The Right Diagnosis Can Save Time
Because the symptoms of Parkinsons vary and often overlap other conditions, it is misdiagnosed up to 30% of the time, Dr. Fernandez says. Misdiagnosis is even more common in the early stages.
Patients who dont know where to turn may make appointments with a rheumatologist, or an orthopaedic or heart specialist, and undergo MRIs, EMGs and other expensive tests.
But only a neurologist can distinguish Parkinsons from essential tremor, drug-induced Parkinsons and Parkinsons plus syndromes, he says.
If patients come to us with typical signs of Parkinsons, we dont need to order expensive tests, he says.
Instead, neurologists base their diagnosis on a detailed patient exam and medical history, along with other information from the patient, family members or caregivers.
Thats all stirred into the pot, he says. Sometimes we can diagnose Parkinsons with one visit. Other times, several follow-up visits are necessary.
Hand And Wrist Exercises
Your healthcare provider may refer you to a physical or occupational therapist for treatment or recommend exercises you can do at home.
Squeezing a stress ball or hand grip for two to 10 seconds, releasing, and repeating 10 times on each hand can be an easy exercise to incorporate into your day.
Rotating the wrists in a circular motion can keep tendons and ligaments flexible. Moving the hands with intention can keep synovial fluid from building up, which prevents or reduces tremors.
Curling a light hand weight with arms resting on a table and your palms facing up can also strengthen and fine-tune your muscle control.
Hand Tremors: How To Stop Shaky Hands
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Tremors are involuntary muscle spasms that can occur in many areas of the body. While twitching muscles can affect the eyes, legs, face, vocal cords, and other body parts, tremors are often associated with the hands. Living with hand tremors can be frustrating and make daily activities such as eating or dressing oneself difficult. Approximately 10 million people in the United States experience some form of hand tremors.
There are numerous types of tremors and reasons why they happen. Some are temporary and go away on their own, and others are linked to more severe health problems. Learn more about what causes hand tremors, how to stop shaky hands, and when to seek medical advice from a healthcare professional about hand tremors.
Surgery For Hand Tremors
In some cases of tremors, especially essential tremors, surgery may be necessary. A minimally invasive process of inserting a neurostimulator into the brain called deep brain stimulation is available. Similar to a pacemaker, the neurostimulator device sends an electrical pulse that can prevent tremors from occurring.
A thalamotomy is another surgery for individuals with essential tremors. This particular surgery interferes with the thalamus on one side of the brain. This surgery is often performed on the side of the brain opposite side of your dominant hand. The results of the operation will then impact and relieve symptoms of the dominant hand. Side effects of the surgery are often temporary but can include speech difficulties, confusion, and balance issues.
A Range Of Treatmentsis Available
The drugs used to treattremor tend to be sedating. Ask whether its safe to drive a car orperform work duties while taking them. Sedatives also may not interactwell with other drugs, which youre more likely to take as you age. So askabout potential problem drug interactions.
At best, medications can slow tremor but rarely stop it completely. When drugs are unable to control an active tremor, other treatment options are deep brain stimulation or high-frequency ultrasound ablation.
In deep brain stimulation, aneurosurgeon implants electrodes in the brain. The electrode uses a smallamount of electricity to normalize brain circuitry and reduce tremor.
Many patients are reluctantto consider surgery at first, but after the procedure, they wish theyd done itsooner, Dr. Gostkowski says.
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Which Body Parts Do Parkinsons Tremors Affect
There are five main places youâll have Parkinsonâs tremors:
1. Hands. Parkinsonâs disease tremors often start in the fingers or hands with whatâs called a pill-rolling motion. Imagine holding a pill between your thumb and index finger and rolling it back and forth.
2. Foot. A Parkinsonâs foot tremor is more likely to happen while youâre sitting or lying down with your feet at rest. If the tremor moves into your thigh muscles. It could look like your whole leg is shaking.
Foot tremors disappear when you stand or walk because those are active movements. A foot or leg tremor while youâre standing may be another condition.
3. Jaw. This is common in people with Parkinsonâs. It may look like youâre shivering. It can become bothersome if the tremor makes your teeth chatter. If you wear dentures, it could make them shift or fall out.
Chewing eases the tremor, so gum might help.
4. Tongue. Itâs rare, but a tongue tremor can cause your entire head to shake.
5. Internal. Some people with Parkinsonâs say they can feel a shaking sensation in their chest or abdomen. But canât be seen from the outside.
