It is very easy to miss subtle shaking until you attempt to do an action which requires fine motor skills such as threading a needle or replacing the tiny pin in the arm of the eyeglasses. Have you been having difficulty to steady your hands to do what used to be routine movements? Shaky hands is also called hand tremor. Hand tremors can be associated with neurological, metabolic, toxic and degenerative conditions. This is quite different from the anxious nervousness we all experienced from time to time which causes us to shake before a performance etc.
The most common type of tremor which affects adults is called essential tremors. Even though it is the most common cause of shaking hands we still do not fully understand why this occurs. Some researchers think the degenerative process interrupts the normal brain function of the cerebellum. The cerebellum known as the little brain plays an important role in balance, equilibrium, coordination and motor functions. Degeneration of the cerebellum affects the neurons and causes them to die.
Hand tremors can also be caused by:
- Parkinson’s disease
- Overactive thyroid
- Cerebellar disease
- Huntington’s disease
- Medication side effects
- Caffeine overdose
- Alcohol abuse or addiction
- Hypoglycemia (low blood sugar)
There is a classic difference between the shaky hands experienced with essential tremors and Parkinson’s diseases. Persons with essential tremors have uncontrollable shaking when they try to perform a motor function (use a muscle) to write, brush the teeth, comb the hair, operate a machine etc. Once they are at rest there is no obvious shaking. On the other hand with Parkinson’s disease the hands shake when at rest (no activity). The shaking stops once the muscles are in use.
Less Common Causes
- Multiple sclerosis
- Para neoplastic disorders
- Spasmodic torticolis
Conservative solutions for mild cases of shaky hands
The good news is, not everyone with shaky hands will require medical treatment. Your doctor may recommend the following practical lifestyle changes:
- Choose easy to open bottles, tins and medication containers
- Replace lightweight daily used eating ware such as utensils, cups, glasses, plates and bowls with heavier ones
- Invest in tools which are designed for easier grip
- Wear wrist weights to steady hand movements
Medical Treatment Options
There is no single treatment that is guaranteed to resolve shaky hands. Your doctor may which to try you on a group of medications called beta-blockers. Beta-blockers are normally used in the treatment of cardio-vascular diseases such as high blood pressure and tachycardia (Fast heart rates).In recent time beta-blockers are used for anxiety, performance jitters and tremors. Some commonly used beta-blockers are:
- Propranolol (Inderal) and the long-acting option
- Primidone (Mysoline)
- Gabapentin used to treat seizure
- Topiramate used to treat seizure
- Xanax (Alprazolam)
- Botulinum toxin type a, popularly known as Botox
Shaky hands which result from other causes (non-essential tremors) can be improved by treating the illness such as seizures, Parkinson’s disease and cerebellum diseases.
In cases where the abuse of stimulants is responsible for the tremors the addiction needs to be addressed. This is so in the case of alcohol, caffeine and nicotine.
Discuss with your doctor the possible side effects of the medications as some of them are habit forming. The benefits and risks should always be assessed.
In a few cases invasive surgical therapy may be recommended. Two techniques used for severe shaking are:
- A surgical procedure called Deep Brain Stimulation (DBS). The surgeon places an electrode in your brain. This device emits an electronic signal which interrupts the brain activity responsible for the tremor.
- Thalamotomy is also a surgical procedure and the surgeon makes a small incision in the section of the brain called the thalamus. This interrupts the brain’s normal electrical activity and results in a reduction and even the cessation of the tremor.
Tips for Lifestyle changes to minimize shaky hands
- Substitute caffeine drinks for decaffeinated options. Some persons will have to gradually reduce their dependence on caffeine. Green tea is a good substitute.
- Reduce intake of alcohol and ultimately eliminate it from your diet
- Make an effort to get 6-8 hours of quality sleep at nights
- Quite smoking
- Manage stress at home and at work
- If you are diabetic, control your blood sugar levels.
- Healthy eating and supplementation will ensure adequate intake of vitamins and minerals
- Vitamin B 12 is essential to maintain healthy nerves, and it can help prevent and treat hand tremor.
A vitamin B 12 deficiency can instead cause tremors in arms and legs, muscle weakness, loss of balance, memory loss and other.
- Vitamin B1 nourishes nerves and protects them from damage, and it can also help prevent hand shaking.
Extremely low levels of vitamin B 1 can cause tremors, nerve damage, confusion, loss of coordination, muscle weakness, dementia, etc.
- Vitamin B 6 supports many nervous system activities, and its deficiency may also result in hand tremor.
- Vitamin E deficiency can be another cause of shakiness. This vitamin is important for the general health of our nervous system, and its lack may lead to loss of coordination and balance, numbness in the limbs, loss of reflexes, and muscle weakness.
Electrolytes transmit electrical impulses from nerves to muscles. When our body is depleted of electrolytes, we may experience serious health problems, including tremors and shaky hands.
- Magnesium deficiency can result in muscle spasms and convulsion, which in turn may cause hand tremors.
- Potassium controls the activity of our muscle and nerve cells, and over time its deficiency may also cause shaky hands and tremors.
- Calcium is a very important mineral. 99% of calcium is found in bones and teeth, while the remaining 1% circulates in the blood. This 1% of calcium makes our muscles contract correctly, promotes blood clotting and helps our nerves carry messages throughout the body.
Extremely low calcium levels can cause frequent tremors, shakiness, muscle weakness, and many other health problems.
- Exercise daily doing what you can according to your level of fitness and mobility
- Review medication with your doctor especially if you associate the tremors with a new medication prescribed for you
- Explore yoga, hypnotherapy and other alternative modalities for relaxation
Be encouraged that a lot of new research is exploring more options to improve and treat shaky hands. Discuss with your healthcare provider treatment option which may be appropriate for you. Together with the involvement of your doctor you can find the specific cause of your shaky hands. There are non-invasive and practical methods to stop or improve hand tremors. Shaky hands can be annoying and even embarrassing but do not be discouraged. The earlier you seek medical assessment the better the outcome.
- Essential Tremor Variants: Effect of treatment WC Koller, S Glatt, N Biary… – Clinical …, 1987 – journals.lww.com
- Propranolol therapy for Head Tremor, WC Koller – Neurology, 1984 – AAN Enterprises
- Delayed onset hand tremor caused by cerebral infarction, JS Kim – Stroke, 1992 – Am Heart Assoc
- Hand tremor in patients with spasmodic torticollis, G Deuschl, F Heinen, B Guschlbauer… – Movement …, 1997 – Wiley Online Library
- Parkinson’s disease: clinical features and diagnosis, J Jankovic – Journal of Neurology, Neurosurgery & Psychiatry, 2008 – jnnp.bmj.com
- Rest tremor in patients with essential tremor: prevalence, clinical correlates, and electrophysiologic characteristics, O Cohen, S Pullman, E Jurewicz… – Archives of …, 2003 – archopht.jamanetwork.com
- β-Blockers and depression: the clinician’s dilemma, SC Yudofsky – JAMA, 1992 – jama.jamanetwork.com