Generality
Hand tremor is a condition that can occur following causes of different origins and nature.
In detail, hand tremor is a symptom triggered by various types of disorders and diseases; although, in some cases and within certain levels (tremor so mild as to be difficult to perceive with the naked eye), it can be considered normal and physiological.
On the contrary, when the tremor in the hands is accentuated and manifests itself clearly (even at rest), it is very likely that it originates from pathological causes. In such a situation, therefore, recourse to consulting a doctor is absolutely necessary.
What is that
What is Hand tremor?
With "tremor in the hands" we want to indicate a particular involuntary movement of the hands characterized by rhythmic oscillations produced by the alternate contraction of mutually innervated antagonist muscles.
As mentioned, the tremor in the hands - when evident and particularly marked - is considered as a symptom that can be attributed to various disorders and diseases.
Although, in itself, the tremor in the hands does not represent a real danger for the patient's life, his presence can make difficult the execution of the simplest and normal daily activities (such as, for example, drinking, eating, etc. .) becoming debilitating.
Physiological tremor
A certain degree of tremor - defined physiological tremor - is present in all healthy individuals. This tremor is an oscillatory movement having a low amplitude and a frequency varying from 7 to 12 Hz. It is an almost imperceptible movement, which can be seen almost exclusively through special electrophysiological methods.
Tremor in non-pathological hands
In some cases, the presence of a slight tremor in the hands - of an intensity greater than the so-called physiological tremor (increase in amplitude but constant frequency) - can be considered a normal phenomenon caused by non-pathological factors. In fact, a certain degree of tremor can occur when taking uncomfortable positions, following a great effort and fatigue or in the presence of stress. In such situations, the tremor is generally eliminated, or in any case attenuated, by taking a more comfortable position and resting. Excessive caffeine consumption can also cause a transient increase in physiological hand tremor; in this case, the reduction in the consumption of this substance and of the foods containing it should be sufficient to restore normal conditions.
Incidence
Hand tremor is a symptom that tends to occur mostly in old age, starting with middle-aged people, up to elderly or very old individuals. In fact, in most cases (but not exclusively), it is closely related to movement disorders and neurological or neurodegenerative diseases that tend to begin in old age.
However, this does not mean that the symptom cannot arise even in young individuals, either as a result of pathological causes, or as a result of taking / exposing drugs or toxic substances.
Causes
What are the possible causes of hand tremor?
The causes at the origin of trembling at the hands can be the most disparate; some of these are typical of old age, while others mostly concern young age.
However, among the pathologies that can give rise to the tremor of the hands, we recall:
- Movement disorders such as:
- Parkinson's disease (typical of old age);
- Parkinsonism, that is pathologies that manifest themselves with symptoms very similar to Parkinson's disease, but with different origins and course from the latter;
- Essential tremor, a particular type of movement disorder whose causes have not yet been clearly identified.
- Multiple sclerosis;
- Psychiatric disorders and disorders. In this case, hand tremor is a somatization of diseases such as anxiety and panic attacks.
- Hyperthyroidism;
- Stroke;
- Brain tumors;
- Demyelinating disorders.
Other factors that can cause tremor in the hands are:
- Trauma;
- Hypoglycemia;
- Abuse and / or abstinence from alcohol;
- Intake, abuse and / or abstinence from drugs or other drugs of abuse (such as, for example, amphetamines, cocaine, etc.);
- Taking some types of drugs (for example, antidepressants, sympathomimetics, lithium and phenothiazines);
- Intoxication from mercury or other heavy metals.
Types of Tremor
Types of Tremor in the Hands
Depending on the moment in which the symptom manifests itself, it is possible to distinguish different types of tremor in the hands:
- Resting hands tremor : occurs when the individual is in a resting condition. It is typical of Parkinson's disease, of which it represents the characteristic symptom.
- Hand tremor in action : occurs when a movement is made with the hands. In turn, it can be distinguished into:
- Kinetic hand tremor, so defined because the symptom appears when a voluntary action is performed.
- Postural hand tremor, defined as such because the symptom tends to appear when a certain posture or position is assumed.
- Intentional hand tremor occurs when an intentional movement is made in order to hit / reach a precise point (or target). The classic example is that of raising the hand to touch the nose with a finger.
- Isometric hand tremor occurs when a hand movement is required that requires a certain degree of strength.
The appearance of a type of trembling in the hands rather than another is closely related to the triggering cause.
Diagnosis
How do you perform the tremor diagnosis with your hands?
To determine the presence of a tremor in the hands it is generally sufficient to observe the patient at rest, or during the execution of voluntary movements. The physician's task is to discriminate between the physiological tremor (difficult to perceive with the naked eye), the physiological tremor in the hands accentuated by non-pathological causes and pathological hand tremor, caused by illness, trauma, addiction or other disorders.
Once the non-physiological hand tremor has been ascertained, the doctor must identify the cause triggering the symptom. To do this, it can make use of the patient's medical history; in this regard, we remind you that - to reach a correct diagnosis - it is useful to know:
- When tremor occurs (at rest, during an intentional movement, when a certain position is assumed, during the performance of a particular activity, etc.);
- What other parts of the body are affected by the tremor in addition to the hands;
- Amplitude and frequency of the tremor.
In addition to the collection of anamnestic data, the doctor can use various types of diagnostic tests and analyzes, such as:
- Complete blood tests (useful for determining the presence of some pathologies - such as, for example, hyperthyroidism - or any addictions or intoxications);
- In-depth physical examination of the patient;
- Electromyography (useful for determining the presence of any problems or disorders in peripheral nerves or skeletal muscles);
- CT and MRI scan (useful for detecting lesions, malignant formations, etc.).
Even performing a specialist neurological examination can be very useful for diagnosis.
Care
Care and Treatment of Tremor in the Hands
Clearly, being a symptom, the resolution of hand tremor is closely related to the care and treatment of the cause that triggered it.
Therefore, the therapeutic protocol varies according to the pathology, the disorder or the condition that gave rise to the symptom; for this reason, the execution of a correct diagnosis is of fundamental importance. Only after identifying the cause responsible for the tremor in the hands, in fact, it is possible to implement the optimal therapeutic strategy for each patient.
However, the available therapies can be both pharmacological and surgical; if necessary, you can also resort to psychological support (such as, for example, in the case of tremor in the hands caused by anxiety, panic attacks or other psychiatric disorders).
However, it is important to remember that the therapy chosen is not always effective in resolving the symptom. For example, in Parkinson's disease - due to the neurodegenerative nature of the disease - the tremor in the hands and other areas of the body does not stop with the currently available drug therapy.
