Hand Tremor: Harmless, or a Neurology Case?

Key takeaways

Everyone's hands shake a little. According to NHS, hold both hands out in front of you and they never stay completely still — and the shake is more obvious when you are stressed, tired or anxious, and after coffee or alcohol.
One question decides which way this goes, and you can answer it yourself: do the hands shake while they are WORKING (held out, pouring water, writing), or while they are AT REST on your lap?
According to NINDS, a tremor in both hands on movement with no other neurological sign is the picture of essential tremor; a tremor that is most obvious while the hand is resting, usually on one side at first, is the pattern seen in Parkinson's disease.
A tremor with slowed movement, stiffness, short steps and a shuffling walk: this group needs a neurologist. Do not settle it yourself — according to NINDS, some people with Parkinson's never have a tremor at all.
The group most often missed, and the one that is REVERSIBLE: tremor from medicines, from alcohol withdrawal, from an overactive thyroid, from low blood sugar. Find the cause and it can be put right.
If you suspect the medicine you are taking is causing the tremor, still do NOT stop it yourself. NHS is explicit: speak to your doctor BEFORE stopping any prescribed medicine. Ask a doctor or pharmacist to review the whole list.
A tremor that appears SUDDENLY with weakness on one side, a drooping face or difficulty speaking: according to CDC those are signs of a stroke — call 115 now, do not wait to see whether it eases.

Everyone's hands shake a little: according to NHS, hold both hands out in front of you and they never stay completely still. A tremor becomes a problem when it worsens or starts getting in the way of ordinary life. The job here is not to look up whether you have Parkinson's — it is to work out which group you are in.

Recognising it: when do the hands shake

One question decides which way this goes, and you can answer it yourself: do the hands shake while they are WORKING, or while they are AT REST? According to NINDS, tremor is classified along exactly that line. Try it where you are: hold both arms straight out in front of you; pour a glass of water; then rest your hands on your lap and let them go loose.

A TREMOR ON HOLDING A POSTURE OR ON MOVEMENT — obvious when you hold your hands out, pour water, write, carry a bowl. According to NINDS, essential tremor is a tremor in BOTH hands on movement, with no other neurological sign.
A TREMOR WHILE THE HAND IS AT REST — it still shakes lying on the lap. According to NINDS, that is the pattern seen in Parkinson's disease: as though rolling a pill between two fingers, usually on one side only at first.
A TREMOR WITH SLOWED MOVEMENT — washing and dressing take longer than they used to; the body is stiff; the face shows less expression; steps are short and shuffling. According to NINDS those are other signs of Parkinson's — this needs a neurologist to examine.

The group most often missed

According to NINDS, this group is usually NOT caused by a disease of the nervous system, and it recovers once the right cause is dealt with.

MEDICINES. According to MedlinePlus: asthma medicines (theophylline, salbutamol), antidepressants, lithium, heart medicines, blood pressure medicines, thyroid medicine taken in excess; NINDS adds corticosteroids and chemotherapy drugs.
COFFEE, ALCOHOL, TOBACCO, TOO LITTLE SLEEP, ANXIETY — according to NHS, the shake is more obvious as you get older, when you are stressed, tired, anxious or angry, and after coffee, tea, alcohol or tobacco.
AN OVERACTIVE THYROID. According to NIDDK: shaking hands with weight loss despite a better appetite, a fast heartbeat, heavy sweating or being unable to tolerate heat, and a swelling at the neck.
ALCOHOL WITHDRAWAL. According to MedlinePlus, someone who has been drinking heavily and then stops abruptly gets shaking hands with sweating, sleeplessness and a fast heartbeat — and it can become life-threatening quickly.
LOW BLOOD SUGAR. According to CDC: shaking with a fast heartbeat, sweating, irritability or confusion, dizziness and hunger — anyone being treated for diabetes should think of this one first.

What to do straight away

WRITE DOWN WHEN IT SHAKES — the most useful thing you can do at home: when it shakes, what the hands were doing at the time (held out, carrying, writing, or resting), one side or both, since when, getting worse or staying the same. According to NINDS, those are precisely the points a doctor works from.
GATHER THE MEDICINES AND BRING THE BOXES TOO, supplements included. According to NHS, the doctor will ask what medicines you take, what other symptoms you have, and about your family history.
CUT OUT OR CUT DOWN COFFEE, STRONG TEA AND FIZZY DRINKS, and get enough sleep — according to NINDS, some tremors are worse when you are tired.

What NOT to do

Do NOT stop, reduce or change a prescribed medicine yourself, even when you suspect that very medicine is causing the tremor. NHS is explicit: speak to your doctor BEFORE stopping any prescribed medicine. Say the suspicion out loud instead, so a doctor or pharmacist can review the list.
Do NOT drink alcohol to settle a tremor: according to NHS alcohol makes a tremor more obvious, and someone who has been drinking heavily and stops abruptly develops a withdrawal syndrome.
Do NOT decide for yourself that it is Parkinson's and then worry, or then feel reassured. According to NINDS, some people with Parkinson's never have a tremor at all.
Do NOT take someone else's tremor medicine, or old medicine from the cupboard — a medicine that eases a tremor does not treat what is causing it.

