Hand tremors - symptoms of what disease?

Posted by Master, Doctor Nguyen Thi Minh Phuong - Department of General Internal Medicine - Vinmec Times City International Hospital

Hand tremors can be just a normal physiological manifestation but can also be a symptom of a number of conditions, such as damage to the brain, liver disease, or thyroid gland.

Tremor is a common movement disorder that occurs due to automatic, rhythmic contraction of muscles. Tremor is most common in the hands, but other parts of the body can also shake, such as the arms, head, vocal cords, trunk, or legs.
Most people can experience mild hand tremors, especially when they raise their arms straight ahead and hold them for a few minutes. This is not a fatal symptom, but tremors can interfere with your daily activities.
Hand tremors can be intermittent, or frequent/continuous. There are several types of hand tremors, but they are mainly divided into two main groups: tremors during movement and tremors at rest. Movement tremor occurs when muscles contract to perform a movement of attention such as when holding a spoon, fork, pen, cup of water.... Resting tremor occurs when the muscles are in a relaxed state ( none) for example when the hand rests on the thigh.

Tremors can be just a normal physiological manifestation but can also be a symptom of a number of conditions, such as damage to the brain, liver disease, or thyroid gland.

Hand tremors can be seen in the following conditions:
2.1 Neurological group Parkinson's disease: A degenerative brain disease with a gradual decrease in the secretion of Dopamine substances. Tremor usually starts from one side, accompanied by a feeling of stiffness in the limbs on the same side, walking slowly, gradually spreading to both hands. Treatment is with dopamine supplements, physical therapy, or surgery to place electrodes in the brain.
Multiple sclerosis: A disease where the loss of myelin - the nerve sheath - leads to damage to motor pathways in the brain. Tremor can be unilateral or bilateral, can be tremor when making intentional movements or tremor when raising and holding hands to resist gravity, the treatment of this disease is mainly medication.
Stroke: Occurs when a blood vessel in the brain is blocked by a blood clot or atherosclerotic disease, causing a cerebral infarction, or when a blood vessel bursts, causing bleeding in the brain. When this happens, some of the nerve cells that control hand movement are damaged and can cause hand tremors. Treatment depends on the type of lesion, the duration of the stroke, and consideration of other comorbidities.
Traumatic brain injury: Like a stroke, after an injury, the nerve cells that control movement are damaged, which can cause hand tremors. Medical treatment is the mainstay.

Muscular dystonia: In this case, nerve cells transmit false information leading to overactive muscles, causing unwanted postures, prolonged abnormal postures, including hand shaking. Treatment can be with medication or Botox injections.
Idiopathic tremor: Hand tremors are often bilateral, occurs when holding cups, bowls, pens... Runs can be very subtle at first, increasing over time making it difficult for you to carry out activities daily activities. Currently the cause of essential tremor is unknown, in some cases it is related to genes and there are familial factors. If symptoms are mild and subtle, no treatment is needed. When symptoms get worse, your doctor will prescribe certain medications such as beta blockers, or surgically place electrodes in the brain.

2.2 Group of metabolic diseases Wilson's disease: A genetic disorder that causes excessive copper deposition in the body. Usually, patients have symptoms related to brain and liver damage such as nausea, vomiting, fatigue, fluid accumulation in the abdomen, jaundice, hand tremors, language problems, personality changes .. .Treatment with oral medications and dietary changes. Kidney failure, liver failure Hyperthyroidism: When your thyroid is overactive, you may experience anxiety, palpitations, rapid heartbeat, sweating, weight loss, and hand tremors. Treatment to stabilize thyroid function will significantly reduce the symptoms of hand tremor. Low blood sugar: When blood sugar is low, you will feel hungry, sweaty and shaking hands.

2.3 Group of hereditary degenerative diseases Some genetic diseases such as hereditary ataxia can cause hand tremors:
Toxic related tremor: Alcohol poisoning, alcohol withdrawal, mercury poisoning Medicines: Medicines for asthma, Amphetamines, caffeine, corticosteroids, drugs for the treatment of neuropsychiatric disorders ... Vitamin B12 deficiency Tremor due to mental diseases: Depression, post-traumatic stress disorder, Birth tremor Reason: Sometimes tremors can occur when you are angry, stressed, anxious, or have trouble sleeping.

If the symptoms of hand tremor are subtle, infrequent, and do not affect daily activities, you should start with lifestyle changes such as limiting coffee consumption, eating in moderation to avoid hunger, exercising regularly. regularly and make sure to get enough sleep. Avoid stressful stimuli, excessive anger or anxiety. Review the medications you are taking (if any) and consult with your treating doctor.
If the above measures have worked well, but the tremor is still progressive or more frequent, you should see a neurologist to find the cause and get the right treatment.
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