Tremors in the hands can occur without a cause or as a symptom of an underlying condition. Shaky hands is not a life-threatening symptom, but it can have an impact on daily activities.
Most people have a slight tremor in the hands, and it may be especially noticeable when holding the hands straight out in front of the body.
Tremors range in severity, and several conditions can cause more noticeable shaking.
In this article, we explore common causes of hand tremors and their treatments.
A tremor is a common movement disorder. An involuntary, rhythmic muscle contraction causes the shaking. Tremors are most common in the hands, but they can also occur in the arms, head, vocal cords, torso, and legs.
Tremors can be intermittent, happening every so often, or constant. Sometimes tremors develop on their own, and other times they signal an underlying health issue.
Shaky hands may lead to difficulty writing and drawing. A person may also have trouble holding and using tools and utensils, such as cutlery.
There are more than 20 types of tremor, but most fall into two categories:
Resting tremors: These occur when the muscles are relaxed, such as when the hands are resting on the lap.
Action tremors: The majority of tremors are action tremors. They happen when the muscles are contracted because of voluntary movement.
Issues affecting the brain are usually responsible for tremors.
In some cases, the cause is unknown, but tremors often result from neurological conditions, movement disorders, or other health problems.
Some neurological conditions that can cause shaky hands include:
- Multiple sclerosis (MS): 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.
- Stroke: An ischemic stroke occurs when a blood clot blocks an artery, preventing blood from reaching the brain. This can cause lasting damage to neurological pathways and lead to tremors.
- Traumatic brain injury: Physical injury to the brain can also damage nerves that play a role in coordinating movement. Hand tremors may occur when an injury affects certain nerves.
- Parkinson's disease: More than 25 percent of people with Parkinson's disease have a related action tremor, as well as a more common resting tremor in one or both hands. Tremors usually begin on one side of the body, and they may spread to the other side. Shaking may become more pronounced during periods of stress or strong emotion.
The following are examples of movement disorders that can cause hand tremors:
- Essential tremor: This is among the most common movement disorders, and the cause is unknown. The tremor usually affects both sides of the body, but it may be more noticeable in the dominant hand. It tends to occur when the person is moving as well as when standing still. Genetics may be responsible for around half of the cases of essential tremor.
- Dystonic tremor: In a person with dystonia, the brain sends incorrect messages, resulting in overactive muscles, abnormal postures, and sustained undesired movements. Young adults and those in middle age are most likely to develop dystonic tremors, which can occur in any muscle.
The following health issues 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 abuse or withdrawal
- mercury poisoning
- hyperthyroidism, or an overactive thyroid
- liver or kidney failure
- anxiety or panic
Certain drugs can also cause hand tremors, such as:
- some asthma medicines
- medicines used to treat certain psychiatric and neurological disorders
If an underlying condition, such as hyperthyroidism, is responsible for the tremor, it will usually get better when a person receives treatment. If a tremor is a side effect, it will often go away when a person switches medications.
The following may also help:
Limiting or avoiding substances that can cause tremors, such as caffeine and amphetamines, can reduce or eliminate a person's shaking.
This can improve muscle control, functioning, and strength while enhancing coordination and balance. An occupational therapist can help people living with tremors to continue to engage in daily activities.
If anxiety or panic is responsible for a tremor, a person may benefit from practicing relaxation techniques, such as breathing exercises.
Most types of tremor cannot be cured, and a mild tremor usually requires no treatment.
If the shaking is impacting everyday life, however, many treatments are available.
Essential tremor treatments
For essential tremor, a doctor may prescribe beta-blockers, such as propranolol, metoprolol, or nadolol. A doctor may also recommend anti-seizure medication, such as primidone.
Parkinson's disease treatments
Doctors often prescribe disease-specific drugs, such as levodopa and carbidopa, to manage advanced cases.
Beta-blockers, anti-anxiety drugs, and anticonvulsive medications are among the treatment options for people with MS-related tremors.
Tremors with no obvious cause
If doctors cannot determine the cause of tremors, they may prescribe tranquilizers. Some may prescribe injections of botulinum toxin, or Botox, though these can lead to weakness in the fingers.
If a person does not respond to medication or has a severe tremor that significantly impacts their life, a doctor may recommend interventions such as deep brain stimulation (DBS).
DBS requires a doctor to place a small generator under the skin in the upper chest. It 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 Parkinson's disease, essential tremor, or dystonia.
The hands may shake more as a person ages. Certain medications, substances such as caffeine, and anxiety can also cause tremors.
If shaking persists or worsens and gets in the way of everyday activities, seek medical advice.