Hand Tremors

Hand tremors (shaky hands) can happen in anyone. All people have tiny tremors, and they can increase with caffeine sensitivity, medication use, or an emotional cause like anxiety, but they're not typically noticeable and aren't part of another diagnosis.

However, the symptom of shaking hands occurs in a number of health conditions. One type of involuntary shaking, called essential tremor, is the most common. In some cases, tremors occur at rest; in others, the shaking occurs with activity. Hand tremors can be due to a metabolic condition as basic as vitamin B12 deficiency or as rare as the genetic disorder called Wilson's disease.

This article presents causes of hand tremors such as Parkinson's disease or hyperthyroidism (overactive thyroid). It explains shaking hands and related symptoms, possible treatments and at-home care, and when you should seek medical attention.

Symptoms of Shaking Hands 

Involuntary shaking can affect one or both hands. This symptom typically comes and goes, or in some medical conditions remains constant. Shaky hands can be associated with stress and anxiety, even when it occurs due to a physical disorder and not as part of a mental health condition.

Hand tremors can look and feel like:

• A rapid tremor in one hand
• A tremor in both hands, which can involve both arms
• Movements of the fingers that appear like pill rolling (most common in Parkinson's disease)
• Shaking while at rest
• Tremors that occur only with action or movement
• Shaking that appears only during times of anxiety or stress
• Shaking that occurs without anxiety can sometimes worsen with stress

If you experience episodic shaking of your hand or hands, it’s important to note the triggers that cause it. Describing the pattern to a healthcare provider can help them determine the type of tremor, which narrows down the cause.

Shaking Hands and Related Symptoms

Some tremors caused by medical conditions may have other associated symptoms, including:

• Sweating
• Fever
• Hand pain or weakness
• Tremulous, shaky voice
• Slow movement
• Stiff movements
• Problems with balance and coordination (ataxia)

Feeling overwhelmed, tired, upset, or scared also can occur with hand tremors that are related to a medical cause but worsen with emotional upset.

Types of Hand Tremors

Because there are so many variations, healthcare providers define types of tremors that might lead to shaking hands. These tremor types are defined by whether they happen at rest or if the shaking hands occur when you're active, for example, focused on a task like putting a key into a lock.

Beyond the two categories of activity or at rest, types of tremors are defined as:

• Essential, which can be genetic but typically arises from an unknown cause in younger people. It affects both hands, often remaining a mild tremor without other symptoms.
• Dystonic tremors (sometimes called focal dystonia when a local site like the hand is affected)
• Cerebellar tremors that typically follow a stroke, disease, or other cause of brain damage
• Functional (psychogenic) tremor, which may occur as any form of tremor
• Enhanced physiologic tremors typically have an underlying cause, like low blood sugar, that can be reversed when treated
• Parkinsonian tremors related to Parkinson's disease

People who are experiencing alcohol or drug withdrawal may experience hand tremors. Certain medications, including Wellbutrin (bupropion hydrochloride) can cause your hands to shake, too.

Causes of Shaking Hands 

Hand tremors can be caused by diminished control over physical movements, which may be associated with issues like fatigue, stress, medication, medical illnesses, or mental health disorders. 

In addition to those discussed, common causes of shaking hands include:

• Fever or infection
• Dehydration or electrolyte imbalances
• Carpal tunnel syndrome, arthritis, or a pinched nerve
• A seizure disorder
• A movement disorder, such as Parkinson’s disease
• Medication side effect, such as Cordarone (amiodarone)
• A neurological condition, such as multiple sclerosis (MS), stroke, brain tumor, meningitis (infection or inflammation of the tissue surrounding the brain), or encephalitis (inflammation or infection of the brain) 
• Overactive thyroid
• Traumatic brain injury
• Mercury poisoning from food or the environment
• Excessive caffeine intake
• Genetic causes like Wilson's disease

These conditions each affects the hands differently, which may lead to shaking.

How to Treat Shaking Hands 

The treatment for shaky hands depends on the condition that is causing it. For some people, it may be as simple as cutting back on caffeine, getting enough rest, or trying stress therapy to learn management techniques.

Other treatments may be needed for a specific and reversible cause, like administering intravenous (IV) fluids to treat dehydration or balancing glucose levels in diabetes. Medication or surgical intervention can manage a musculoskeletal disorder, such as carpal tunnel syndrome or arthritis.

However, tremors due to stroke or brain tumors (or a neurodegenerative or autoimmune disease like MS) are not typically reversible. Other treatments often are necessary.

Medications

Certain medications are used to treat the underlying causes of hand tremors. They include:

• Beta blockers (essential and other action tremors)
• Anti-seizure medications
  
• Benzodiazepine tranquilizers
• Dopaminergic agents used to treat tremors in Parkinson’s disease.
• Anticholinergic medications (dystonic tremors)
• Botox injections for dystonic (and some essential) hand tremors

Surgeries

Surgeries and procedures that may be used to treat some causes of hand tremor can include:

• Deep brain stimulation for hand tremors caused by brain injury
• Radiofrequency ablation
• Focused ultrasound used with magnetic resonance imaging (MRI)

Lifestyle Changes

For people with hand tremors, physical therapy may be helpful along with other lifestyle changes. They can include adaptations in the household (like changing storage space), wearing different clothes and shoes, and using special utensils to make meals safer and easier.

Are There Tests to Diagnose the Cause of Shaking Hands? 

In general, the cause of shaking hands is diagnosed based on a medical history and physical examination.

Sometimes anxiety disorders can be difficult to identify, especially when you are experiencing physical signs of anxiety without recognizing and acknowledging those feelings. In some situations, it can take several medical visits and discussions to establish that anxiety is a cause of shaking hands.

A physical examination can identify other signs indicating conditions associated with shaky hands. For example, MS often causes changes in reflexes, sensation, and motor strength. Parkinson’s disease typically causes a pattern of motor stiffness. 

Diagnostic testing can also be a part of this process. Diagnostic tests would be ordered based on a symptom history and a physical examination.

Some tests that might help determine medical causes of shaking hands can include:

• Blood tests: May identify electrolyte disturbances, measure thyroid function, confirm signs of infection
• Brain imaging tests: Can detect signs of MS or meningitis
• Electroencephalogram (EEG): Used to recognize signs of an underlying seizure disorder

When to See a Healthcare Provider 

Shaky hands can be disruptive, may interfere with your day-to-day life, and can be upsetting. Furthermore, shaky hands can be a sign of a medical condition that requires treatment.

It’s important to make an appointment to see a healthcare provider if you have recurrent episodes of shaky hands.

Get prompt medical attention if you experience any of the following symptoms along with your shaking hands:

• Changes in consciousness
• Changes in vision
• Uncontrollable shaking
• Balance problems
• Changes in body temperature
• Excessive sweating
• Difficulty speaking or communicating

Additionally, if you are concerned or if your hand shaking is severe, persistent, or continuous, you should seek medical attention.

Summary 

Shaking hands can be a sign of many different medical and psychological conditions. You may experience shaking of one or both hands, and it can occur frequently, or it may only happen in certain situations.

It’s important to get medical attention for this problem because it can be caused by serious medical issues that require treatment. Even when shaking hands is caused by a condition that is not otherwise harmful, it is still essential to get treatment so that you can avoid the physical and emotional distress associated with the symptom.