Shaky Hands

Shaking of the hands is medically called tremors, which are involuntary (not at our will) movements of hands.

Tremor or shaking can be associated with fatigue, stress, anxiety, anger, or rage. However, constant tremor that is not associated with altered emotional states may be a sign of disease or abnormal condition that needs evaluation.

If severe, tremors can interfere with activities, especially fine motor skills (such as writing). Speech may also be occasionally involved.

Conditions Where Shaky Hands Is the Primary Symptom

• Familial tremor (runs in families)
• Essential tremor (no known cause)
• Drug induced tremor (drugs known to induce tremors include valproic acid, lithium and cyclosporine)
• Other disorders, such as Parkinson’s disease, as well as other illnesses may cause tremors along with other symptoms.

Common Causes

1. Drinking too much coffee or other caffeine-containing drink
2. Excessive alcohol consumption, alcoholism, or alcohol withdrawal
3. Stress
4. Normal aging
5. Cocaine use
6. Essential tremor
7. Drugs such as amphetamines, antipsychotics, and lithium toxicity, phenothiazines, or phenytoin, valproic acid, and cyclosporine
8. Insulin overdose in diabetics (hypoglycemia)
9. Wilson’s disease
10. Disease causing parkinsonism
11. Parkinson’s disease  – Characterized by shaking that is constant at rest and improves when the person reaches out for something. Apart from hands, legs or even the head may tremble or shake. Parkinson’s disease is often accompanied by slowness of movement, muscle rigidity, and abnormal gait.

Essential tremor

It is usually hereditary, is common in people older people. Essential tremor is rarely present when the hands are not being used.  When we try to do something, like reaching for an object or writing, hands start shaking. Movements may be rhythmic or not in rhythm. It is not caused by an underlying disease.

Diagnostic Tests that May Be Performed

• Blood tests such as CBC, blood differential, thyroid function tests, urine and glucose test
• Head CT scan
• MRI of the head
• EMG or nerve conduction studies

Treatment

• For hand tremor caused by stress, try to relax. Uncontrollable trembling hands can be managed by simple relaxation techniques like yoga and meditation.
• Avoid all alcoholic beverages. They add up to symptoms like trembling of hands. Shaking becomes worse if such drinks are taken.
• Limit on caffeine intake.
• Consume plenty of water.
• For hand tremor caused by essential tremor, there are numerous medications that may be effective in controlling symptoms. These include beta-blockers, Gabapentin, Mysoline and others.
• Medical conditions like, parkinsonism, can also be treated by medications.
• If the tremors are severe and not responsive to medications, surgery may be an option.