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Tremors are unintentional trembling or shaking movements in one or more parts of the body. They can be caused by a variety of factors, including stress, fear, anxiety, alcohol use, brain damage, brain tumours, metabolic conditions, neurodegenerative conditions, traumatic brain injuries, and certain medications. Tremors are often categorized as either rest or action tremors, depending on whether they occur when the muscles are at rest or in action. Rest tremors are commonly seen in people with Parkinson's disease, while action tremors occur during voluntary muscle movement. Tremors can also be classified as postural, kinetic, isometric, orthostatic, dystonic, essential, or Parkinsonian, among other types. While some tremors are mild and do not require treatment, others can severely impact daily activities and cause emotional distress. Treatment options include physical therapy, wrist weights, adaptive devices, medications, botox injections, and in severe cases, deep brain stimulation surgery.
| Characteristics | Values |
|---|---|
| Definition | Unintentional trembling or shaking movements in one or more body parts |
| Types | Resting, action, postural, kinetic, isometric, orthostatic, dystonic, essential, Parkinsonian, functional, task-specific, physiologic, and acerebellar |
| Causes | Brain damage, alcohol use disorder, brain tumours, certain medications, metabolic conditions (e.g., hyperthyroidism), neurodegenerative conditions (e.g., Parkinson's disease, multiple sclerosis), traumatic brain injuries, stress, anxiety, fear, caffeine, asthma medicines, chemotherapy, corticosteroids, poisoning from toxic substances (e.g., pesticides, heavy metals) |
| Diagnosis | Physical exam, brain and nervous system exam, blood or urine samples, diagnostic imaging, electromyogram |
| Treatment | Physical therapy, wrist weights, adaptive devices, deep brain stimulation (DBS), medication, Botox injections, surgery, self-care measures (e.g., relaxation techniques, avoiding caffeine and stimulants, adequate sleep) |
| Impact | May affect daily activities (e.g., eating, walking, dressing), cause emotional distress, interfere with work, lead to neurological symptoms |
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What You'll Learn
- Types of muscle tremors: resting, action, postural, kinetic, and isometric
- Causes: brain damage, alcohol use, brain tumours, certain medications, metabolic conditions
- Dystonic tremors: caused by dystonia, a movement disorder with involuntary muscle contractions
- Orthostatic tremors: rapid muscle contractions in the legs when standing, cause is unknown
- Treatment: physical therapy, wrist weights, deep brain stimulation, medication, surgery
Types of muscle tremors: resting, action, postural, kinetic, and isometric
Tremors are characterised by involuntary, rhythmic, oscillatory movements of a body part. They are the most common movement disorder encountered in primary care. While some conditions, like essential tremor, only have tremors as a symptom, in other conditions, such as Parkinson's disease and multiple sclerosis, tremors are one of many symptoms.
Healthcare providers categorise tremors into two main types based on when and how they start: resting tremors and action tremors. Resting tremors occur in a body part that is relaxed and completely supported against gravity. For example, if your arm is resting on a flat surface and it starts shaking, that is a resting tremor. Action tremors, on the other hand, occur with voluntary contraction of a muscle and can be further subdivided into postural, isometric, and kinetic tremors.
Postural tremors occur when a body part is held in a position against gravity. They can be observed by having the patient stretch their arms and hands out. Postural tremors can become a very disabling symptom in patients with certain conditions, such as CIDP.
Isometric tremors occur during a voluntary muscle contraction that does not involve motion, such as making a fist or holding a heavy object in the same position.
Kinetic tremors are associated with any voluntary movement and include intention tremors, which are produced with target-directed movement. They can be observed through a simple finger-to-nose test. Kinetic tremors can also be seen as the affected body part approaches a particular target, such as a finger reaching the nose.
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Causes: brain damage, alcohol use, brain tumours, certain medications, metabolic conditions
A muscle tremor is a rhythmic movement of a body part that occurs involuntarily. Tremors can be categorised as either resting tremors or action tremors. Resting tremors occur in a body part that is relaxed and supported against gravity, while action tremors occur when muscles in the affected body part are voluntarily contracted.
