Hand Tremors: Causes and When to Seek Medical Help

Tremors in the fingers during exertion?

Hello, doctor.
When I exert force with my right index finger, it shakes (all five fingers do).
When I place my hand on my thigh, it does not shake.
When I exert force with my right biceps, I can clearly see the skin on the right side of the biceps trembling.
My thumb also shakes when I use my phone with it suspended in the air.
My arm shakes as well, but the amplitude is smaller.
All these issues are only with my right hand.
I'm wondering if this could be due to long-term smartphone use.
My right thumb also feels weaker than my left thumb.
I would like to know what might be wrong so I can seek medical attention.

kai, 10~19 year old female. Ask Date: 2020/10/10

Dr. Jiang Junyi reply Neurology

Hello, based on your description, 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 but may arise in specific situations such as stress, anxiety, or anger.
Certain 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 and do not have a fixed pattern.
Treatment primarily 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, individuals experience more tremors when holding objects, while others may tremble when writing or performing specific actions.
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, and metabolic abnormalities (e.g., hypoglycemia or hyperthyroidism).
These types of tremors tend to be more persistent.
I recommend consulting a neurologist for discussion and treatment.
Wishing you good health and peace.
Dr.
Jiang, Department of Neurology, Taoyuan Medical Center, cares about you.

Reply Date: 2020/10/10

More Info

Hand tremors can be a concerning symptom, especially when they affect your daily activities and overall quality of life. Based on your description, it seems that you are experiencing tremors primarily in your right hand, particularly when exerting force or when the arm is in certain positions. Here, I will discuss potential causes of hand tremors, when to seek medical help, and the importance of a thorough evaluation.

Possible Causes of Hand Tremors
1. Essential Tremor: This is one of the most common movement disorders and is characterized by involuntary shaking, particularly during voluntary movements. It often affects the hands and can worsen with stress or fatigue.

2. Parkinson’s Disease: While typically associated with resting tremors, Parkinson’s can also cause action tremors as the disease progresses. Other symptoms may include stiffness, bradykinesia (slowness of movement), and postural instability.

3. Muscle Fatigue or Overuse: Given your mention of frequent smartphone use, it is possible that muscle fatigue or overuse could be contributing to the tremors. Prolonged use of the thumb and fingers can lead to muscle strain, which may manifest as tremors.

4. Caffeine or Stimulant Use: Excessive consumption of caffeine or other stimulants can lead to increased muscle excitability and tremors.

5. Anxiety or Stress: Emotional factors can also play a significant role in the manifestation of tremors. Anxiety can lead to muscle tension and shaking, particularly in the hands.

6. Neurological Conditions: Other neurological disorders, such as multiple sclerosis or peripheral neuropathy, can also lead to tremors.
7. Thyroid Issues: Hyperthyroidism can cause tremors as well, due to increased metabolism and muscle excitability.

When to Seek Medical Help
It is advisable to seek medical attention if:
- The tremors are persistent and worsening over time.

- You experience additional symptoms such as weakness, stiffness, or changes in coordination.

- The tremors interfere significantly with your daily activities or quality of life.

- You notice any changes in sensation, such as numbness or tingling in your fingers or hand.

Importance of a Thorough Evaluation
A comprehensive evaluation by a healthcare professional is essential to determine the underlying cause of your tremors. This may include:
- Neurological Examination: A thorough assessment of your motor skills, reflexes, and coordination.

- Blood Tests: To check for thyroid function, electrolyte levels, and other potential metabolic issues.

- Imaging Studies: In some cases, MRI or CT scans may be necessary to rule out structural issues in the brain or spinal cord.

- Electromyography (EMG): This test can help assess the electrical activity of your muscles and identify any neuromuscular disorders.

Conclusion
In summary, while hand tremors can arise from various causes, it is crucial to identify the underlying issue to receive appropriate treatment. Given your symptoms and their impact on your daily life, I recommend scheduling an appointment with a neurologist or a healthcare provider who specializes in movement disorders. They can provide a comprehensive evaluation and guide you toward the most effective management strategies. Early intervention can often lead to better outcomes, so don’t hesitate to seek help.

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