Tremors are involuntary rhythmic muscle contractions that can cause body parts to shake or tremble. Tremors in the hands are common. In some cases, they can be completely normal and benign, while in others they may signal an underlying medical condition.
For some people, shaky hands may be a minor inconvenience. For others, the symptom may lead to difficulty using the hands for everyday tasks.
This article describes what tremors are, outlines some potential causes of shaky hands, and asks whether it is common to have shaky hands. We also provide tips on how to stop the hands from shaking and discuss some of the treatment options available.
Tremors are involuntary, rhythmic muscle contractions that make a body part appear to be shaking or trembling. Everyone has a slight tremor when moving or maintaining a particular posture. This is called physiologic tremor.
Physiologic tremors are often so small that a person does not see or notice them. Hand tremors may be more noticeable when a person holds their hands out straight in front of the body or when they are stressed or anxious.
Tremors mostly affect the hands. However, it can also occur in other body parts, such as:
- the head
- the arms
- the legs
- the torso
- the voice box (larynx), which may cause a shaky voice
- Resting tremors: These occur when the muscles are relaxed, including when the hands are resting on the lap.
- Action tremors: These occur when the muscles are contracted due to voluntary movement. The majority of tremors are action tremors.
Sometimes, tremors can indicate an underlying health issue, especially if they are persistent or very pronounced.
Tremors can be normal or could result from neurological conditions, other health problems, or medication use. Below are some potential causes of tremors.
Enhanced physiologic tremor
Enhanced physiologic tremor (EPT) is a more noticeable form of physiologic tremor. It usually affects the hands and fingers on both sides of the body.
The following may cause EPT in some people:
- lack of sleep
- excessive caffeine intake
- vigorous exercise
- overactive thyroid
Enhanced physiological tremor does not require medical treatment, except when a person needs to rely on fine muscle coordination for their work or other activities.
- Multiple sclerosis (MS): This degenerative disease attacks the brain and spinal cord, making it difficult for the nerves to relay messages. Many people with MS experience some degree of tremor. This often develops when the disease damages areas in the pathways of the central nervous system that control movement.
- Parkinson’s disease (PD): This disease involves a loss of nerve cells in part of the brain that plays a critical role in motor movement.
About 75%people with PD have tremors, whether resting, action, or mixed. Tremors usually begin on one side of the body, and may spread to the opposite side. Shaking may become more pronounced during periods of stress or strong emotion.
- Stroke: After a stroke, a person can show a variety of tremors depending on the area affected. Damage to the basal ganglia causes a person to have resting tremors, while damage to the cerebellum causes intention tremors.
- Traumatic brain injury (TBI): Tremor as a consequence of TBI is called post-traumatic tremor (PTT). A
2020 studyfound that PTT happens as a result of damage to specific brain areas responsible for movement. These tremors are uncommon.
- Dystonia: Dystonia is a movement disorder in which involuntary muscle contractions cause repetitive, involuntary movements and postures. The condition is due to improper functioning of the basal ganglia in the brain. A 2021 study stated that dystonia and tremor are closely linked. Tremors occurring in people with dystonia are either jerky and irregular, regular and wave-like, or mixed. Mixed types commonly affect the hands.
The following health conditions can also cause shaky hands:
- psychiatric conditions, such as depression or post-traumatic stress disorder
- inherited degenerative disorders, such as hereditary ataxia or fragile X syndrome
- alcohol misuse or withdrawal
- mercury poisoning
- liver or kidney failure
- anxiety or panic
Certain drugs can also cause hand tremors. Examples include:
- some asthma medications
- Drugs for psychiatric conditions, such as certain antidepressants and mood stabilizers
- seizure medications, such as valproate (Depakene) and valproic acid (Depakote)
- anti-arrhythmic drugs, such as procainamide
- cancer medications, such as thalidomide
- Medications that suppress the immune system, such as cyclosporine
- certain antiviral drugs
- specific antibiotics
It is normal to have shaky hands. This is especially if a person is feeling stressed or anxious or has had insufficient sleep.
Mild hand tremors that do not affect a person’s daily life are not usually a cause for concern. However, if a person experiences severe or persistent hand tremors that interfere with their daily activities, they should see a doctor to help determine the cause.
Below are some methods people may be able to use to help stop their hands from shaking.
- Lifestyle changes: The following lifestyle changes may help to reduce hand tremors in people with enhanced physiologic tremor:
- avoiding vigorous exercise
- avoiding excess alcohol consumption
- avoiding stimulants, such as caffeine and amphetamines
- Treating underlying conditions: Hand tremors that occur due to an underlying condition, such as hyperthyroidism or alcohol withdrawal, typically improve following treatment for the underlying condition.
- Psychological techniques: People who experience tremors due to anxiety or panic attacks may benefit from practicing relaxation techniques, such as mindfulness and breathing exercises.
- Switching medications: Tremor can be a side effect of taking certain drugs. A person who experiences tremors while taking a medication should report the side effect to their doctor. The doctor may be able to adjust the medication dosage or switch the person to a different drug.
- Physical therapy: A physical therapist can teach people exercises to improve the following:
- muscle control, functioning, and strength
- Occupational therapy: An occupational therapist can help people living with tremors to continue to engage in their usual daily activities.
Anyone who suddenly develops tremors in their hands or other parts of their body should see their doctor for a diagnosis. A doctor will need to rule out more serious causes, some of which may require prompt medical treatment.
People with existing tremors should see a doctor if the tremors worsen or begin to interfere with their daily life.
Most types of tremors are incurable. However, treatment options are available to help a person manage the symptoms.
Doctors may prescribe medications to help reduce the frequency and severity of tremors. Possible treatment options include:
- beta-blockers, such as propranolol
- anxiety medications
- anti-seizure medications, such as primidone
Doctors may also prescribe disease-specific drugs for people with tremors related to specific conditions such as PD and MS. If doctors are unable to determine the cause of tremors, they may prescribe tranquilizers to help relax the involuntary muscle movements.
Botox is a neurotoxin that causes localized paralysis. Botox injections may be beneficial in treating voice and head tremors. However, botox injections for hand tremors can lead to weakness in the fingers.
Some people may experience a severe tremor that does not respond to medication or that significantly impacts their quality of life. In such cases, a doctor may recommend surgical interventions, such as deep brain stimulation (DBS).
When performing DBS surgery, a doctor places a small generator under the skin in the upper chest. The generator sends electrical signals to electrodes implanted in the thalamus, which is the part of the brain that coordinates and controls some involuntary movements.
Doctors use DBS to treat tremors associated with essential tremor, PD, or dystonia.
If a person is not eligible for DBS, a doctor may recommend other procedures, such as:
- Radiofrequency ablation: Involves using an electric current to heat nerve tissue in order to disrupt its ability to relay signals for several months.
- Radiosurgery: Involves administering highly focused radiation beams to destroy the overactive brain cells causing the tremor.
Everyone experiences a slight tremor in their hands or other body parts when moving or maintaining a particular posture. This is normal and is known as a “physiologic tremor.” Certain factors can make the tremor more noticeable, including stress or anxiety, caffeine consumption, and lack of sleep.
In some cases, severe or persistent tremors may indicate an underlying medical condition or a side effect of a particular medication. Anyone who suddenly develops tremors should see their doctor as soon as possible for a diagnosis.