When you must go to hospital

CALL 115 (the emergency number in Vietnam) NOW if the tremor appears SUDDENLY with any of the stroke signs CDC names: numbness or weakness in the face, an arm or a leg on one side · drooping on one side of the face · slurred speech, or not understanding what others are saying · confusion · sudden blurred vision · walking unsteadily, loss of balance · a severe headache with no clear cause. ONE sign is enough; signs that have already cleared completely still mean going to emergency care now. Also call 115 if: someone who has just stopped drinking alcohol has a fit, a fever, severe confusion, sees or hears things that are not there, or has a wildly irregular heartbeat; or someone being treated for diabetes is shaking with sweating and fierce hunger and then becomes confused and cannot eat or drink unaided. — BE SEEN THE SAME DAY if someone who has just stopped drinking alcohol has shaking, sweating, restlessness and sleeplessness — MedlinePlus advises contacting a doctor at once or going to an emergency department; or if the tremor comes with a fever. — BE SEEN SOON, not as an emergency, if: the tremor is worsening or starting to get in the way of ordinary life; it is most obvious while the hand is resting; it is on one side only; it comes with stiffness, slowed movement and short steps; it started after a medicine was added or changed; it comes with weight loss, a fast heartbeat and intolerance of heat.

A Y Te Xanh doctor comes to the house, takes the history and examines at the bedside: whether the tremor is at rest or on movement, one side or both, testing muscle strength, reflexes and balance, and then says clearly whether this case can be followed up or needs a neurologist.

If a medicine is the suspect, our medication review service goes through everything you are taking, points out duplicated active ingredients and interactions, and sets it out so you can take it back to the doctor who wrote the prescription — we do not change or stop medicines on your behalf. If you are unsure whether to go to hospital, call the remote consultation first (a video call). With a sign from the box above, go in first and call afterwards.

This article passes on the recommendations of NINDS and NIDDK at the United States National Institutes of Health, MedlinePlus at the United States National Library of Medicine, NHS in the United Kingdom and CDC in the United States, in our own words, and does not replace being examined. CDC has no public page on hand tremor, so the CDC material above covers only the stroke signs and low blood sugar. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

NHS — Tremor or shaking hands
MedlinePlus — Tremor

Frequently asked questions

Does a hand tremor mean Parkinson's disease?

A tremor does not automatically mean Parkinson's. According to NINDS, essential tremor is one of the most common movement disorders, and its hallmark is a tremor in both hands on movement with no other neurological sign. The Parkinson's pattern is different: most obvious while the hand is resting, usually on one side only at first, and often accompanied by slowed movement, stiffness, short steps and a shuffling walk. NINDS also notes that some people with Parkinson's never have a tremor at all. The shape of a tremor is not enough to name a disease — that takes an examination.

I think the medicine I am on is making my hands shake. Should I stop it?

Do not stop it yourself. NHS is explicit: speak to your doctor before stopping any prescribed medicine, and MedlinePlus likewise says not to stop any medicine without asking your doctor. Stopping blood pressure medicine, heart medicine or anticonvulsants on your own can be more dangerous than the tremor itself. What to do instead: write down the names, bring the boxes, note when the shaking started relative to when a medicine was added or changed, and ask a doctor or pharmacist to review the list. According to MedlinePlus, a tremor caused by a medicine often settles once the medicine responsible can be stopped — but that decision belongs to the doctor.

My hands shake when I am stressed or before speaking in public. Is that a disease?

Usually not. According to NHS, a slight tremor is normal in everyone, and it becomes more obvious when you are stressed, tired, anxious or angry, after coffee, tea or fizzy drinks, after alcohol or tobacco, and when you are too hot or too cold. NHS also notes that a slight tremor not caused by another condition usually needs no treatment at all. The point at which to be seen is when the tremor worsens over time, or starts to get in the way of ordinary daily life.

A young adult with shaking hands — what should be considered first?

The reversible group, first. According to NINDS, a fine, rhythmic tremor in both hands is often not caused by a disease of the nervous system but is a reaction to certain medicines, to alcohol withdrawal, or to a condition such as an overactive thyroid or low blood sugar, and it recovers once the cause is dealt with. An overactive thyroid is the one most often missed: according to NIDDK, shaking hands go with weight loss despite a better appetite, a fast heartbeat, restlessness and poor sleep, heavy sweating or being unable to tolerate heat, frequent bowel movements, and a swelling at the neck. Essential tremor can also start in the teenage years.

When does a hand tremor mean calling an ambulance?

When it appears SUDDENLY and comes with neurological signs. According to CDC, the signs of a stroke are numbness or weakness in the face, an arm or a leg on one side; confusion, difficulty speaking or not understanding others; blurred vision; walking unsteadily and loss of balance; and a severe headache with no clear cause — when they appear suddenly, call for an ambulance at once, and one sign is enough. Two more situations also mean calling for an ambulance: someone who has just stopped drinking alcohol who has a fit, a fever, severe confusion, or who sees or hears things that are not there; and someone being treated for diabetes who is shaking with sweating, a fast heartbeat and fierce hunger and then becomes confused and cannot eat or drink unaided.

What can be done at home to ease a tremor?

A few things with evidence behind them that need no prescription. According to NINDS: cut out or cut down coffee; sleep enough and keep moving regularly, because some tremors are worse when you are tired; use plates, cutlery designed for the purpose or weighted utensils to make eating and drinking easier; and choose clothes that are easy to put on and slip-on shoes rather than laces. NINDS also notes that working with people trained in physical, speech and occupational therapy can help in managing a tremor and adapting to daily life. The rest is keeping that written record of when the shaking happens and what the hands were doing, to take with you when you are seen.