Some Tremors Run In Families
Some people are more likely thanothers to develop shakiness as they get older. Essential tremor is commonlypassed down genetically through families, for example.
Active tremors are notnecessarily inevitable as we age, but if your parents had age-relatedshakiness, youre more likely to have it too, Dr. Gostkowski says.
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If You Have A Tremor You Have Parkinsons Disease: Fiction
A tremor can be a symptom of Parkinsons disease, however, it does not mean that you have Parkinsons, explains Dr. Azmi. It could be an essential tremor.
Parkinsons disease is essentially a head-to-toe disorder with both motor and non-motor symptoms some are related to movement, cognition, emotions or sleep. Many systems can be involved, presenting in a variety of symptoms, and you may or may not have a tremor, says Dr. Azmi. Symptoms of Parkinsons include tremors, slowed or impaired movement, speech changes, and gait or balance problems.
With essential tremors, you may experience tremors, but not all of the other symptoms that go along with Parkinsons.
How Is Tremor Diagnosed
Tremor is diagnosed based on a physical and neurological examination and an individuals medical history. During the physical evaluation, a doctor will assess the tremor based on:
- whether the tremor occurs when the muscles are at rest or in action
- the location of the tremor on the body
- the appearance of the tremor .
The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain.
Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup. Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.
The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.
Trouble Moving Or Walking
Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.
What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.
What Are The Symptoms Of Essential Tremor
If you have essential tremor, you will have shaking and trembling at different times and in different situations, but some characteristics are common to all. Here is what you might typically experience:
- Tremors occur when you move and are less noticeable when you rest.
- Certain medicines, caffeine or stress can make your tremors worse.
- Tremors may improve with ingestion of a small amount of alcohol .
- Tremors get worse as you age.
- Tremors dont affect both sides of your body in the same way.
Here are signs of essential tremor:
- Tremors that are most obvious in your hands
- Difficulty doing tasks with your hands, such as writing or using tools
- Shaking or quivering sound in your voice
- Uncontrollable head-nodding
- In rare instances, tremors in your legs or feet
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What Treatments Are Available
Treatment depends on the symptoms and extent of disability caused by the tremor. If the tremor is mild, lifestyle adjustments may be all that are needed. As the condition progresses, medications or surgery can be used to relieve the symptoms.
Caffeine and stress should be avoided, and good sleep is recommended. Your doctor may recommend physical therapy, which can improve your muscle strength. Adaptive devices, including wide-grip pens and eating utensils, may help you compensate for your tremor. Alcohol, used in moderation, can reduce tremor for short periods of time.
Your doctor may prescribe certain drugs or injections to help reduce the tremors. These include, but are not limited to:
- Propranolol, a beta-blocker that is primarily used to treat high blood pressure
- Anti-seizure medications, including primidone, gabapentin, and topiramate
- Anti-anxiety medications, including clonazepam, diazepam, lorazepam, and alprazolam
- Botulinum toxin injections for head and voice tremors
The goal of surgery is to reduce symptoms by modifying the abnormal signals that cause the tremor. This can be done with deep brain stimulation or with radiosurgery.
DBS surgery involves implanting electrodes within the brain and connecting them to a stimulator device that resembles a pacemaker. The stimulator delivers electrical pulses to regulate brain activity. Radiosurgery creates a small, permanent lesion in the brain without a permanent implant.
When Should Someone See A Doctor For Shaky Hands
If you have hand tremors, seeking professional help sooner than later could prevent the worsening of a severe medical condition. Medications that slow the onset and progression of neurological disorders could be an essential step to managing your wellness. On the other hand, your healthcare professional may inform you that you just need to reduce stress in your life or switch to decaf. Either way, finding out why you have hand tremors should be a priority.
You’re Experiencing Intense Emotions
Shaky hands often manifest when we are “in our feelings.” So those nerves you were feeling when you were trying to get that big project done last week? Those emotions triggered your autonomic nervous system to “enhance” those physiological tremors. Your autonomic nervous system controls involuntary body functions such as breathing, blood pressure, heartbeat, and eye dilation. When you feel threatened or vulnerable, your sympathetic nervous system fires up and signals your adrenal glands to release epinephrine into your body.
Your heart might start beating out of your chest. You breath might quicken. You could start sweating or shaking. This is what is commonly known as “fight-or-flight” mode, according to Harvard Health. Your body is preparing to protect itself from dangereven if that threat isn’t as scary as a tiger chasing after you. The “danger” could be grumpy messages from your boss.
Nerves, anxiety, stress, excitement, and even intense anger can act as an emergency signal to the body’s self-defense systems, potentially causing your hands to shake.
