It is quite impossible to keep your hands completely still and therefore to some degree everyone has a tremor (Harvard Health Publishing, 2015). The root cause of this shakiness is due to the tiny muscle fibers found within the hands and arms that are constantly contracting and resting (Piedmont healthcare, 2017). At times this involuntary movement may become imbalanced as some of the muscle groups may continue to contract instead of entering the resting phase setting the timing off (Piedmont healthcare, 2017).

The trick here is figuring out if this shakiness of the hand is normal or abnormal (Harvard Health Publishing, 2015).

““You know your body best,” says Dr. Etienne. “If you feel shaky after a couple cups of coffee or as you prep for a public speaking engagement, it may very well be the caffeine or adrenaline causing your shakiness, and there is no cause for alarm. But if you can’t control it, even when you aren’t using your hands, this might be a sign to seek your doctor’s advice”” (Piedmont healthcare, 2017).

Causes

There are a variety of conditions that contribute to hand tremors. Common causes of shaky hands include:

Anxiety. Anxiety takes on a form of a psychological tremor, involuntary muscle movement occurring within the body of a healthy person resulting in mechanical and nervous system interactions (Tomczak, Gajewski, & Mazur–Różycka, 2014).  When dealing with such strong emotions, nerves are heightened causing shaky hands usually due to significant feelings of anger, stress, tiredness or being anxious.

Lack of Sleep. When the body is deprived of sleep it may trigger neurological reflexes that can then result in shaky hands, irritation, mood change, and lack of concentration (Piedmont healthcare, 2017).  Sleep deprivation can also contribute to chronic physical health issues and increase risk for things such as weakened immunity, memory issues, and weight gain (Healthline, 2018).

Alcoholism. The consumption of too much alcohol can result in liver and other health problems such as an alcohol disorder. Alcohol affects everyone differently however, common changes include personality and behavioral change such as irritability and lack of motivation, change in daily regimes, shaky hands, and slurred speech (Nazario, 2018). Depending on the severity of one’s alcohol intake hand shaking can last for a few days to years to even a longer duration of time (Nazario, 2018).   

Liver Damage. Cirrhosis occurs at the end stage of chronic liver disease when there is severe damage caused to the liver resulting in liver scarring (Healthline, 2018a). Common causes are due to alcohol abuse and viral infections (Healthline, 2018a). Positive physical examination tests will show pale skin, yellow eyes (jaundice), hand tremors, reddened palms, an enlarged liver or spleen, and finally, small testicles (Healthline, 2018a).  

Low Blood Sugar (Hypoglycemia). As the blood sugar levels decline well below normal, the nerves and muscles are deprived of fuel causing a variety of different effects such as, shakiness of the hand, sweating, anxiety, hunger, irritability, pale skin, fatigue and irregular heart rhythm (Mayo Clinic, 2018). Keep in mind that the adrenaline system will instantly respond and therefore it will make the shakiness worse for the time being. Overall hypoglycemia is a good indicator that an underlying health problem exists in some cases (Stearn, 2014).  

Overactive Thyroid (Hyperthyroidism). Known to be more prevalent in women and in individuals in their 20s and 30s (Piedmont healthcare, 2017). Excess thyroid hormone being released into the body speeds up processes and can not only result in shakiness but also anxiety, nervousness, rapid heartbeat, sweating, sleeping issues and weight loss (Aleppo, 2018).

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In 2007, Oprah Winfrey announced that she had a thyroid problem diagnosed as hypothyroidism (Gentile, 2017).

“ My body was turning on me. First hyperthyroidism, which sped up my metabolism and left me unable to sleep for days. (Most people lose weight. I didn’t.) Then hypothyroidism, which slowed down my metabolism and made me want to sleep all the time. (Most people gain weight. I did! Twenty pounds!)” (Parker-Pope, 2007).

Too Much Caffeine. If too much coffee, tea or chocolate is consumed it can result in shaky hands, feeling of jitters, anxiety, rapid heartbeat, stomach irritation and headaches especially if one has substance sensitivity (Zehr, 2017). Caffeine acts as a central nervous system stimulate and when consumed in adequate amounts it makes the consumer more awake, energetic and alert (Zehr, 2017).

Essential Tremor. A nerve disorder causing uncontrolled shaking or tremors to different areas of the body. Most common areas of the body that are affected include arms, hands, larynx, tongue, head, and chin. In majority of cases lower body parts are not affected by this condition (WebMD, 2018).  A key aspect of essential tremors is that it produces more noticeable movements as the muscle fibers contracting and resting are synchronous oppose to contracting at random (Stearn, 2014).

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“ The late “actress Katharine Hepburn is an extreme example of advanced essential tremor – it affected her voice, head and arms, as well as her hands,” Rezak notes. Playwright Eugene O’Neill also suffered from essential tremor. So does rocker J. Roddy Walston, of J. Roddy Walston & The Business, who became increasingly vocal about his condition in the band’s 2013 LP “Essential Tremors.”” (Colino, 2015).

Psychogenic Tremor (Functional Tremor).  Can come and go as any form of shakiness within the body. The tremor worsens during times of peak stress and declines or stops when distracted (Office of Communications and Public Liaison, 2018).  It is very common for individuals with psychogenic tremor to also have an underlying psychiatric disorder such as depression or post-traumatic stress disorder (PTSD) (Office of Communications and Public Liaison, 2018).

Multiple Sclerosis (MS). An immune system targeting disease that affects the nerves, brain, spinal cord and causes shaky hands (WebMD, 2017). Essential tremors in the hand or foot are very common in MS and occur when one is already performing the act of moving (WebMD, 2017).

Jack Osbourne Son of the famous British rock star Ozzy Osbourne,  publicly announced having multiple sclerosis in 2012.

“Since his diagnosis, Osbourne’s motto is “Adapt and Overcome.” He uses the hashtag #Jackshaft on Twitter to talk about his experience with MS. “I will never say that I am thankful for MS,” he said in an open letter. “But I will say that without MS, I don’t know if I would have made the necessary changes in my life that have changed me for the better” (Healthline, 2018b).

Post-Traumatic Stress Disorder (PTSD). A disorder where the brain reacts with excessive fear and nervousness even after one has already experienced or seen a traumatic or terrifying event, long after the original trauma event is over (Peterson, 2018). The brain reacts by staying in overdrive and in a state of hyper alertness for the next trauma (Peterson, 2018). This causes nervousness, jittering, and shaking (Peterson, 2018). Alternately, followed by a traumatic event, one can become numb and shut down their feelings and start to avoid certain situations that recall traumatic events. Other individuals can fall prey for depression, irritability, or risky behavior (Peterson, 2018).

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Lady Gaga released an open letter to her fans talking about her battle with post-traumatic stress disorder.

She wrote: “I have wrestled for some time about when, how and if I should reveal my diagnosis of Post-Traumatic Stress Disorder (PTSD). After five years of searching for the answers to my chronic pain and the change I have felt in my brain, I am finally well enough to tell you. There is a lot of shame attached to mental illness, but it’s important that you know that there is hope and a chance for recovery” (Hinde, 2017).

Parkinson’s Disease (PD). A less common condition in comparison to essential tremor. PD causes shakiness of the hand just as essential tremor but rather than causing difficulties in performing tasks the shaking of the hand is the worst when one is resting and not utilizing the hand (Stearn, 2014). The shakiness in Parkinson’s disease is referred to as ‘pill rolling’ this is because its similar to rolling a pill between one’s thumb and side of the index finger (Stearn, 2014).

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In 1984, Muhammad Ali’s condition was officially diagnosed as Parkinson’s disease, three years after he retired from the professional boxing (Sawer, 2016).

“at the age of 38, tempted back into the ring by money and his love of the crowd, he suffered a terrible beating at the hands of Larry Holmes, his former sparring partner. In 1981 he took another pummelling, losing on points to Trevor Berbick before finally retiring for good. By now Ali’s physical deterioration was obvious. He suffered from permanent fatigue, his mouth drooled saliva and he developed a tremor in his hand” (Sawer, 2016).

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Medications. Involuntary drug induced shakiness can occur as the nervous system and muscles respond to medication’s ingested (Medline Plus, 2018). Some common medications that can cause shaking include:

  • Excessive movement disorder medication (Tetrabenazine)
  • Cancer medicines (cytarabine and thalidomide)
  • Antidepressants (tricyclics and Selective serotonin reuptake inhibitors (SSRIs))
  • Seizure medicines (sodium valproate and valproic acid)
  • Heart medications (procainamide and amiodarone)
  • Asthma medication (albuterol and theophylline)
  • Lithium (mood stabilizer)
  • Immune suppressing medicines (tacrolimus and cyclosporine
  • Stimulants (amphetamines and caffeine)  
  • Antibiotics
  • Nicotine
  • Weight loss/ bariatric medication (tiratricol)
  • Overactive thyroid medication (levothyroxine)
  • Blood pressure medications
  • Antivirals (vidarabine)
  • Epinephrine and norepinephrine

(Medline Plus, 2018)

There are many causes for shaky hands ranging from non-severe issues such as consuming too much coffee to more chronic issues such as essential tremors. Information provided is for educational purposes only and does not replace a licensed physician’s professional diagnosis, treatment or medical advice on your shaky hands problem.

