The Condition

A tremor occurs when you cannot control shaking or trembling in part of your body. Everyone’s hands shake once in a while, so you should not be alarmed if you notice a slight shake here and there. It happens because the tiny muscle fibres in your hands and arms constantly contract and relax randomly. Sometimes, there is an imbalance between muscle groups, which causes these contractions to be out of synch. It’s quite normal to have a slight tremor. For example, if you hold your hands or arms out in front of you, they will not be completely still.

Different Reasons for having Shaky Hands^[1]
You might ask: Why are my hands shaking? How normal is it – and can it be treated?

This paper describes what tremors are, gives some potential causes and asks whether it is common to have shaky hands. It also provides tips on stopping the hands from shaking and provides some of the treatment options available.

Tremors in the hands are common^[2]:

• A tremor, or shaky hands, is not always the result of an illness or disease – it can be a reaction to something like medication or stress and can range in severity. They can occur randomly, or they can be constant.
• In some cases, a tremor can be completely normal and benign, while in others, it may signal an underlying medical condition.
• For some people, shaky hands may be a minor inconvenience, but in others, the symptom may lead to difficulty using their hands for everyday tasks.
• Understanding the underlying condition or issue can often help you and your doctor find a helpful treatment.

Picture Credit: “Female hands holding cup of coffee” by wuestenigel is marked with CC BY 2.0.

 If shaky hands are affecting your life, it’s best to see a GP straight away as treatment is available that may help to reduce it. Sometimes a tremor becomes more noticeable, for example:

• As you get older.
• When you’re stressed, tired, anxious or angry.
• Smoking.
• After drinking caffeine (for example, in tea, coffee or cola)
• If you’re very hot or cold.

Some medicines and conditions can cause tremors. Speak to your GP before you stop taking any existing prescribed medications. Your GP may refer you to a specialist for further tests if your tremor could be a symptom of a condition such as Parkinson’s disease or multiple sclerosis.

Treating a severe tremor^[3]
If you have a tremor that’s affecting your life, your GP may prescribe medicine. It will not cure the tremor, but it often helps to reduce the shaking or trembling.

You may need to take medicine all the time or only when you need it – for example, before a stressful situation that causes your tremor to get worse.

If a tremor is affecting your head or voice, you may be offered injections to block the nerves and relax the muscles.

In rare cases, brain surgery may be an option to treat a severe tremor that is not being helped by medicine.

Read more about brain surgery for severe tremors on the National Tremor Foundation (NTF) website.^[4] The NTF also offers support and information on tremor if it’s affecting your life.

Surgery to treat shaky hands
A doctor is unlikely to recommend surgery as your first treatment option. Surgical treatments are typically reserved for people who have a severely disabling tremor. Surgery may become an option as you age or if the tremor worsens.

Deep brain stimulation
Deep brain stimulation (DBS) is a surgical procedure used to treat tremors. During a DBS procedure, a surgeon places electronic devices called electrodes in your brain that receive an electronic signal that interferes with the brain activity responsible for the tremor. The signal is transmitted from a device implanted under the skin of your upper chest. DBS is currently only recommended for people with advanced or severe limb tremors.

Thalamotomy
Thalamotomy is another surgical option. During this procedure, your surgeon will use radiofrequency sound waves to make a permanent lesion in a very small area of your brain’s thalamus. An MRI scan guides where the waves are aimed – it interrupts the brain’s typical electrical activity and reduces or stops the tremor.

Different Tremors and their causes

Orthostatic Tremor
An Orthostatic tremor is a condition that involves the unintentional, rhythmic muscle movement of one or more parts of the body.  It usually occurs when a person is standing upright. It is seen as a progressive condition.

On a day-to-day basis, people feel stressed and frustrated – but they are not alone. People with orthostatic tremors will often struggle with:

• standing
• walking
• other physical movements
• exhaustion
• pain

Dystonic Tremor
Dystonic tremor occurs in people who are affected by dystonia—a movement disorder where incorrect messages from the brain cause muscles to be overactive, resulting in abnormal postures or sustained, unwanted movements. Dystonic tremor usually appears in young or middle-aged adults and can affect any muscle in the body.  Symptoms may sometimes be relieved by complete relaxation.

