Hand Tremor

Hand tremor means shaky hands. It is a quite common finding, especially in older people. It may be a relatively harmless symptom but sometimes it is a sign of a serious illness. Long-lasting tremor should never be underestimated.


Response to cold

Shaking of hands and the whole body is a result of rapid muscle contractions that should produce heat energy. Similarly, tremor occurs in fever when “normal desired body temperature” is increased in the control center of the brain.

Stress, fatigue, anger

Emotions and fatigue may be associated with hand tremor. It is a quite common and medically insignificant condition.

Parkinson's disease

This neurological disease is very prevalent among the elderly. In principle, it is caused by disorder of deep structures of the brain known as the basal ganglia that are designed to assist in formation of movement patterns. Tremor is just one of many symptoms of the disease (see relevant article). Parkinson's tremor occurs at rest and tends to disappear with intentional movement.

Cerebellum disorders

The cerebellum is a part of the brain responsible for the coordination of movement. Violation of certain parts of the cerebellum gives rise to the so-called intention tremor. Intention tremor is not visible at rest but occurs in movement, for example when the affected person tries to reach for an object. There are many possible causes of cerebellar damage including an injury, hemorrhage, brain tumors, etc.

Essential tremor

This is a special disease manifesting with hand tremor. It probably has a genetic basis, although the exact cause is not known. Interesting is the fact that the tremor disappears after alcohol drinking, which can gradually lead the patient to alcoholism.


Low blood sugar manifests by sweating, nervousness, impaired consciousness and sometimes with tremor and muscle convulsions. Most commonly this occurs in patients with diabetes treated with insulin or oral antidiabetics that cause a too strong decrease of blood sugar level.

Delirium tremens

This condition can occur in a severe alcoholic who is suddenly prevented from alcohol intake. Delirium tremens manifests by hand tremor and impairment of consciousness (confusion, aggression).

Overactive thyroid gland

Excessive production of thyroid hormones may result in hand tremor. The most obvious this is in so-called thyreotoxic crisis when the body is flooded with thyroid hormones. Treatment is done classically by drugs causing suppression of thyroid function. Thyreotoxic crisis is a life-threatening condition.

Liver failure

Damage to the brain caused by nitrogen-containing substances in liver damage results in a series of symptoms including hand tremor. The tremor in a patient with heart failure is known as asterixis (flapping tremor). It occurs typically in the situation where the patient is ordered to keep his hands outstretched. Damaged brain is unable to hold the hands that continuously fall down, while the patient returns them back into desired position. The outcome movement is similar to flapping of bird wings.

Effect of various compounds

Many toxic substances can impair brain function and cause tremor. The tremor is characteristic in mercury poisoning. Moreover, tremor occurs when receiving an excessive amount of caffeine and alcohol. We should also not forget the impact of a range of medications and addictive drugs.

Diagnostic approach

The tremor is usually examined by neurologists. In addition to medical history and physical examination, the doctor may use methods such as brain computed tomography or magnetic resonance imaging. Blood tests may bring many information about inner environment of the body including mineral values, liver tests, renal parameters, blood sugar, CRP, thyroid hormones, etc. Neuromuscular signal transmission is examinable by electromyography.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources