What Can Be Causing My Hands To Tremor?

I am 75 years old and started having tremors about six months ago. My hands tremble when they are hanging down — if I hold my hands upward, they don’t tremble. I was advised to have a glass of wine, but so far, I’ve only had one ounce of red wine. I am going to increase the amount. I remembered that my grandfather had tremors, so that when handed a glass of water, he would spill it out of the glass. I also have an exercise ball for my hands. Whenever I feel a tremor, I squeeze the ball. What else can I do to help myself?

A tremor is defined as an involuntary rhythmic trembling or quivering. Almost everyone can have a tremor under certain circumstances — when they are anxious, fatigued, or under stress — and this physiologic or normal tremor can be accentuated by certain diseases such as hyperthyroidism, by withdrawal from alcohol, or by certain drugs.

The description that you have given of your tremor does not really allow me to make a diagnosis, since you describe certain characteristics of two separate and unrelated conditions that both may cause tremors.

Essential tremor, also sometimes called familial tremor, is a fine tremor of the hands, and also often involves the head and the voice. It is strongly inherited, so the fact that your grandfather had a tremor would make me think of this diagnosis. It is also very often improved by drinking small quantities of alcohol, so the recommendation that you drink some wine might have been on the mark. The tremor in this condition usually appears, or gets markedly worse when one tries to move one’s hands to do something, like lifting that glass of wine. The spilling that your grandfather had would be quite typical. I have a friend who has severe essential tremor, and she is unable to raise a glass to her lips, until she has had a little alcohol. Unfortunately as she has pointed out to me, you can’t drink alcohol all day long and get anything else done. The anti-hypertensive drug propanolol will often reduce the tremor, and some anti-seizure medications may be tried if propanolol is ineffective.

What doesn’t fit with this diagnosis in your description is the fact that you apparently have your tremor when your hands and arms are at rest, that is while hanging down, and it gets better when you hold them up. This is not the way that essential tremor appears.

The other common cause of tremor is Parkinson’s disease. The tremor of Parkinson’s is usually slower and coarser than that of essential tremor. It typically is present at rest and gets better when one moves the hands to do something. Most of us have seen someone with the tremor of Parkinson’s disease. The person will often be sitting quietly with their hands in their lap, and one or both hands will be moving in a rhythmic way often described as a “pill rolling” tremor. The hands, arms, legs, tongue and face may all show the tremor, but the voice is unaffected. Parkinson’s disease also produces rigidity of the muscles, making a person appear to be stiff with slow movements. The gait becomes shuffling, and falling is frequent due to the person’s inability to rapidly correct their balance. The face ultimately may become mask-like from the rigidity. Alcohol will generally not improve the tremor of Parkinson’s disease.

Primary Parkinson’s disease is caused by the degeneration of special cells deep in the brain known as the substantia nigra. Its cause is not known. There are also cases of Parkinson’s disease caused by other degenerative diseases, by certain medicines, by a notorious illegal drug called MPTP, and following some forms of encephalitis. An epidemic of von Economo’s encephalitis between 1918 and 1924 caused many cases of the disease.

There are now many treatments — both medical and surgical — for Parkinson’s disease, so you should see your doctor or a neurologist for a proper diagnosis. Although your use of an exercise ball will be good for maintaining your hand strength, I don’t think it will do anything to reduce the tremor in the long run. If squeezing the ball stops the tremor while you are doing it, this would strengthen the diagnosis of Parkinson’s disease.

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