Although some of the symptoms are similar, dystonic tremor differs from essential tremor (see below) in some ways.  The dystonic tremor:

• is associated with abnormal body postures due to forceful muscle spasms or cramps;
• can affect the same parts of the body as an essential tremor, but also—and more often than essential tremor—the head, without any other movement in the hands or arms;
• can also mimic resting tremors, such as the one seen in Parkinson’s disease; and
• the severity of dystonic tremor may be reduced by touching the affected body part or muscle, and tremor movements are “jerky” or irregular instead of rhythmic.

Essential Tremor
An essential tremor (also called benign tremor, familial tremor, and idiopathic tremor) is why your coffee cup will not stay still while you are holding it. It’s the most common cause of hands shaking involuntarily in adults, and a condition doctors still do not fully understand. A tremor kicks in when your hands do something but goes away when they’re not. There’s no clear cause, but it can sometimes be traced to a change in a gene. If your symptoms are mild, you may not need treatment. If the symptoms interfere with everyday tasks or your job, you may need medicine, occupational therapy, or surgery.

Essential tremor is not well understood. It’s thought to be caused by a disruption in the normal functioning of parts of your central nervous system, such as your cerebellum^[5]. Researchers aren’t entirely sure what causes the neurological interruption or how to stop it. They’re also unclear about whether it’s a degenerative process.

This type of tremor sometimes runs in families. According to the National Institute of Neurological Disorders and Stroke^[6], about half of essential tremor cases are thought to be genetic. People with essential tremors experience frequent shaking that worsens when in motion. The shaking can’t be controlled and often occurs in your hands, arms, head, and vocal cords. The shaking may be more pronounced in your dominant hand, but it can affect both sides of your body.

Diagnosing essential tremor involves reviewing your medical history, family history and symptoms and conducting a physical examination. There are no medical tests to diagnose essential tremor. Diagnosing it is often a matter of ruling out other conditions that could be causing your symptoms. To do this, your doctor may suggest the following tests^[7]:

• In a neurological examination, your doctor tests your nervous system functioning, including checking your:
• Tendon reflexes
• Muscle strength and tone
• Ability to feel certain sensations
• Posture and coordination
• Gait

Laboratory tests of blood and urine may be tested for several factors, including:

• Thyroid disease
• Metabolic problems
• Drug side effects
• Levels of chemicals that may cause tremor
• To evaluate the tremor itself, your doctor may ask you to:
• Drink from a glass
• Hold your arms outstretched
• Write
• Draw a spiral

If your doctor is still unsure if your tremor is an essential tremor or Parkinson’s disease, they might order a dopamine transporter scan. This scan can help your doctor tell the difference between the two types of tremor.

Parkinson’s Disease
People with Parkinson’s disease typically experience a hand tremor when their muscles are at rest and see a reduction in the tremor when their muscles are in use. These are called resting tremors. But about one in four people^[8] with Parkinson’s disease also have an action tremor or a tremor that occurs when the muscles are used. Tremor is typically an early sign of Parkinson’s disease. Most people will experience the shaking on one side of their body, but it may spread with time. Stress, anxiety, or excitement can make the shaking worse.

When you have this condition, your hand shakes because brain cells that tell your muscles to move are damaged. The shaking usually starts on one hand but may spread to the other over time. You may also move more slowly, have trouble with balance, or find that your arms and legs stiffen up. The main treatment for this condition is medication and sometimes surgery for better muscle control.

The side effects of Medications
Shaky hands can be the result of medication side effects, including certain:

• Psychiatric medications
• Antiepileptic medications
• Anti-asthma medications
• Immunosuppressant medications

One reason these drug-induced tremors occur is that these medications block a brain chemical called dopamine. This chemical moves information from one part of your brain to another. When the dopamine can’t reach the parts of your brain that it should, movement issues like shaky hands can develop.

If you stop the medication, the tremors will likely go away, but you must ask your doctor about a different medication that may be less likely to cause shaking hands.

Several medications can cause tremors^[9]:

• Albuterol (an asthma drug sold under the brand name Proventil® or Ventolin®).
• Corticosteroids (like prednisone).
• Lithium (especially when combined with an antidepressant).
• Reglan®.
• Cyclosporine.
• Antiarrhythmic drugs (like Cordarone®, Procanbid®).
• Alcohol (chronic use).
• Tegretol® (a seizure drug, especially when combined with lithium).
• Nicotine.
• Dilantin® (a seizure drug).
• Cocaine.
• Ritalin®.
• Sudafed®.
• Certain antidepressants like Paxil®, Prozac®, Zoloft®, Pamelor®, and others.

Other
Rubral tremor is characterised by coarse slow tremor, which is present at rest, at posture and with intention. This tremor is associated with conditions which affect the red nucleus in the midbrain, classically unusual strokes.

Deficiencies of magnesium and thiamine^[10] have also been known to cause tremors or shaking, which resolves when the deficiency is corrected.^[11] Tremors in animals can also be caused by some spider bites, e.g. the redback spider of Australia.^[12]

Caffeine overdose
If you’ve ever had a cup of coffee or tea on an empty stomach, you might know the impact that caffeine may have on your hands. Caffeine is a stimulant, so the same natural chemical that helps you wake up will also make your hands shake if you have too much. Too much caffeine can lead to shaking hands. That’s because caffeine stimulates your body’s muscles, causing them to move out of sequence. Other symptoms of a caffeine overdose include:

• rapid heartbeat
• confusion
• headache
• insomnia

Coffee isn’t the only culprit. You can also find caffeine in over-the-counter headache medicine, chocolate, and some soft drinks.

Multiple Sclerosis (MS)
This condition damages the coating (called myelin) on your nerves. When this happens, you may get symptoms that include shaking in your hands or other parts of your body. Medicine is the most common way to treat it. A physical or occupational therapist can help you learn ways to manage your symptoms.

Multiple sclerosis (MS) is a progressive disease that occurs when your body’s immune system attacks your brain, nerves, and spinal cord. This leads to issues like inflammation and lesions in your central nervous system and brain.

As the damage worsens, symptoms like shaking hands may appear. In fact, MS can cause several tremors.

Huntington’s disease
Huntington’s disease is a condition that causes the progressive breakdown of nerve cells in your brain. A shaking or jerking hand is one of the most common signs of Huntington’s disease. Over time, the condition will greatly impair a person’s cognitive and emotional capabilities, as well as their physical ones.

Overactive Thyroid (Hyperthyroidism)
The thyroid is a gland in your neck that sits just above your collarbone. It produces the hormones that help supply your body with energy, and it uses those hormones to regulate your metabolism. If you produce too much of these hormones, you may have a metabolic condition known as overactive thyroid (hyperthyroidism)^[13]. An overactive thyroid makes your body more active than it needs to be. This can cause issues like:

• Increased heart rate
• Trouble sleeping
• Shaking hands

Have you had your thyroid hormone levels checked lately? Shaky hands may be a sign of hyperthyroidism. This means your thyroid gland is working too hard and kicking your heart rate into high gear. You may also notice that you lose weight without trying, are sensitive to light, get a fast heartbeat, and have trouble sleeping. A simple blood test will help your doctor discover what’s going on.

Alcohol Withdrawal
If you have an alcohol addiction, you could get symptoms that include shaky hands when you stop drinking. It starts as soon as 10 hours after your last drink and can last a few weeks. Some detox programs use medication to help you manage withdrawal symptoms.

Traumatic brain injury
A physical injury to your brain can impair your brain’s typical functioning. The damage to your brain may impact physical movement. Hand tremors or shaking may occur when the injury affects certain areas of your brain, like the cerebellum or the nerves that control hand movement. A brain injury may occur in an accident, such as a car collision or a fall. It can even result from activities like sports.

Alcohol overuse or withdrawal
People whose bodies are physically dependent on alcohol may experience several withdrawal symptoms if they try to stop drinking. Shaky hands, or “the shakes,” is one of the most common signs of alcohol withdrawal. Other symptoms include:

• sweating
• hallucinations
• nausea
• vomiting

The shaking or tremors may last a few days, but if your body has been physically dependent on alcohol for a long time, this symptom, as well as others, can last many months.

Lack of Sleep
You can’t expect a car to run if you don’t give it fuel. And you can’t expect your brain to send messages to all the right places without sleep. When you don’t get enough sleep, it can cause your brain to tell your hands to tremble mistakenly. Luckily, you can sleep your way back to steady hands.

Low Blood Sugar
Your nerves and muscles are powered by blood sugar. When they don’t get enough, they tell your hands to shake. Low blood sugar can be caused by diabetes, certain medications, too much alcohol, or not enough food. A doctor can help you narrow down what’s happening and why.

Stress
Your nerves kick into overdrive when something stresses you out, like giving a speech or watching a scary film. Your hands shake, and your heart beats faster. The shakiness will go away when the stress subsides. Try stress relief techniques like deep breathing or meditation.

Certain Medications
Twitchy hands are a common side effect of many types of prescription drugs – arising from the most common medicines for mood, seizures, migraine, neuropathy, and asthma. Some antihistamines cause this problem, too.

Smoking
Though some people do it because they hope it will ease stress, smoking can cause anxiety. Nicotine, the addictive drug in tobacco, gets into your bloodstream and makes your heart beat faster. It can make you feel anxious and make your hands shake. Talk to your doctor to get ideas on how to quit tobacco.

Lack of Vitamin B12
B12 plays a big role in keeping your nervous system healthy. If you don’t eat meat or eggs, don’t drink milk, or if you take certain medications, you might have lower-than-normal levels of this vitamin. It can cause your hands to shake or make your arms and legs feel numb and tingly. Your doctor can tell you if you need to take supplements.

Pheochromocytoma
Pheochromocytoma is a medical word for a rare tumour that grows in your adrenal gland. Though the tumour is usually benign, it makes your blood pressure go way up. It could make you shake and cause heavy sweating, shortness of breath, and headache. The tumour can also lead to heart disease and stroke, so it’s best to remove it with surgery.

Liver Disorders
Shaking is a symptom of a few liver disorders, like Wilson’s disease. In this genetic condition, a buildup of copper in your body damages your liver and brain. You’ll also feel tired and get jaundice – a yellowish tint to your eyes and skin. Doctors treat Wilson’s (the liver disease) with medication and diet changes.

Brain Disorders
If you’ve had a stroke or a traumatic brain injury, the muscles in your hands may have a mind of their own. Ask your doctor about medication or occupational therapy to manage shakiness. And steer clear of caffeine, nicotine, or anything else that worsens the symptoms.

Stroke
An ischemic stroke^[14] occurs when a blood clot blocks an artery that supplies blood to your brain. This condition prevents blood and oxygen from reaching your brain. Long-term, lasting damage can occur if the stroke is not immediately treated. Any lasting damage can affect the neurological pathways in your brain and cause tremors in your hands.

Commonly prescribed Medications and Treatment^[15]
According to the National Tremor Foundation, the most commonly prescribed medications for treating shaky hands due to essential tremors are:

• propranolol (Inderal)
• primidone (Mysoline) – an antiseizure medication.

Propranolol is a beta-blocker designed to treat:

• arrhythmia
• fast heart rate
• hypertension

If these medications don’t work for you, your doctor may recommend others.

Other beta-blockers
Metoprolol (Lopressor) and atenolol (Tenormin) are also beta-blockers that may be used to treat essential tremors. Your doctor may prescribe one of these medications if other medications don’t help your tremors, but it may not work as well as propranolol.

Other antiseizure medications
Gabapentin (Neurontin) and topiramate (Topamax) are other medications primarily used to treat neurological or psychiatric conditions, such as seizures or neuropathic pain. They may be helpful for people with essential tremors.

Anti-anxiety
Stress and anxiety are a reality of everyday living for many people. A sudden rush of adrenaline can lead to a faster heartbeat and an increase in the blood flow to your brain. It may also cause shaky hands. Stress can also worsen an existing tremor.

