March 21, 2011
Tremors: Causes & Remedies
S.A. Helton
St. Joseph Mercy Hospital
You may remember when you felt your hands trembling, but no one noticed.
That may have occurred when you accepted a special award or trophy; when
you were giving an important speech; or when you stepped to the line for two
free throws that would decide the game.
But why are your hands shaking now when you try to pour a
cup of coffee? You feel the tremor, and there is no question
that others notice it.
A tremor is an unintentional movement of the muscles of
some part of the body–usually the hands. Sometimes there is
a specific cause such as nervousness, excitement or a neurological disorder. And sometimes the hands shake for no
apparent reason.
In fact, we all have what is known as a physiologic tremor in
all voluntary muscle groups–a tremor so slight that it is
rarely visible to the human eye unless it becomes temporarily
exaggerated because of anxiety, fear, exhaustion, fever or too
much caffeine or alcohol. You can see it other times if you
extend both of your arms and hold a piece of paper on one
of your hands.
There are more than 40 types of tremor that are visible to
others and may indicate a health problem. Most are more
common after age 50, and they may over time become more
than a nuisance.
ESSENTIAL TREMOR
By far the most common reason for a shaking hand is known as essential tremor, meaning
a tremor that is associated with no known illness. There is a strong genetic component to
essential tremor; if one of your parents had it, you have a 50 percent risk yourself.
Persons with a genetic susceptibility tend to develop tremor earlier in life, even before age
30. Persons who develop this type of tremor in their 60s and 70s usually have a type
known as sporadic essential tremor.
In a person who develops tremor early in life, the severity can increase with age or as a
result of stress, emotion, fatigue, illness or low blood sugar.
In some individuals, essential tremor merely involves a shakiness in one or both hands
- continued next page
mymercy.us
remarkable medicine. remarkable care.
If you have questions about programs and services of St. Joseph Mercy Port Huron, please
visit us online at: mymercy.us. To find a physician near you, call toll-free 1-888-MERCYME.
Understanding Tremor
- continued
that is most apparent when they are outstretched or making fine
movements. Occasionally, though, the condition gets gradually worse
over a three- or four-year period, sometimes involving the head, voice,
tongue, legs and trunk as well as the hands. The person may even
have a slight gait disturbance.
Although there are no health risks, some individuals become severely
disabled, and unable to continue jobs that require fine hand movements. Some patients become inhibited about eating, writing or
speaking in public.
A small amount of alcohol may ease the tremor. Excessive or longterm alcohol use, however, is likely to have the opposite effect.
PARKINSONIAN TREMOR
A tremor–usually on one side–is frequently an early sign of
Parkinson’s disease, a neurodegenerative disorder that effects about one percent of
Americans age 60 and over.
Tremors associated with Parkinson’s disease most commonly occur when the hand or
effected body part is relaxed or at rest. It’s classically seen as a pill rolling motion of the
hands, but it may also effect the chin, lips, legs and trunk, particularly when the person is
under stress.
Generally, this tremor disappears when the hand is moved purposefully. While it may be
troublesome, a tremor is usually one of the least disabling symptoms of Parkinson’s
disease. Other signs of the disease include rigidity, slow movements, a shuffling gait and
reduced arm swing.
For reasons unknown, about 20 percent of persons with essential tremor eventually develop
Parkinson’s as well. Most experts do not believe there is a cause/effect relationship.
ORTHOSTATIC TREMOR
These tremors present as rhythmic muscle contractions in the legs and trunk while you’re
standing, or otherwise supporting yourself on these muscles. It often occurs to persons
waiting in line for an extended period, and they may be able to control the contractions by
leaning against a wall or by sitting.
Sometimes known as “shaky legs syndrome,” this tremor creates an increased risk of falling.
CEREBELLAR OR INTENTION TREMOR
This is a slow, broad tremor that occurs at the end of an intended movement such as
writing, pressing a button or reaching for an object. The tremor usually goes away when
the effected body part is relaxed.
This problem is usually caused by damage to the cerebellum of the brain as a result of a
- continued next page
Page 2
remarkable medicine. remarkable care.
If you have questions about programs and services of St. Joseph Mercy Port Huron, please
visit us online at: mymercy.us. To find a physician near you, call toll-free 1-888-MERCYME.
Tremor: Causes & Remedies
- continued
stroke, tumor or disease such as multiple sclerosis. It can also be an effect of chronic
alcoholism or overuse of some medications.
Other manifestations of cerebellar damage could include speech problems; rapid, involuntary rolling of the eyes; an abnormal gait and a tremor of the trunk and neck.
TREATMENT Options
Join Us...
Healthy Aging Seminar
Join St. Joseph Mercy Chaplain
Sister Kathy Wood, OP, as she
explores the joy of laughter in
maintaining a healthful lifestyle
at: “Laughter: It Really is the Best
Medicine”. The event will be held
Wednesday, April 20, at 2 p.m., at
St. Joseph Mercy Hospital’s
Baggot Street Café (cafeteria). To
make your reservation to attend,
call 1-888-MERCYME
(1-888-637-2963). To obtain
regular updates, check out St.
Joseph Mercy Port Huron on
facebook.
Unless there is a treatable underlying reason for the tremor, there is ordinarily no cure,
but there are numerous ways of managing the condition and overcoming the inconvenience, embarrassment and disability.
Essential tremor can usually be relieved, at least in part, by beta blockers. Orthostatic
tremor is usually treated with a combination of these types of medications.
Parkinsonian tremors are more difficult to manage, but are often treated with drug
therapy. Cerebellar tremors usually do not respond to drug therapy.
Surgery can be used for certain severe, disabling tremors, but there are far less invasive
options such as treatment injections.
In the majority of cases, the patient can be helped through physical therapy and lifestyle
changes. Adjustments can be made: putting a napkin between a cup and saucer to reduce
rattling; learning to write and eat with the hand that does not shake; avoiding foods such as
soup and spaghetti when eating out.
A physical therapist can help the patient learn to gain control through bracing the effected limb against something or changing positions. Braces, splints, wrist or ankle weights
or assistive devices may help. For stress-related tremors, meditation and relaxation therapy
may be prescribed.
Despite the name often given, essential tremor is by no means benign to the person
experiencing it. Although it may help to know that no serious illness is involved, the
important task is to reduce the disabling effects.
If you suffer from tremors, talk to your doctor today about a treatment option that might
be right for you.
To find a St. Joseph Mercy physician near you, call toll-free 1-888-MERCYME, or
visit us online at mymercy.us.
The information provided in Healthy
Living is for educational purposes only.
Speak with your doctor directly about any
issues that effect your health.
Editor: Stephanie Armstrong-Helton
810-984-1166
heltons@trinity-health.org
mymercy.us
Check Us Out
St. Joseph Mercy Port Huron has
expanded our updates on Facebook.
Search us and let us know if you “like”
what you see!
St. Joseph Mercy Port Huron O 2601 Electric Avenue, Port Huron, MI 48060 O mymercy.us
If you have questions about programs and services of St. Joseph Mercy Port Huron, please
visit us online at: mymercy.us. To find a physician near you, call toll-free 1-888-MERCYME.
mymercy.us
St. Joseph Mercy Port Huron O 2601 Electric Avenue, Port Huron, MI 48060 O mymercy.us