Hand Tremors: When to Seek Medical Advice

Consulting a doctor about issues such as tremors?

Hello Doctor, about 4-5 years ago, my family noticed that sometimes when I eat with chopsticks or pick up things, my fingers would tremble, especially when I am nervous, which is more pronounced.
After a year or two, they finally took me to the hospital for an examination.
I remember the doctor asked me questions and had me extend my hand.
The most noticeable symptom was when I opened my palm; sometimes my fourth finger would have a slight tremor.
The doctor also seemed to examine my eyes for some reason.
Later, they tested my thyroid, which appeared normal, and also checked for copper levels or something similar, but there were no issues, so they said it wasn't a very rare disease.
The final diagnosis leaned towards psychogenic tremors due to anxiety or essential tremor.
They prescribed me something similar to muscle relaxants, but they didn't insist that I had to take them, just that it would help during times of significant tremors.
Recently, I came across articles discussing Parkinson's disease, but I'm unsure if my symptoms could be related to that, even though the doctor seemed to say that my tremors wouldn't be indicative of it.
However, I didn't have any blood tests done.
After researching online, I feel that my symptoms don't quite match, but I also wonder if this condition could progress slowly and be hard to detect.
Although I notice that my fingers tremble less now, unless I am really nervous, it seems to be the same as before.
I would like to ask the doctor if I need to undergo any further examinations, or if the previous tests were detailed enough.
I tend to overthink and scare myself when I read about these things, so I hope to hear your advice.
Thank you for your patience in reading and responding.

Yu, 20~29 year old female. Ask Date: 2020/08/17

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it may be necessary to consider physiological tremors.
In the early stages of Parkinson's disease, low-frequency tremors occur primarily at rest.
The causes of tremors can be categorized into four types: physiological tremors, psychological tremors, essential tremors, and pathological tremors.
1.
Physiological tremors: These do not occur under normal circumstances and only arise in specific situations such as stress, tension, or anger.
Some medications, such as bronchodilators, as well as the consumption of beverages like coffee, tea, or cola, can also lead to physiological tremors.
2.
Psychological tremors: These may occur intermittently without a fixed pattern.
Treatment focuses on addressing the underlying mental health issues and managing stress.
3.
Essential tremors: The exact cause of these tremors cannot be determined; they may be due to a unique constitution or hereditary factors.
Typically, these tremors are more pronounced when holding objects, and some individuals may experience tremors while writing or performing specific movements.
4.
Pathological tremors: These are caused by dysfunction in the nervous system, such as in Parkinson's disease, lesions in the midbrain, cerebellum, or basal ganglia, or metabolic abnormalities (such as hypoglycemia or hyperthyroidism).
These types of tremors tend to be more persistent.
I recommend consulting a neurologist for further discussion and treatment.
Wishing you good health and peace.
Dr.
Jiang, Neurology Department, Taoyuan Hospital, cares about you.

Reply Date: 2020/08/17

More Info

Understanding hand tremors can be a complex issue, especially when considering the potential underlying causes and the appropriate steps to take for diagnosis and treatment. Based on your description, it appears that you have experienced tremors primarily when you are tense or anxious, which aligns with the diagnosis of essential tremor or psychogenic tremor that your doctor previously suggested.
Tremors can be classified into several types, with essential tremor being one of the most common forms. This condition often manifests as rhythmic shaking, particularly in the hands, and can be exacerbated by stress or anxiety. The fact that your tremors are more pronounced during stressful situations suggests that they may be linked to your emotional state rather than a neurological disorder.
On the other hand, Parkinson's disease is a neurodegenerative disorder that can also present with tremors, but these are typically characterized by a resting tremor, meaning the tremor occurs when the muscles are relaxed. Other symptoms of Parkinson's include bradykinesia (slowness of movement), rigidity, and postural instability. Since your tremors seem to be triggered by tension and are not present at rest, it is less likely that you are experiencing Parkinson's disease. However, it is understandable to be concerned about the possibility, especially given the gradual nature of the disease's progression.

Regarding your previous evaluations, it sounds like you underwent a thorough assessment, including blood tests for thyroid function and possibly other metabolic factors. If your doctor ruled out significant neurological conditions at that time, it is likely that further testing may not be immediately necessary unless your symptoms change or worsen.
However, if you continue to experience anxiety about your symptoms or if the tremors become more frequent or severe, it would be prudent to seek a follow-up consultation with a neurologist. They may recommend additional tests, such as a neurological examination, imaging studies (like an MRI), or even a referral to a movement disorder specialist if warranted.
In the meantime, managing stress and anxiety can be beneficial. Techniques such as mindfulness, cognitive-behavioral therapy (CBT), or relaxation exercises may help reduce the frequency and intensity of your tremors. Additionally, if your doctor prescribed muscle relaxants or other medications, it may be worth discussing their use further, especially if you find they help alleviate your symptoms during stressful situations.

In summary, while your previous evaluations seem comprehensive, staying vigilant about your symptoms is essential. If you notice any changes or if your anxiety about the tremors increases, do not hesitate to seek further medical advice. Understanding your condition and having a supportive healthcare team can significantly impact your quality of life.

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