I am in my late 30s and have noticed slight tremors in my hands lately. It is much worse after I have been drinking or after a lot of coffee. It used to be much worse when I was in college and drank more often. My wife said I should get it checked out. What do you think? If it just related to drinking and coffee, is it an issue?
A tremor is defined as a rhythmic shaking movement in one or more body parts, most often in the hands, but the head, arms, legs, trunk and even the tongue or vocal cords can be affected. The shaking happens due to synchronous or alternating contractions of antagonistic muscle groups of the particular body part.
Tremors can be categorised in a few different ways. One way to differentiate them is by the activating conditions that give rise to the tremor namely, action or rest tremors. Action tremors are more common and occur with voluntary muscle contraction. Voluntary means you decide to move the affected body part.
Luckily, a tremor is very common and can occur on and off in individuals in the form of exaggerated physiologic tremor. Physiologic tremors are the most common cause of an action tremor. Sometimes they can be due to hyperthyroidism, low blood sugars or a side effect of certain medications. You mentioned that after consuming a lot of caffeine/alcohol that your tremor gets worse. This is very reassuring and points to a physiologic tremor. When the simple causes are corrected, the tremor typically resolves partially or completely. Is there anyone else in your family who suffers with a similar tremor? Another type of tremor that is inherited is a benign essential tremor (ET). The exact cause is unknown.
The incidence of ET increases with age and has an estimated worldwide prevalence of up to 5pc. In most cases, ET affects the upper limb (hands and arms) on both sides (bilaterally) but not always equally on both sides (asymmetric). It is often noticed more in the dominant hand because it is an action tremor. ET becomes apparent when the arms are held in a horizontal outstretched position. It typically increases at the end of goal-directed movements such as drinking from a cup/glass and can be elicited during finger-to-nose testing on clinical examination.
The typical tremor seen in Parkinson’s disease (PD) is called a rest tremor. The shake occurs when the affected body part is fully supported against gravity and completely at rest. Another feature of a rest tremor is that the tremor is temporarily reduced or even goes away during a voluntary action. Rest tremors can fluctuate in severity depending on whether the person feels under observation, under stress or during excitement/recent exercise.
The rest tremor in PD is typically on one side (unilateral) and occurs first in one hand or less commonly in one leg but may also involve the face, lip or jaw. Rest tremors can follow a relatively benign course, can progress over time to PD, or be part of another neurological disease such as Parkinsonian syndrome.
In order to get a proper diagnosis, it is best to attend your doctor for a physical examination. It is important to assess the full neurological system for balance/speech abnormalities and increased muscle stiffness or rigidity. You should have blood tests and your doctor may consider ordering diagnostic imaging tests to ensure normal brain anatomy. But judging by the description of your tremor, it does not sound like anything serious.
If you have any queries, email email@example.com. Dr Jennifer Grant is a GP with Beacon HealthCheck