Tremors can be caused by various factors, including brain damage, alcohol use, brain tumours, certain medications, and metabolic conditions. Here is a more detailed description of these causes:
Brain Damage
Brain damage can result from traumatic brain injuries or stroke, damaging the neural pathways responsible for communication between the brain and the rest of the body. Cerebellar tremors, for instance, occur due to injury to the cerebellum, leading to slow and visible shaking movements in the arms and legs. Midbrain tremors, or rubral tremors, arise from damage to the neural pathways connecting the cerebellum to the brain stem. Psychogenic tremors, or functional tremors, can also occur due to underlying psychological conditions such as depression or post-traumatic stress disorder (PTSD) following brain injuries.
Alcohol Use
Alcohol withdrawal can cause tremors, typically known as alcohol shakes or jitters. These tremors occur as the part of the brain controlling muscles reacts to the absence of alcohol. They usually start within 6 to 12 hours after the last drink, worsening with movement and improving after a few days. Alcohol shakes primarily affect the hands but can also impact the arms, legs, and other body parts.
Brain Tumours
Brain tumours can exhibit various symptoms depending on their location in the brain. While common symptoms include headaches, nausea, and seizures, tremors can also occur due to increased intracranial pressure affecting specific brain areas. For example, a tumour in the frontal lobe, which controls movement, can potentially cause tremors.
Certain Medications
Several medications have been linked to the development or worsening of tremors. Immunosuppressants, used after organ transplants, have been associated with medication-induced tremors, particularly at higher doses. Antibiotics, such as aminoglycosides, and medications for hypothyroidism, like levothyroxine, have also been implicated. Additionally, selective serotonin reuptake inhibitors (SSRIs) and amitriptyline have been known to influence tremor progression or amplitude.
Metabolic Conditions
Certain metabolic conditions, such as hyperthyroidism, hypocalcemia, hypoglycemia, and hypomagnesemia, can lead to tremors. These conditions are typically treatable, and addressing them often resolves the associated tremors.
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Dystonic tremors: caused by dystonia, a movement disorder with involuntary muscle contractions
A muscle tremor is a rhythmic movement that is out of your control. It can occur when you are voluntarily contracting a muscle but not moving your muscle or limb, such as when you make a fist. Tremors can also occur with voluntary movement, like closing and opening your eyes or lifting your hand to touch your nose.
Dystonic Tremors
Dystonic tremors are caused by dystonia, a movement disorder with involuntary muscle contractions. Dystonia is a nervous system disorder that causes uncontrollable muscle contractions, meaning a person's muscles tense up without them trying to make them do so. It is a complex, highly variable neurological movement disorder that affects the brain's control of muscles throughout the body. The key symptom of dystonia is uncontrollable muscle movements, often uncomfortable or painful, repetitive, variable in duration, and twisting or stretching in nature. Dystonic tremors are usually irregular and jerky, and they can be stopped by certain hand or arm positions. They are caused by damage to the basal ganglia.
Dystonia can affect muscles or groups of muscles in different ways. Focal dystonia, for example, is limited to one area of the body and can affect the neck, eyes, jaw/mouth/lower face, vocal cords, or arms/legs. Other types of focal dystonia can cause unusual stretching, bending, or twisting of the trunk or abdominal wall. Segmental dystonia affects two or more adjacent body parts, such as different parts of the face, head and neck, or hand and arm. Cervical dystonia, which affects the muscles in the head and neck, is the most common example of segmental dystonia.
Dystonia can develop at any age and knows no racial or ethnic boundaries. It is believed to affect about 250,000-300,000 people in the United States, though it is hard to know the exact number due to under-diagnosis. The early signs of dystonia are often mild and infrequent and linked to specific activities. There is no definitive test for dystonia, but doctors can diagnose it through a neurological exam and learning about symptoms. Brain MRIs and genetic testing may also be used to rule out other causes or in specific cases.
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Orthostatic tremors: rapid muscle contractions in the legs when standing, cause is unknown
A muscle tremor is a rhythmic movement of a body part that occurs involuntarily. Tremors can be categorised into two main types: resting tremor and action tremor. Resting tremor occurs in a relaxed body part that is supported against gravity, while action tremor occurs when muscles in the affected body part are voluntarily contracted.
Orthostatic tremors are a specific type of action tremor that involves rapid muscle contractions in the legs when standing. This type of tremor is rare and its cause is currently unknown. Individuals experiencing orthostatic tremors may feel unsteady or unbalanced while standing, but the tremors improve or disappear when walking, sitting, or leaning. The contractions occur very quickly and may not be visible, but they can be felt by touching the thighs or calves. Orthostatic tremors do not develop into other conditions or affect other systems of the body, and they are primarily characterised by their position-specific nature.
