Shaky hands

Normally, our hands shake very, very slightly all the time we are awake. This is because the tiny muscle fibres in our hands and arms constantly contract and relax at random. It is only when shakiness of our hands begins to interfere with writing, holding a cup of coffee or using a knife and fork that it becomes a problem. When people notice their hands are shaky, they often start to worry that they have Parkinson’s disease, but this is usually not the case.

If you are worried about shakiness, consult your doctor rather than try to work out the cause yourself. There are many varieties of shakiness that are difficult to describe, but doctors can recognize the common types easily from experience. Also, some simple tests, such as a blood test for thyroid overactivity, might be appropriate. Your doctor may use the word ‘tremor’ to describe shakiness that consists of small movements.

Common causes
Anxiety. We all become trembly if we are angry, stressed, anxious (‘shaking with nerves’) or very tired.

Low blood sugar causes shakiness because the nerves and muscles are deprived of fuel. The adrenaline system responds by kicking in, and this can make the shakiness worse for a while. The circumstances will make it obvious if this is what is happening in your case. A low blood sugar is most likely to occur if you eat a lot of sugary snack foods; these raise the blood sugar sharply, but then it plummets down again. The answer is to eat more slowly digested carbohydrates, such as porridge for breakfast instead of a sweet cereal and fruit instead of sweet puddings. Low blood sugar can also occur after excessive exercise.

Too much coffee and tea can make you a bit shaky, particularly in combination with a low blood sugar. So cut down the amount of coffee or strong tea that you drink, and avoid snack ‘meals’ that are mainly sweet foods and lots of coffee.

‘Essential tremor’ is one of the most common types of shakiness. Instead of contracting at random, the tiny muscle fibres contract and relax together (‘synchronization’), resulting in more noticeable movements. (In medicine, the word ‘essential’ has a special meaning – it is used to describe a condition that is not caused by any other medical condition or disease, but simply exists on its own.)

• Essential tremor is unusual in young people, but affects 1 in 20 of the population over the age of 40.
• It tends to run in families, so some of your close relatives may also have it.
• It usually affects the hands, often the head, and sometimes the voice and other parts of the body as well.
• It becomes worse when you use your hands to do something, such as picking up a small object, or if you try to maintain a position, such as holding a cup steady. If you rest your hands quietly on your lap, the shaking usually stops.
• It is uncontrollable and does not mean you are ‘nervy’ or ‘neurotic’ (although, frustratingly, it becomes worse when you are anxious).
• An alcoholic drink often improves it, but obviously you should not overdo this remedy.
• If the shaking is really troublesome, your doctor can prescribe a drug such as a beta-blocker or primidone. Avoid too much coffee and strong tea.

Less common causes
Medications can sometimes be responsible, in particular some asthma medications, some antidepressants and lithium. A few medications, such as some tranquillizers, can cause shakiness if you stop taking them suddenly. Similarly, a heavy drinker may get ‘the shakes’ the morning after a binge.

Parkinson’s disease is much less common than essential tremor. It does cause shaking of the hands but, unlike essential tremor, the shaking is worse when you are resting and not using the hand. The shaking in Parkinson’s disease is called ‘pill rolling’ because it is like rolling a small pill between your thumb and the side of your index finger.

Overactive thyroid is more common in women than in men, and occurs most commonly in the people in their 20s and 30s. If your thyroid is overactive, shakiness will not be the only symptom; for example, you usually lose weight even though you are eating well. Your doctor can do a blood test to check your thyroid hormone levels.

Useful contacts
Parkinson’s Disease Society is a UK not-for-profit organization. The website has an A–Z of information about Parkinson’s disease. Write to: 215 Vauxhall Bridge Road, London SW1V 1EJ, UK. Tel: 020 7931 8080.
www.parkinsons.org.uk

National Parkinson Foundation is a US not-for-profit organization with a very informative website about Parkinson’s disease. The website has a Tremor Questionnaire to help you decide what sort of shakiness you have. Write to: Bob Hope Parkinson Research Center, 1501 N.W. 9th Avenue, Bob Hope Road, Miami, Florida 33136-1494, USA. Tel: 001 305 243 6666.
www.parkinson.org

The American Academy of Family Physicians has a factsheet about ‘essential tremor’ on its website. There is also a link to a detailed article for doctors written in 2003.
www.aafp.org/afp/20031015/1553ph.html