Alprazolam (Xanax) is used to treat anxiety and panic disorders, but early research^[16] indicates that it might be an effective treatment for essential tremors. This drug should be taken with caution as it is habit-forming.

Low blood sugar
Low blood sugar, or hypoglycemia, occurs when your body doesn’t have enough energy, or glucose, to manage your activities. Skipping meals, taking too much medication, exercising too much, or eating too little can lead to a drop in your blood glucose levels. When your blood sugar levels drop too low, your body triggers its own stress response, making you feel shaky and jittery. Other symptoms of low blood sugar include:

• sudden nervousness
• rapid heartbeat
• trouble thinking
• sweating
• dizziness

For people with diabetes, low blood sugar can be extremely dangerous. If left untreated, it can lead to loss of consciousness, seizure, or coma.

Botox
Botulinum toxin type A (Botox) shows promise as a treatment for essential tremors affecting the hands. This medicine may cause significant muscle weakness where injected, so be sure to speak with your doctor about the potential risks and benefits. The benefits from a successful injection can last up to three months, and subsequent injections may be needed.

Shaky Hands in Young People
The manifestation of hand tremors sometimes occurs in young people engaged in heavy physical activity – from muscle overstrain^[17].

Shaky hands in young people can be caused by a neurological disorder or a side effect of taking certain types of prescription medications or illegal drugs, as stated by the US National Institute of Neurological Disorders and Stroke.

Neurological disorders known to cause shaky hands include multiple sclerosis, stroke, traumatic brain injury, and neurodegenerative diseases that damage parts of the brain, such as the cerebellum. Drugs, like amphetamines and corticosteroids, mercury poisoning, liver failure and alcohol abuse or withdrawal can also cause shaky hands in young people.

Therapies
A doctor may recommend one or more strategies to help ease the symptoms of essential tremor. Suggestions may include^[18]:

• Using heavier objects. You may need to replace lightweight or delicate objects with heavier versions, such as glasses, silverware, or plates. The extra weight may make the item easier to handle.
• Using specially designed utensils and tools. Gripping and controlling items like pens, pencils, garden tools, and kitchen utensils may be difficult if you have shaky hands. You might consider looking for versions of these items that are designed for people with grip and control challenges.
• Wearing wrist weights. The extra weight on your arm may make control easier.

Is there a cure for Shaky Hands?
Although there’s no cure for most tremors, there are several treatment options. Finding the cause of your hand tremor determines which treatment is best. If an underlying condition causes your tremor, treating that condition may reduce or eliminate the tremor. For example:

• If caffeine, alcohol, or other stimulants affect your tremor, consider removing them from your diet.
• If your tremor is a side effect of medication, speak with your doctor about your options.

If essential tremors cause your shaky hands, there’s no cure, but there are ways to manage the tremors.

The types of treatment you use will depend on how severe the shaking is and the potential side effects of each treatment option. You and your doctor can discuss your options.

Speak with your doctor about treatments
If you’ve experienced shaky hands or symptoms of essential tremor, make an appointment to speak with your doctor. They will likely request several medical and physical tests to rule out other possibilities before a diagnosis can be made. Once a diagnosis is made, you can begin to discuss treatment options.

Treatment may not be necessary if the tremor is mild and doesn’t interfere with day-to-day activities. If the shaking becomes too difficult to manage, you can revisit the treatment options. Finding one that works well with minimal side effects may take time. You can work with your doctor and any therapists or specialists you visit to find a plan that best suits your needs.

