Skip to main content
ASK AN EXPERT
Got a question about a health story in the news or a health topic? Here's your chance to get an answer. Send us your questions about general health topics, diet and fitness and mental health. If your question is chosen, it could be featured on CNN.com's health page with an answer from one of our health experts, or by a participant in the CNNhealth community.




* CNN encourages you to contribute a question. By submitting a question, you agree to the following terms found below.
You may not post any unlawful, threatening, libelous, defamatory, obscene, pornographic or other material that would violate the law. By submitting your question, you hereby give CNN the right, but not the obligation, to post, air, edit, exhibit, telecast, cablecast, webcast, re-use, publish, reproduce, use, license, print, distribute or otherwise use your questions(s) and accompanying personal identifying and other information you provide via all forms of media now known or hereafter devised, worldwide, in perpetuity. CNN Privacy Statment.
Thank you for your question!

It will be reviewed and considered for posting on CNNHealth.com. Questions and comments are moderated by CNN and will not appear until after they have been reviewed and approved. Unfortunately, because of the voume of questions we receive, not all can be posted.

Submit another question or Go back to CNNHealth.com

Read answers from our experts: Living Well | Diet & Fitness | Mental Health | Conditions

Expert Q&A

  • Share this on:
    Share
  • E-mail
  • Save
  • Print

Other possible causes of hand tremors

Asked by Beth, Georgia

Open quote
Close quote

Last week, Dr. Otis Brawley answered Beth's question about whether her chemotherapy for breast cancer could be causing her hands to shake excessively. Now he looks at other reasons this might be happening.

Expert Bio Picture

Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

There are a number of things that can cause tremors or shakiness. They include: commonly used, over-the-counter and prescription drugs, some exposures to heavy metals such as lead and arsenic, certain vitamin deficiencies as well as brain and neurologic disorders such as stroke, multiple sclerosis or Parkinson's disease. This list is by no means exhaustive.

The approach to a patient with a tremor often requires a neurologist specializing in kinetic disorders. It's important that the doctor get a full history of the illness. This includes: when it started, when it happens, what seems to stop it. A complete physical exam with attention to the nervous system and certain laboratory blood studies are also needed.

The doctor may order some imaging of the brain and spinal cord by computerized tomography or magnetic resonance imaging. A patient with a history of breast cancer of any type who has new-onset tremor will also be assessed for metastasis or spread of the cancer to the brain.

A detailed description of the tremor is important and can be obtained from the patient and from observation. There are numerous types of tremors, among them resting tremors, intention tremors and action tremors. Each has a different set of possible causes.

Resting tremors are the most common. They are evident with the affected body part supported and at rest, and they temporarily dampen or disappear during voluntary activity.

Conditions or disorders associated with resting tremors include Wilson's disease in which the liver has difficulty handing copper, midbrain injury due to stroke and trauma, or demyelinating diseases such as multiple sclerosis.

The brain disorders, known as the Parkinsonian syndromes, are the most common causes of resting tremors. Parkinson's disease is one of these syndromes and usually comes with slowness of motion and unsteady gait along with tremors.

Action tremors remain unchanged during the course of a voluntary movement. The most common action tremor is known as an Essential Tremor. It usually affects the hands and arms and can be asymmetric. It can affect the head, voice, chin, trunk and legs. It increases at the end of goal-directed movements, such as drinking from a glass or finger-to-nose testing. It is often inherited, commonly starts in the 40s and may be a risk factor for development of Parkinson's disease.

Intention tremors increase during the course of goal-directed movement. They are most commonly caused by damage to the part of the brain called the cerebellum or the long nerves of the spine.

All of us have small physiologic tremors that are not visible under ordinary circumstances. Indeed, that's normal.

Many factors can enhance the physiologic tremor to the point of detection, most often by increasing sympathetic nervous activity. The sympathetic nerves are the system of nerves excited by adrenalin from our adrenal gland when a person is frightened. It causes a person to be tense, increases blood pressure and alertness.

Common causes of physiologic tremors are:

• beta-adrenergic drugs such as terbutaline, isoproterenol and epinephrine, which are used to treat asthma

• amphetamines, used to treat a number of conditions

• selective serotonin reuptake inhibitors used to treat depression and anxiety

• tricyclic antidepressants commonly used to treat depression, anxiety and neurogenic pain

• lithium, used to treat bipolar disorder

• levodopa used to treat Parkinson's disease

• Nicotine from tobacco use including chewing tobacco

• xanthines such as the asthma medicine theophylline and caffeine found in numerous drinks

• corticosteroids used to treat a number of things,

• the anti-seizure drug sodium valproate,

• opioid withdrawal

• thyroid disease and thyroid replacement therapy

Other causes are anxiety, excitement, fright, muscle fatigue, low blood sugar, alcohol and fever. A rare tumor known as pheochromocytoma can cause tremors, as can chemical exposures, such as to bromides, mercury, lead and arsenic.

By far the most common cause of tremors are drugs commonly used such as the selective serotonin reuptake inhibitors and tricyclic antidepressants. Asthma and thyroid medicines are also common causes of tremors.

More Q&A

  • CNN's Medical UnitCNN's medical unit brings you the best experts available to answer your questions about current events and health issues that matter most to you.
Is secondhand smoke really that risky?asked by: Asked by David; Tampa, Florida
Can a nerve stimulator stop my back pain?asked by: Asked by Larry; New York
Is the inability of cancer patients to eat a concern?asked by: Steve Snodgrass; Bowling Green, Kentucky

CNN Comment Policy: CNN encourages you to add a comment to this discussion. You may not post any unlawful, threatening, defamatory, obscene, pornographic or other material that would violate the law. All comments should be relevant to the topic and remain respectful of other authors and commenters. You are solely responsible for your own comments, the consequences of posting those comments, and the consequences of any reliance by you on the comments of others. By submitting your comment, you hereby give CNN the right, but not the obligation, to post, air, edit, exhibit, telecast, cablecast, webcast, re-use, publish, reproduce, use, license, print, distribute or otherwise use your comment(s) and accompanying personal identifying and other information you provide via all forms of media now known or hereafter devised, worldwide, in perpetuity. CNN Privacy Statement.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.