Hand tremor: causes, treatment in children andadults

Update: October 2018

Tremor is a frequent involuntary and rhythmic movement.
caused by the contraction of muscle fibers. Each of us in life at least
once experienced such a condition as shaking hands. Withчины, почему
shaking hands are very diverse. If the physiological condition –
it passes independently, with the pathological – it grows,
often repeated and indicates the presence of any disease.


To understand how to get rid of hand tremor, you need to
understand not only its cause of occurrence, but also determine
what kind of jerking it is, further will depend on it
diagnosis, treatment. Trembling рук подразумевает такие

  • The amplitude of movements is a shiver, sweeping shaking,
    subtle hand shake
  • The time when it appears – when moving, trying to take the item
    or alone
  • What looks like – rolling pills, counting coins
  • Origin – peripheral or central (location
    center generating jitter)
  • The presence or absence of diseases – pathological or
    physiological twitching.

There are the following main types of jitter:

  • Resting tremor – low frequency (3-6 Hz), arises and intensifies
    at rest. It is a typical manifestation of Parkinson’s disease and other
    neurological diseases associated with the syndrome
    parkinsonism. Therefore, it is often called parkinsonian
  • Postural – characterized by the fact that it appears when you hold
    limbs in any particular position. Its frequency
    is 6-12 Hz. It occurs in many diseases, including
    including hereditary tremor, endocrine diseases.
  • Intentional – differs a certain pattern of movement, he
    krupnorazmashisty with a frequency of not more than 5 Hz. Strengthens when standing
    with eyes closed, arms outstretched forward and outstretched
    with your fingers. Increases when performing precise movements, for example, when
    trying to hit the tip of your nose with your index finger
    eyes closed. It is characteristic of any lesions.
    stato-coordinating function of the brain.
  • Рубральный  – появляется при поражении среднего мозга.
    Withчиной этого может стать опухоль, инсульт, рассеянный склероз,
    injury. Its peculiarity is that tremor is first expressed
    rest, noticeable increases in postural manifestations and to the maximum
    выражен интенционный tremor. Shaking observed in limbs
    opposite localization of the lesion in the midbrain.
  • Psychogenic– it differs in that the onset of the disease is abrupt and
    associated with some kind of emotional experience. Shaking not
    progresses, has remission, often associated with the passage
    psychotherapy or treatment with medication prescribed
    psychotherapist. Могут быть проявления  tremor покоя, 
    постурального,  интенционного в равной степени.

Physiological causes

This condition does not require treatment and consultation with a doctor. Him
the frequency is usually 8-12 Hz. Withчинами его могут быть:

  • Psycho-emotional stress – stress, exam, public
    performance In this case, shaking hands due to the peculiarities of the nervous
    system and is not a pathology.
  • Excessive drinking or smoking
    energy drinks (dangerous for teenagers)
  • Long breaks in food, when fasting or craving hard
  • Hypothermia It goes away after warming the body.
  • Excessive physical exercise – on the muscles of the arms, after
    long running, after training, weight lifting, and
    forced prolonged immobility of hands – can cause
    short shaking.
  • Withем некоторых лекарств может иметь подобное побочное
    action, these include some psychostimulants,
    antidepressants, lithium preparations, aminophylline, narcotic drugs.
    It stops shortly after discontinuation of the drug.

Sometimes the physiological tremor is complemented by trembling in the knees,
heads, voices, chin. If it lasts more than 2 weeks and
not related to physiological reasons – this may indicate
pathological conditions then careful

Pathological дрожание

Trembling рук может быть одним из проявлений intoxication,
diseases of the kidney, thyroid, liver, encephalitis, sugar
diabetes, etc.:

Alcohol Tremor

It manifests itself in patients with alcoholism. Muscle tone is maintained
normal or slightly reduced. Arises at rest,
differs in the big amplitude of movements, amplifies at static
load. Tremor occurs when standing with eyes closed,
outstretched arms forward, with frequent eyelid tremor.
The pathophysiology of the phenomenon is not yet fully understood, it is believed that
the cause is disruption of motor neuron and intercalary

  • Alcohol twitching is different from other causes.
    intense amplitude.
  • After taking the next dose of alcohol or reducing
    intoxication организма — тремор прекращается.
  • With запущенном алкоголизме он длится несколько дней или
  • Withсоединение дрожания голоса, глазных яблок, мышц живота,
    gait disturbance observed in the late stages of alcoholism.

For treatment in the hospital used – detoxification
therapy, calcium antagonists, vitamins, sedatives,
magnesium preparations.

Parkinson’s disease

With this disease, shaking is one of the main
symptoms. It occurs at rest, characterized by a frequency of about
4-5 Hz. The onset of the disease is characterized by the appearance of a left or
right hand in the distal section. Gradually tremor can become
two-sided, but always one hand will tremble a little stronger, this
one of the diagnostic criteria. The nature of trembling with the disease
Parkinson is compared to a score of coins or a roll of pills. One
of the features is the appearance of pathology at rest, reducing it
about moving or performing targeted actions with your hands.


It is a hereditary disease in which tremors may not
only hands, but also other parts of the body (head, legs). Shaking hands
usually both in the same way. Tremor frequency is 6-10 Hz.
It occurs when performing simple, but requiring accuracy,
hand movements (shaving, putting a spoon to the mouth). Trembling
is postural, enhanced by drawing out straight arms in front of
By itself, during physical exertion, stress and fatigue.

Damage to the cerebellum and brainstem

  • with multiple sclerosis
  • traumatic brain injury
  • Wilson-Konovalov disease
  • intoxication
  • brain tumors
  • barbiturate poisoning

In this case, the most characteristic large-scale intentional
tremor. Cerebellar most often not treatable, but taking
Clonazepam or Primidone improve the condition.

Diseases of the thyroid gland and adrenal glands

In some cases (with thyrotoxicosis, pheochromocytoma) this
тоже может быть одним из symptoms.

Kidney and liver failure

At critical stages of these pathologies can be observed
the rarest, most severe form is asterixis. Manifests itself
it’s like clumsy, made with great difficulty trying to flex and
arm extension.

Trembling рук у новорожденных

This aspect is worth considering separately, since most
the reasons mentioned above cannot be correlated with the appearance of tremor of the hands in
baby, newborn, baby.


Newborns often have trembling limbs and other
parts of the body. Shaking hands with a baby can talk about pathology
or to be physiological, this is due to the immaturity of the nervous

  • At an early age, children are not yet fully developed.
    экстрапирамидная часть нервной system.
  • Also the imperfection of the adrenal glands in babies can
    cause twitching since during a period of strong emotional
    experiences can be released into the blood of a large number

Predispose to trembling of a chin, handles of a baby or
other body parts:

  • crying, discontent
  • hunger, swimming
  • dressing up
  • scare or other irritants

The amplitude is barely noticeable, small, but even in this case
you should report this to a neurologist and monitor the baby. With
Formation of the nervous system is considered critical moments
– 1, 3, 9 and 12 months. baby’s life. Usually tremor in newborns
self passes after 3 months and the child in the treatment does not


The probability of a pathology of the nervous system in
baby Withчиной патологического подергивания может быть:

  • birth injury
  • hydrocephalus
  • intracranial hemorrhage
  • Cerebral palsy

Refer to the pediatric neurologist to identify the causes you need,
if a:

  • If it is constant
  • His episodes are seen several months (after 3 months)
  • Jerking amplitude increases
  • Episodes become frequent
  • There are other violations in the child’s health


Tremor of the hands of adolescents may be associated with hormonal
adjustment, moreover, in adolescence a child has
serious nervous load, like at home (TV, computer games,
conflicts with parents) and at school (increased workloads,
sections, training), as well as emotional experiences when communicating with
peers, first love.

Since the immaturity of the brain still does not allow a teenager
easy to recycle large streams of information cope with
overflowing emotions and feelings, it can lead to
расстройству нервной system. Teenagers дрожание рук может
increase with physical exertion, agitation, as well as at rest,
which often leads to the development of complexes, the emergence of isolation in
to myself.

In most cases, the tremor self passes, the child
the nervous system should be strengthened by auto-training, meditation, more often
walk in the open air, develop fine motor skills, engage
sports, eat rationally. Parent support, their attention,
care and love will help the child overcome this period, avoid
serious nervous disorders.

With выраженном потряхивании от сильного волнения (к примеру, при
child’s public speaking or exam), the doctor may prescribe
single reception of a tranquilizer, in other cases – non-selective
beta blockers, anticonvulsants or therapy
the main diseases (according to the result of diagnosis) leading to
trembling limbs.

Why shake hands when excited

Most often this is due to the peculiarity of the nervous system.
a particular person with her overvoltage. It does not require treatment,
if the pathology disappears after a provoking event (exam,
interview, conflict, tragic news, etc.).

Истерические  — когда тряска рук более длительная,
characterized by significant amplitude and unstable rhythm. is he
appears sporadically and increases with even small
psychogenic factors. Accompanied by other symptoms of hysteria –
spasms, paralysis, stupefaction, seizures, demonstrative
laughter, tears, screams that pass when there are no others

With нервном истощении — при депрессии, физическом, нервном
exhaustion even small experiences (innocent from the point of view of healthy
human) and a slight physical tension in such a person can
cause inadequate emotional outbursts. Often patients
suffer from lack of appetite, insomnia, differences
blood pressure.

Shaking hands with diet or hunger

Это объясняется гипогликемией – резким падением уровня
blood glucose. In a healthy person after a severe physical
labor, a long break in food or lack of high-calorie food
hypoglycemia develops for a long time – this is normal. Also
blood sugar level drops in a starving person, or
following a strict diet. Human hypoglycemia is accompanied by
not only tremor, but also:

  • anxiety
  • headache, dizziness
  • болью за грудиной,  сердцебиением
  • aggressiveness

After eating a lot of carbohydrates, the general condition
improves and everything stops. However, such episodes require
diagnostics because it may be one of the initial signs
of the following diseases:

  • diabetes mellitus – eating suppresses jerking
  • pancreatic cancer – after a long break in food or
    in the morning on an empty stomach there is a shaking attack (the tumor produces
    insulin, quickly lowers the level of sugar)
  • liver diseases (cirrhosis, hepatitis) – secretion is disturbed
    glucose in the liver causing hypoglycemia
  • alcoholism – with systematic use of alcohol
    reserve of glycogen is depleted, which must be transformed into
    glucose if necessary.


For the differential diagnosis of physiological and
the pathological condition is often lacking the collection of anamnesis. With
pathological causes need more detailed

  • Neurological examination
  • Conducting various tests and tests to clarify the type
  • Laboratory methods for endocrine testing
  • CT scan, brain MRI

How to independently determine how intense the tremor?

It is not difficult, you should draw a spiral on paper:

  • smooth spiral – physiological tremor
  • jagged edges at the helix – should monitor their condition
    2 more weeks

If after 2 weeks the spiral turns out with jagged edges –
it is a pathological disorder, an appeal to the therapist is required,
Neurologist, endocrinologist for a thorough diagnosis.


Many patients with this problem believe that this is trivial.
a symptom that it is treated very simply, they think that the doctor will prescribe them
лекарство от tremor и все сразу пройдет. Treatment подразумевает
Kupiraavnye pathology, which is manifested by trembling hands.

With физиологическом дрожании, связанном с волнением,

  • walks in the open air
  • moderate physical activity
  • psychotherapy
  • aromatherapy.

With эссенциальном применяются бензодиазепины и β-блокаторы.
The latter are used more often and have higher efficiency.
they allow to reduce the amplitude of shaking. Benzodiazepines cause
addictive, rarely used, sometimes in combination with

With болезни Паркинсона используются различные препараты
(dopaminergic drugs, MAO inhibitors, reverse inhibitors
neuronal dopamine uptake) allowing slow
disease progression, reduce disease manifestations.

The appointment of drugs for the treatment of these diseases,
корректировка, подбор дозы  должен производиться только
by the attending physician.

Rarely, but surgical treatment can be used. is heо
lie in the stereotaxic destruction of one of the nuclei of the thalamus.
The operation is extremely difficult and is carried out only on one side.
Withменяется при сильном треморе, осложняющем жизнь больного и
lack of efficacy from drug therapy.

Автор: Ревус Олеся Григорьевна врач-невролог

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