Sources and Further Reading

• https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet
• https://www.webmd.com/parkinsons-disease/ss/slideshow-reasons-your-hands-are-shaking
• https://tremor.org.uk/surgery-tremor
• https://tremor.org.uk/orthostatic-tremor
• https://www.nhs.uk/conditions/tremor-or-shaking-hands/
• https://www.prevention.com/health/a29000940/why-do-my-hands-shake/
• https://www.healthline.com/health/treating-shaking-hands
• https://www.healthline.com/health/treating-shaking-hands#seeking-medical-help
• https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet
• http://www.tremor.org.uk/
• https://www.healthline.com/health/stroke/cerebral-ischemia
• https://klubwife.ru/en/symptoms-and-disorders/why-the-hands-are-shaking-can-shaking-hands-for-hormones/
• https://www.mayoclinic.org/diseases-conditions/essential-tremor/symptoms-causes/syc-20350534
• https://www.mayoclinic.org/diseases-conditions/essential-tremor/diagnosis-treatment/drc-20350539
• https://my.clevelandclinic.org/health/diseases/11886-essential-tremor
• https://health.clevelandclinic.org/are-you-bound-to-get-shaky-ands-as-you-age/
• https://en.wikipedia.org/wiki/Tremor
• https://en.wikipedia.org/wiki/Essential_tremor
• https://www.health.harvard.edu/diseases-and-conditions/whats-causing-your-shaky-hands
• https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/movement_disorders/conditions/
• https://en.wikipedia.org/wiki/Dyskinesia
• https://en.wikipedia.org/wiki/Movement_disorder
• https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/

Picture Credit: “Healthy Neuron” by National Institutes of Health (NIH) is marked with CC BY-NC 2.0

CAUTION: This paper is not medical advice. No advice is implied or given in articles published by us but is only for general information. You should always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. This paper is compiled from the sources stated but has not been medically reviewed. It should never be used as a substitute for obtaining advice from your Doctor, a consultant Neurologist, Movement Disorder Specialist (MDP), or other qualified clinician/medical practitioner. If you have already been given dietary advice, you should not make changes without first talking to your GP, consultant or dietitian. Any medications mentioned may include names for US drugs which may have a different name to those available in the UK. The facts are believed to be correct as at the date of publication, but there may be certain errors and omissions for which we cannot be responsible. There is no implied endorsement or promotion of any organisation by the writer. The hyperlinks were valid at the date of publication.

1. Sources: https://www.webmd.com/parkinsons-disease/ss/slideshow-reasons-your-hands-are-shaking, https://tremor.org.uk/orthostatic-tremor, https://www.nhs.uk/conditions/tremor-or-shaking-hands/ © Crown copyright acknowledged ↑
2. Source: https://www.medicalnewstoday.com/articles/322195 ↑
3. Source: https://www.nhs.uk/conditions/tremor-or-shaking-hands/ © Crown copyright acknowledged ↑
4. At: http://www.tremor.org.uk/ ↑
5. See: https://www.healthline.com/health/human-body-maps/cerebellum ↑
6. Source: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet ↑
7. Source: https://www.mayoclinic.org/diseases-conditions/essential-tremor/diagnosis-treatment/drc-20350539 ↑
8. Ibid ↑
9. Source: https://my.clevelandclinic.org/health/diseases/11886-essential-tremor ↑
10. Source: National Research Council. 1996. Nutrient Requirements of Beef Cattle, Seventh Revised Ed. Washington, D.C.: National Academy Press. ↑
11. Source: Soar, J; Perkins, GD; Abbas, G; Alfonzo, A; Barelli, A; Bierens, JJ; Brugger, H; Deakin, CD; Dunning, J; Georgiou, M; Handley, AJ; Lockey, DJ; Paal, P; Sandroni, C; Thies, KC; Zideman, DA; Nolan, JP (October 2010). “European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution”. Resuscitation. 81 (10): 1400–33. doi:10.1016/j.resuscitation.2010.08.015. PMID 20956045. ↑
12. Source: Brooks, R. (January 2008). “Spider Bite”. Australian Venom Research Unit. University of Melbourne. ↑
13. See: https://www.healthline.com/health/hyperthyroidism ↑
14. Source: https://www.healthline.com/health/stroke/cerebral-ischemia ↑
15. Source/Acknowledgement: https://www.healthline.com/health/treating-shaking-hands#seeking-medical-help ↑
16. Source: https://www.ncbi.nlm.nih.gov/pubmed/24667763 ↑
17. Suggested at: https://klubwife.ru/en/symptoms-and-disorders/why-the-hands-are-shaking-can-shaking-hands-for-hormones/ ↑
18. Source: https://www.nhs.uk/conditions/tremor-or-shaking-hands/ © Crown copyright acknowledged ↑