What Causes Hand Tremors? How Can They Be Treated?

Hand tremor is the involuntary and rhythmic shaking of the hands. Hand tremors are classified into different types based on their severity, speed, and the situations in which they occur, and treatment is administered accordingly. We have compiled detailed information for you on the causes of hand tremors, when to be concerned, and treatment options.

What Causes Hand Tremors?

Hand tremor is a problem that can occur in anyone due to physiological reasons. Although it can be seen at any age, it occurs more frequently, especially in middle and advanced age. Tremor is not a symptom unique to Parkinson's disease and can result from the following causes:

Stress
Fatigue
Heavy lifting
Insomnia
Caffeine consumption
Thyroid problems
Fine motor movements
Certain medications

Tremors caused by diseases are evaluated according to their frequency (speed) and amplitude. Large, slow tremors are common in Parkinson's disease, while small, fast tremors are more common in essential tremor and are mostly seen in young people. In addition, hyperthyroidism, stress, and fine motor movements can also increase tremor.

Is Every Hand Tremor Parkinson's Disease?

No, of course, not every hand tremor indicates Parkinson's disease. In Parkinson's disease, the hand may not tremble at all. The belief that everyone with a hand tremor will develop Parkinson's, or that those without a tremor will not have Parkinson's, is incorrect.

What is Parkinsonian Tremor?

Resting tremor (tremor at rest) seen in Parkinson's disease is one of the four cardinal signs of the disease. This tremor occurs not when the person is trying to do something, but rather when they are motionless. For example, during an examination, when the patient is asked, "Place your hands on your lap, side by side," the hand or fingers may begin to tremble while at rest. Similarly, when walking with arms swinging freely, a tremor may be seen in the swinging arm.
In contrast, the type of tremor we call postural tremor occurs when the hand or arm is held in a certain position against gravity. During fine motor movements – such as holding a cup, drinking tea, or writing with a pen – small, fast tremors become pronounced. In fact, the tremor may increase as the person tries to stop the movement to control the tremor. Whereas, if they continue bringing the cup to their mouth, the tremor may decrease somewhat.
Parkinson's disease is typically characterized by a resting tremor; this tremor disappears when the person starts to move. However, because Parkinson's patients have slowed movements (bradykinesia), they have difficulty carrying tea or performing tasks quickly in daily life. Sometimes, medication use can also mimic this condition. Antipsychotic drugs, in particular, can cause resting tremors as a side effect, similar to those in Parkinson's disease. In this case, a condition called "drug-induced parkinsonism" emerges. Drug-induced tremors can be "mixed" type tremors, seen both at rest and during posture.

What is the Difference Between Essential Tremor and Parkinson's Disease?

In Parkinson's, there is a tremor at rest that decreases with movement. In essential tremor, there is no tremor at rest; it occurs during fine motor tasks. In drug-induced tremor, it can be seen both at rest and during movement.

Is Hand Tremor Genetic?

The question "Can hand tremor be genetic?" is one that is frequently asked. Genetic transmission is common in essential tremor. It can skip generations; it may occur in a grandparent or an uncle. However, it can also be seen in individuals with no family history.

What is the Treatment for Hand Tremor?

Hand tremor is a condition that can be completely eliminated or controlled depending on its cause. Treatment for hand tremor is determined according to the underlying cause. If the tremor occurs as a side effect of a medication, discontinuing the drug or switching to another usually solves the problem. Similarly, if the cause of the tremor is a thyroid disease, especially hyperthyroidism, treating the thyroid will largely improve the tremor. However, some types of tremor, particularly those due to genetic or degenerative causes (where cells gradually lose function), cannot be completely eliminated. In these cases, "symptomatic treatment" is applied. That is, the goal is not to completely eliminate the tremor, but to reduce it to a level that facilitates daily life.
This approach can be compared to the treatment of hypertension or diabetes: when medication is taken, blood pressure or blood sugar drops to normal levels, but the problem returns when the medication is stopped. The same applies to hand tremors; the tremor is significantly reduced when medication is taken, but it reappears when the medication is discontinued.
Therefore, for these types of tremors, an expectation such as "I took medication for a while, it's finished, my hand will never tremble again" is not correct. The effect of the treatment depends on regular use of the medication and requires continuity.

Is it possible for a patient not to notice their tremor?

Some head tremors, especially mild or involuntary ones, may go unnoticed by patients. In fact, the tremor may be observed by others while the individual themselves does not feel their head shaking. This is because the brain automatically corrects the continuous shaking motion of the head and keeps vision stable. Thus, the person does not notice their head tremor, and their eyesight remains unaffected.

Can tremors occur in other parts of the body besides the hand?

Yes. The head, chin, and voice can also tremble. Some head tremors are seen in essential tremor or muscle contraction disorders such as dystonia. People with head tremors may not notice them; the brain automatically stabilizes the image, so they do not feel the shaking.

Is hand tremor also seen in people with thyroid disorders?

Tremor does not occur due to hypothyroidism, which is defined as an underactive thyroid. However, in the case of hyperthyroidism, which results from an overactive thyroid, hand tremor is one of the initial symptoms. These individuals may also experience complaints such as weight loss, hand tremors, insomnia, and fatigue. Additionally, the tremor may be felt more depending on the person's occupation. For example, individuals performing finer tasks may feel hand tremors more intensely.

This content was prepared by Yeditepe University Hospitals Medical Editorial Board.