The main symptom of orthostatic tremors is the feeling of unsteadiness while standing, which can be alleviated by sitting or walking. The rapid muscle contractions may not be visible, but they can often be felt as a rippling sensation by touching the legs. While orthostatic tremors are typically not painful, some individuals may develop leg muscle pain over time. It is important to note that orthostatic tremors are distinct from orthostatic myoclonus, which refers to sudden, involuntary jerking of muscles caused by contraction or relaxation.
To diagnose orthostatic tremors, healthcare providers will consider an individual's symptoms and medical history, followed by a physical and neurological examination. A surface electromyogram (EMG) can also be used to evaluate the electrical impulses of muscles during contraction and at rest, aiding in the diagnosis of orthostatic tremors. Certain medications, such as clonazepam and gabapentin, have been found to help relieve symptoms associated with orthostatic tremors. Additionally, mobility aids can assist in managing everyday tasks.
While the exact cause of orthostatic tremors remains unknown, they are believed to be related to disorders of the central nervous system, particularly the cerebellum or basal ganglia. Tremors can also be caused by anxiety or medication use.
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Treatment: physical therapy, wrist weights, deep brain stimulation, medication, surgery
Muscle tremors are involuntary and uncontrollable muscle movements that can affect various body parts, such as the hands, arms, legs, or head. Tremors can interfere with daily activities such as eating, drinking, walking, or dressing, impacting an individual's quality of life and independence. While tremors can be a standalone condition, they can also be a symptom of other neurological disorders such as Parkinson's disease or multiple sclerosis.
Physical Therapy
Physical therapy can be a crucial part of managing muscle tremors. While it may not directly cure the tremors, it can help individuals cope with the symptoms and improve their overall quality of life. This may include exercises to improve muscle strength, coordination, and balance, as well as strategies to adapt and perform daily tasks more efficiently.
Wrist Weights
Wrist weights, also known as weighted bracelets, are assistive medical devices designed to help individuals with hand and arm tremors. They can be worn throughout the day and help stabilise the hands and arms, making it easier to perform tasks such as eating and drinking. The effectiveness of this treatment is directly related to the amount of weight applied to the wrist, with more weight often leading to better results.
Deep Brain Stimulation (DBS)
Deep brain stimulation is a surgical procedure used to treat movement disorders, including muscle tremors. It involves implanting electrodes in specific areas of the brain and attaching them to a small impulse generator placed under the skin on the upper chest. DBS does not destroy brain tissue and can be adjusted or removed at any time, making it a flexible option. However, as with any surgery, there are risks involved, including bleeding in the brain, paralysis, seizures, and infections.
Medication
Medication can be a crucial part of managing muscle tremors, especially in the early stages of treatment. Various drugs can help reduce the severity of tremors and slow down their progression. It is important to consult a healthcare professional to determine the most suitable medication and dosage for an individual's specific needs.
Surgery
In more severe cases of muscle tremors, surgery may be considered as an option. Surgical procedures aim to target the areas of the brain responsible for the tremors and can include techniques such as thalamotomy (destruction of the thalamus) or the implantation of electrodes in deep brain stimulation. Surgery is typically a last resort when other treatments have proven inadequate, as it carries risks and may not be suitable for everyone.
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Frequently asked questions
A muscle tremor is an unintentional trembling or shaking movement in one or more parts of the body.
There are several types of muscle tremors, including:
- Resting tremor
- Action tremor
- Postural tremor
- Kinetic tremor
- Isometric tremor
- Orthostatic tremor
- Dystonic tremor
- Parkinsonian tremor
Muscle tremors can have various causes, including:
- Brain damage
- Alcohol use disorder or withdrawal
- Brain tumours
- Certain medications
- Metabolic conditions
- Neurodegenerative conditions
- Traumatic brain injuries
- Stress, anxiety, or fear
The treatment for muscle tremors depends on the underlying cause. In some cases, medications or Botox injections can help relieve symptoms. Physical therapy, speech-language therapy, and occupational therapy may also be recommended. For severe cases that do not respond to medications, surgery, such as deep brain stimulation (DBS), may be an option.