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References

Aleppo, G. (2018). Hyperthyroidism Overview. Retrieved from https://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidism-overview-overactive-thyroid

Colino, S. (2015). The Truth About Essential Tremor: It’s Not Just a Case of Nerves. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2015/11/11/the-truth-about-essential-tremor-its-not-just-a-case-of-nerves

Gentile, J. (2017). Celebrities with Thyroid Disorders. Retrieved from https://www.endocrineweb.com/conditions/thyroid/celebrities-thyroid-disorders

Harvard Health Publishing. (2015). Tremor – Harvard Health. Retrieved from https://www.health.harvard.edu/decision_guide/tremor

Healthline. (2018). 11 Effects of Sleep Deprivation on Your Body. Retrieved from https://www.healthline.com/health/sleep-deprivation/effects-on-body#1

Healthline. (2018a). Cirrhosis. Retrieved from https://www.healthline.com/health/cirrhosis

Healthline. (2018b). Celebrities with Multiple Sclerosis. Retrieved from https://www.healthline.com/health/multiple-sclerosis/celebrities-with-ms#2

Hinde, N. (2017). 17 Celebrities Open Up About Mental Health. Retrieved from https://www.huffingtonpost.co.uk/entry/celebrities-who-opened-up-about-mental-health_uk_591311ade4b050bdca6121d6?guccounter=1&guce_referrer_us=aHR0cHM6Ly93d3cuZ29vZ2xlLmNhLw&guce_referrer_cs=aUwns0nu64MgNodXX_C5lw

Livinglifewithessentialtremor. (2018). Katherine Hepburn & ET! Retrieved from https://livinglifewithessentialtremor.wordpress.com/2018/01/23/katherine-hepburn-et/

Mayo Clinic. (2018). Hypoglycemia. Retrieved from https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685

Medline Plus. (2018). Drug-induced tremor: MedlinePlus Medical Encyclopedia. Retrieved from https://medlineplus.gov/ency/article/000765.htm

Nazario, B. (2018). Signs of Drug Addiction. Retrieved from https://www.webmd.com/mental-health/addiction/signs-of-drug-addiction#2

Office of Communications and Public Liaison. (2018). Tremor Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet

Parker-Pope, T. (2007). Oprah’s Thyroid Club. Retrieved from https://well.blogs.nytimes.com/2007/10/19/oprahs-thyroid-club/

Peterson, M. (2018). Post-traumatic Stress Disorder (PTSD) Symptoms, Tests & Treatments. Retrieved from https://www.emedicinehealth.com/post-traumatic_stress_disorder_ptsd/article_em.htm#what_is_post-traumatic_stress_disorder_ptsd

Piedmont healthcare. (2017). Shaky hands – normal or not? Retrieved from https://www.piedmont.org/living-better/shaky-hands-—-normal-or-not

Sawer, P. (2016). His longest round: Muhammad Ali’s fight with Parkinson’s disease . Retrieved from https://www.telegraph.co.uk/news/2016/06/04/his-longest-round-muhammad-alis-fight-with-parkinsons-disease/

Stearn, M. (2014). Shaky hands. Retrieved from https://www.embarrassingproblems.com/problem/shaky-hands

Tomczak, A., Gajewski, J., & Mazur–Różycka, J. (2014). Changes in Psychological Tremor Resulting From Sleep Deprivation Under Conditions of Increasing Fatigue During Prolonged Military Training. Biol Sport, 31(4), 303-308. doi:10.5604/20831862.1127343

WebMD. (2017). Can multiple sclerosis (MS) cause shaky hands? Retrieved from https://www.webmd.com/brain/qa/can-multiple-sclerosis-ms-cause-shaky-hands

WebMD. (2018). The Brain and Essential Tremor. Retrieved from https://www.webmd.com/brain/essential-tremor-basics#1

Zehr, M. (2017). How to Treat Hand Tremors by Exercising. Retrieved from https://www.livestrong.com/article/449077-how-to-cure-hand-tremors-by-exercising/

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