later stages of the disease. If the result is not achieved, then Primidon, Hexamidine, and other anticonvulsants are prescribed.

What to do if the listed drugs do not help and your hands are still shaking - in especially difficult cases, botulinum toxin-A injections are prescribed intramuscularly.

In especially severe cases, when resistant and pharmacological treatment does not help, neurosurgical intervention is used.

Exercises for limbs

Exercises to reduce hand tremors:

1. Place your palms together and raise them to eye level - this is the starting position. Take a deep breath. As you exhale, lower one hand half a finger, and squeeze the lowered one with the other hand. While inhaling, return to the starting position. Repeat the cycle 10 times.
2. For hysterical or psychogenic tremors, rubbing the palms until the hands become warm helps.
3. Strengthen the hands and restore lost control over the muscles of the hands by modeling clay or plasticine, playing musical instruments, and needlework (knitting).
4. Card tricks develop coordination of movement and concentration.

ethnoscience

Folk remedies for treating hand tremors

If tremors occur due to nervousness, the following are recommended:

• in the evening, 150 grams of unpeeled oats are boiled in 2 liters of water, the broth is infused at night, in the morning the mixture is filtered and drunk in small portions throughout the day; course – 5 days, in case of relapse the course is repeated.
• soothing teas from heather, valerian, motherwort, mint, lemon balm: 1 tablespoon per 200 ml of water; The decoction is infused and drunk in small portions throughout the day.
• A warm bath with 2 liters of broth and a few drops of essential oil will calm the nervous system and help you relax.
• meditation and relaxation.

It is often difficult to determine a clinical diagnosis for hand tremors, this is explained by:
a variety of somatic and neurological diseases, a symptom of which is trembling;

patterned manifestation of tremor for various causes and mechanisms of occurrence.

You should:

• avoid stressful situations, overwork;
• stop using caffeine, tobacco, alcohol;
• exercise;
• spend active recreation in nature.

Standard Treatments

Your doctor will treat the underlying cause if possible, such as stopping the medication that is causing the shaking or treating hyperthyroidism. Parkinson's disease is treated with levodopa or other medications.

For mild tremor, no treatment is required. If the shaking is severe and bothersome, you can take some simple measures:

• to avoid dropping the object, hold it firmly and close to your body;
• avoid uncomfortable poses;
• Avoid other circumstances that cause tremors (such as caffeine, lack of sleep, or fatigue);
• Use assistive devices that are recommended to you by a specialist in the restoration and maintenance of impaired skills.

Accessory devices may include swing knives, kitchen utensils with large handles; if the tremor is severe, you may be advised to use hooks for fastening buttons, Velcro instead of buttons and laces, zippers, straws, and shoehorns.

The main thing that older people need to know:

Many older people don't see a doctor because they think tremors are part of the normal aging process. This is the wrong approach. You need to see a doctor: the doctor will conduct a physical examination, talk with the patient and find out the possible causes of the tremor. Your doctor can then provide helpful tips on how to live with tremors and may prescribe medications to help relieve them.

In addition, older people take many medications and are more susceptible to their side effects. Some medications may cause tremors in the limbs. When prescribing this medicine to an elderly person, the doctor tries to choose the lowest effective dose. This dose may be lower than those used to treat younger patients. In older people, doctors avoid the use of drugs that have anticholinergic effects whenever possible.

Tremor can significantly reduce the quality of life of older people and their ability to perform various activities. This is especially significant if the tremor is accompanied by physical or mental disorders. Exercise and occupational therapists can offer older patients simple ways to manage tremors and assistive devices that improve quality of life.