A slight hand tremor or shake shouldn’t be cause for alarm if it’s transient and can be blamed on anxiety, excess coffee or over-indulgence in alcohol.
Worry begins when a tremor persists without an obvious cause.
The likelihood of hand tremor increases with advancing age: By age 80, about 20 percent of older adults notice at least some trouble.
The most common type of tremor is termed “essential.”
Physicians call a symptom or ailment essential when the cause isn’t understood and the problem exists by itself without other associated troubles.
Essential tremor has also been called benign tremor, familial tremor and senile tremor.
Essential is the preferred term since the shakiness is not benign (or harmless) to the person who shakes, doesn’t always run in the family and can begin at younger ages.
Essential tremor is characterized by a rapid shake (six to eight movements per second) that’s exaggerated by certain positions of the arms.
It may decrease with the initiation of voluntary movement, only to worsen as the hand reaches its destination.
And it often subsides, or even disappears, with total rest of the arm and hand.
Although uncommon, essential tremor can also involve the head and tongue.
The tremor most often begins in the sixth or seventh decade, but can present much earlier.
It may slowly progress in severity, but more often it remains unchanged for many years.
The shaking is usually mild and a nuisance, but it can be severe and incapacitating. It’s made worse by fatigue, stress and caffeine.
Ingestion of alcohol dramatically reduces the movements.
Use of alcoholic beverages to relieve the shake, however, is strongly discouraged: Tremors may diminish after a drink or two, but is often worse the following day.
A person with essential tremor carries not only the burden of spilled coffee, but also the fear of social rejection.
The worry of being noticed in public and considered senile can lead to isolation, and even to depression.
Self-confidence is essential for those with an essential tremor, and it begins with understanding that the shake is not associated with other health problems and has nothing to do with loss of mental faculties.
Essential tremor is generally resistant to medical interventions, but beta-blocking drugs such as propranolol and metoprolol may provide some relief.
Unlike essential tremor, the shake of Parkinson’s disease is associated with other problems.
The tremor is just one part of a much larger symptom set, and the troubles tend to be progressive.
Parkinson’s disease almost always includes generalized rigidity of body muscles, slowing of gait, imbalance and a reduction of spontaneous gestures and facial expressions.
The tremor is very noticeable in most, but is absent is some.
It’s coarse and slow (about 4 movements per second) compared to the finer and quicker shake of essential tremor, and is more pronounced when the arms and hands are at rest.
The tremor of Parkinson’s disease almost always begins in just one hand, but eventually involves both.
Drugs can cause tremors
Prescription and non-prescription drugs can cause or exacerbate a hand tremor.
A careful review of all medications is essential for anyone who is experiencing a new hand tremor.
If you’re told that you have essential tremor, be reassured that it will not affect your general health.
Openly discussing the matter with family and friends is a good way to begin building self-confidence and to avoid psychological consequences from the problem.
Dr. Michael Spilane, now retired, spent more than four decades practicing and teaching geriatric medicine in St. Paul. Send comments or questions to firstname.lastname@example.org.