What are hand tremors?
Tremors are involuntary muscle contractions that cause shaking movements. Tremor can lead to shaking hands, legs, head, and even a shaky voice. Different diseases, most notably, Parkinson’s disease, can cause hand tremor because they damage the parts of the brain that control movement. Other causes include an overactive thyroid, chronic alcohol use, or anxiety.
You may notice a hand tremor when you have trouble holding objects or you notice a change in handwriting—or when someone else notices the shaking movements.
Tremors can look different depending on the condition that causes it. These differences can often help diagnose the cause of the tremor.
Medication is the most common treatment, but injections, or surgeries may also help control shaking hands. In some cases, people don’t need treatment.
If your hands shake when you hold something, it may be an essential tremor. Some tremors are made worse by doing an activity, like holding a cup or using a fork. To determine the type of tremor, your doctor will ask about any difficulties you have with these tasks and may even have you replicate some of the movements. —Dr. Karen Hoerst
1. Enhanced physiological tremor
- Fine shaking in both hands that comes and goes
An enhanced physiological tremor is not a neurological disease, but caused by other things like muscle movement and blood flow. Most of the time, the tremor is not noticeable. But sometimes it can become more pronounced and visible.
Some common triggers are anxiety, caffeine use, alcohol withdrawal, overactive thyroid (hyperthyroidism), or certain medications, such as stimulants.
Treating enhanced physiological tremor
To diagnose physiological tremor, your doctor will ask you about the pattern of the tremor (when it appears and what it looks like) and your risk factors.
Treatment is usually fixing the underlying issue, such as reducing doses of medications, reducing caffeine use, or treating hyperthyroidism.
2. Essential tremor
- Shaking in hands that is worse with movement or activity
- Head shaking (for example in a no-no pattern)
- Shaking voice
Essential tremor is the most common neurological cause of tremor. People with essential tremor of the hands often notice problems completing tasks, such as writing, pouring a cup of water, or playing an instrument. The symptoms may fluctuate with time and vary in severity, but they are usually mild when you are at rest.
Treating essential tremor
Treatment varies based on how much the tremor bothers you. Some people have a very mild tremor that does not affect their day-to-day activities and they may not want to treat it. If the tremor is severe or it prevents you from performing daily activities, you may need treatment.
You can start with adaptive technology such as weighted utensils. Other treatments range from oral medications like propranolol to injections, such as Botox, which paralyzes muscles to stop tremors.
When tremor is severe, you may need surgery called deep brain stimulation (DBS).
3. Parkinson’s disease
- Rigid, stiff, or slow movements
- Instability and falls
- Memory problems
- Change in behavior
- Hallucinations (auditory, visual)
Parkinson’s disease is a neurological disorder that causes significant problems with the movement or “motor” system because of a problem with a brain chemical called dopamine. Classic symptoms are tremor and shaking or trembling hands. Tremors worsen over time.
Unlike essential tremor, the tremor happens mostly when you are at rest. People with Parkinson’s disease have stiff, slow movements, balance problems, and are at risk of falls. The tremor can also affect the legs. Other symptoms of Parkinson’s include dementia, mood disorders like depression, psychosis, and hallucinations.
Treating Parkinson's disease
Parkinson’s is treated with a medication called levodopa, which increases the amount of dopamine in the brain. Physical therapy is also helpful to improve movement and balance. Your doctor may have you try adaptive technology, such as weighted utensils or gloves.
You may need medications to treat other symptoms, such as antidepressants for depression or stool softeners for constipation. Surgery, such as deep brain stimulation, can reduce the physical symptoms of Parkinson’s disease in some people.
- Weakness on one side of the body
- Facial weakness or slurred speech
- Sudden, severe headache
Stroke can cause a specific type of tremor called rubral tremor. It may happen during a stroke and can persist after the stroke. Rubral tremor causes irregular, jerk-like movements of the arms or legs. It is often made worse with movement.
Stroke can also cause a different type of tremor called a cerebellar tremor, which tends to occur when our brain needs to coordinate a specific movement, such as reaching for an object. This happens because a part of the brain called the cerebellum, which controls coordination, is damaged.
If you have stroke symptoms and develop a sudden tremor, you should call 9-1-1.
Treatment includes medications to reverse the effects of a stroke (called tissue plasminogen activase or tPA). You may also be given medications such as aspirin or other blood thinners to prevent more strokes.
Treating tremor caused by a stroke includes a combination of medications, such as levodopa, the medication used for Parkinson’s disease, or certain anti-seizure medications. You may need surgery, such as deep brain stimulation.
Some medications can cause hand tremors. Stimulant-type medications like methylphenidate, used to treat ADHD, and thyroid replacement medication called levothyroxine, commonly cause tremors. So can medications for asthma and other breathing problems, like steroids and albuterol inhalers. —Dr. Hoerst
Other possible causes
Other conditions that may cause shaking hands include:
- Multiple sclerosis
- Wilson’s disease
- Metabolic disorders
- Brain tumors
When to call the doctor
- Your tremor is worsening or interfering in your daily activities.
- You notice a tremor after starting or changing the dose of a medication.
- You have other symptoms with your tremor, such as balance problems, stiffness, or speech difficulty.
Should I go to the ER?
Most tremors are not an emergency, but if you have a tremor that starts abruptly (over the course of minutes to an hour) you may be having a stroke and you should call 911.
- Avoid triggers for physiological tremor, such as caffeine.
- Relaxation techniques for anxiety if this makes tremor worse
- Adaptive technology, such as weighted utensils
Try to stop shaky hands by holding them in certain positions. Getting more sleep and reducing how much coffee you drink may also help. If these strategies don’t make a difference, talk with your doctor. —Dr. Hoerst
Best exercise for hand tremors
There is some evidence that doing meditation exercises may reduce tremors. Follow these relaxation exercises from the International Essential Tremor Foundation.
Other treatment options
- Parkinson’s disease medications, including levodopa and propranolol, and seizure medications
- Injections, such as Botox
- Deep brain stimulation surgery
Dr. Hoerst is a board-certified Neurologist. She received her undergraduate degree in Neuroscience from the University of Scranton in 2005 and Jefferson Medical College (now Sidney Kimmel Medical College) in 2009. She completed an internal medicine internship, neurology residency and vascular neurology fellowship at Thomas Jefferson University Hospital in Philadelphia (2014). After completing her training, Dr. Hoerst joined Reading Hospital in West Reading, Pennsylvania where she acted as the Stroke Program Medical Director in addition to providing emergency, inpatient, and outpatient care. In 2019, she transitioned to the role of teleneurologist at SOCTelemed, providing emergency and inpatient care via teleneurology to patients with neurological disease across the country.
She also serves as a physician clinical reviewer for Magellan Health. Dr. Hoerst joined Buoy Health in 2021. She believes that providing accessible, accurate medical knowledge allows people to make informed and empowered decisions about their health.