Have you recently asked yourself, Why do my hands shake when I hold something? Or maybe you notice that your hands shake more when you’re at rest? No matter the scenario, shaky hands can be worrisome. Bottom Line Personal turned to board-certified neurologist and Michael S. Okun, MD, for answers to commonly asked questions about shaky hands.
Are shaky hands and hand tremors always a cause for concern?
Not every tremor indicates something serious, but a new or persistent hand tremor is worth a medical check-in.
What are the most common medical conditions that cause shaking hands?
The neurological disorder essential tremor is the most common cause (see below). Parkinson’s disease, multiple sclerosis, thyroid disease, low blood sugar, poor sleep, nutrient deficiencies (vitamins B-1, B-12, E, magnesium and calcium) and liver disease also can cause hand tremors. And certain medications as well as too much caffeine can cause shaky hands. Each of these conditions and causes has a different treatment ranging from medication adjustments to lifestyle changes and, in some cases, even surgery if you have essential tremor or Parkinson’s disease.
What is essential tremor?
Essential tremor is the most common tremor disorder, usually affecting both hands during movements such as drinking or writing. It can run in families and sometimes improves with alcohol. Caution: The response to alcohol has not been shown to be an effective treatment, and we do not recommend this approach. When mild, essential tremor also often responds to medication. Caution: Essential tremor also can cause walking and balance challenges, so fall prevention is an important consideration.
What is Parkinson’s disease?
Parkinson’s is a disease of both the brain and the body. It is due to a loss of dopamine-producing cells in the brain and degeneration of brain circuits. There also is evidence of Parkinson’s in many body organs. These brain circuits and organs, such as the gut and skin, have clumps of abnormal proteins called alpha-synuclein. Parkinson’s can lead to tremor and slowness, stiffness and walking changes, as well as nonmovement symptoms such as sleep, mood or thinking challenges.
Note: “Parkinsonism” is a grab bag term that describes conditions that can mimic Parkinson’s disease, such as strokes or rare syndromes, such as multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration. These conditions are much less responsive to treatment with dopamine-replacement drugs. Also: Certain drugs may cause side effects that look like Parkinson’s.
Do shaky hands typically happen or worsen when holding an object like a coffee cup?
Many tremors, especially essential tremor, become more obvious when the hand is in use, such as when you are holding a cup or eating with utensils. Parkinson’s tremor more commonly occurs at rest, but many people will experience re-emergence of resting tremor when holding a newspaper for more than a few seconds, for instance.
Is there ever a more benign cause for shaky hands?
Fatigue, stress, sleep deprivation and even anxiety can cause a temporary tremor that is not caused by a serious underlying disease. In fact, we all have a physiological tremor that can be brought out or enhanced by stress, anxiety, sleep deprivation and even some medications. In these cases, improving sleep and nutrition and managing depression and anxiety can calm the nervous system and reduce tremor. Caffeine also can drive essential tremor and other tremor disorders, so reducing caffeine intake can sometimes be helpful.
When should someone see a doctor?
If a tremor is new, persistent or worsening even after addressing sleep, nutrition and mood, see a doctor. A neurologist is the right next step if Parkinson’s disease or another neurologic disorder is suspected and especially if there are other emerging symptoms such as stiffness, slowness and/or changes in balance. Look for a neurologist with expertise in Parkinson’s disease and/or movement disorders.
Important: Balance should be checked frequently in anyone with tremor because falling is common and preventable.
Reminder: While delaying treatment likely won’t hasten progression of the condition or disease, it can mean missing early treatment opportunities for Parkinson’s, thyroid disease, liver problems and other serious conditions.