Medications That Cause Tremors
Hand tremors are the potential side effect of numerous medications. Prescription drugs used to treat depression, asthma, cancer, and acid reflux are among many that can cause shaky hands. Some antibiotics, weight loss medications, and antivirals are also on the list of drugs that can result in temporary hand tremors.
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Essential Tremor Is Not Parkinsons Disease
Essential tremor and Parkinsons disease are different conditions. Essential tremor is characterised by shaking when movement starts, which can continue or worsen during movement. The symptoms of Parkinsons disease include:
- involuntary tremor when you are not moving
- muscle stiffness
- slowness of movement
Parkinsons disease is caused by a lack of supply of the brain chemical dopamine, which is necessary for smooth and controlled muscular movement.
What Is A Tremor
A tremor is a rhythmic shaking movement in one or more parts of your body. It is involuntary, meaning that you cannot control it. This shaking happens because of muscle contractions.
A tremor is most often in your hands, but it could also affect your arms, head, vocal cords, trunk, and legs. It may come and go, or it may be constant. Tremor can happen on its own or be caused by another disorder.
What Is An Essential Tremor
Tremor is the shaky movements of your hands, limbs, head or voice that you can’t control. Sometimes tremor is a normal reaction to a situation such as fear, fatigue or anger. It also can be a side effect of too much caffeine, a medication, or withdrawal from a drug or medicine. When tremor occurs during activities and there is no emotional or chemical cause, it can be a sign of a neurological disease called essential tremor.
Essential tremor is different than Parkinson’s disease, another neurological illness. Essential tremor is most noticeable when your body is in action, such as when you are writing, typing or pouring a beverage. In contrast, the tremors of Parkinson’s are more noticeable at rest.
In essential tremor, tremors begin when you use your hands. For example, when you are writing, typing or pouring a beverage. Essential tremor often begins in the dominant hand.
People sometimes worry that essential tremor is the start of Parkinson’s disease. The two conditions are very different. The tremors of Parkinson’s are more noticeable at rest. People with Parkinson’s watch their hands shake when they rest in their lap. But when they reach out to grab or hold something, such as a cup of coffee, the shaking stops.
As many as one in four people develop essential tremor as they age. You are more likely to develop essential tremor if you have a parent or sibling with the condition.
Essential tremor is much more common than Parkinson’s disease.
Medications For Essential Tremor
Propanolol and primidone are two of the medicines often prescribed to treat essential tremor.
Propanolol blocks the stimulating action of neurotransmitters to calm your trembling. This beta blocker is effective in 40% to 50% of patients and is less useful in reducing head and voice tremor. It is usually avoided in patients with asthma, emphysema, congestive heart failure or heart block, and should be used with caution by people with diabetes who are on insulin. These drugs may reduce exercise tolerance, lower blood pressure or heart rate, exacerbate depression and cause impotence. Other adrenergic blockers with fewer side effects include atenolol, nadolol, metoprolol and timolol.
Primidone controls the actions of neurotransmitters. Some patients starting primidone may experience a first dose phenomenon during which they have transient feelings of unsteadiness, dizziness and nausea during the beginning stages of treatment. This is usually short-lived. Sedation is another common side effect and can be reduced by following a slowly escalating dose schedule. Most patients are able to tolerate the side effects, and studies have shown that 60% to 100% of patients respond positively.
If primidone or propranolol are not effective by themselves, a combination of both may provide relief for some patients.
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Hand Tremors: What Are They
Hand tremors, or shaky hands, may not be life-threatening on their own, but they can still disrupt your life. In some cases, hand tremor may be a signal of neurological issues or degenerative disease. Its a good idea to seek out your healthcare provider if youve suddenly developed or noticed hand tremor.
Although learning more about your health and body on your own is important, an official diagnosis and treatment plan made in conjunction with your doctor is the best course of action to treat hand tremor symptoms.
Talk To Your Doctor About Treatments
If youve experienced shaky hands or symptoms of essential tremor, make an appointment to speak with your doctor. Your doctor will likely request several medical and physical tests to rule out other possibilities before a diagnosis can be made.
Once a diagnosis has been made, you can begin to discuss treatment options. Treatment may not be necessary if the tremor is mild and doesnt 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. Work with your doctor and any therapists or specialists you visit to find a plan that best suits your needs.
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Treating A Severe Tremor
If you have a tremor that’s affecting your life, your GP may prescribe medicine. Medicine 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 helped by medicine.