Last updated date: 07-Feb-2023

Medically Reviewed By

Medically reviewed by

Dr. Lavrinenko Oleg

Originally Written in English

Hands shaking – am I nervous or are my nerves damaged?

    Hands shaking

    Hands shaking is medically known as tremor which is the term used to describe the shaking or trembling of your hands (or any other part of your body for that matter). While having a mild tremor is normal and sometimes physiological, it can also be a symptom of an underlying serious condition, usually having something to do with your nerves and the way they work.

    Having a tremor is not a life threatening thing to happen to someone, but apart from the fact that it ca interfere with the day to day life activities, it can be a sign of something not working properly in the neurological department, which is something that, in turn, can become life threatening.

    In this article we will discuss the multiple potential causes of shaking hands, ranging from usually harmless activities and behaviors to some serious diseases that impair one’s quality of life drastically.


    Hands shaking causes

    Here is a list of the most common causes of shaking hands:

    • essential tremor;
    • Parkinson’s disease;
    • Multiple Sclerosis;
    • thyroid dysfunction (hyperthyroidism);
    • side effects of some medication;
    • too much caffeine;
    • alcohol consumption;
    • stress and anxiety;
    • intense physical activity.

    Some other medical conditions and physical dysfunctions in which patients might experience hand tremor are: Huntington’s disease, Wilson’s disease, seizures, cerebellar disease, tumor in the adrenal gland, lack of sleep, smoking, low levels of sugar in the blood and deficit of B12 vitamin.

    Further, we’ll take the most common of these causes and see what they are and how exactly they can give you shaking hands.


    1. Essential Tremor

    Essential tremor is the most common cause of shaking hands. This is a neurological disorder (it affects the nervous system) that causes involuntary shaking of your body parts, more frequently your hands, head or legs. It is quite normal to have a tremor to some degree, everyone experiencing these movements, but without noticing them. However, when the tremor becomes noticeable, it usually means that you have a essential tremor.


    Who gets essential tremor and why?

    While it can affect anyone at any age, it is usually diagnosed in people over 40. There is also a genetic component to essential tremor which means that if one of your parents has essential tremor, you have 50% chances of getting the gene responsible for this disorder (in which case it can be referred to as “familial tremor”). The cause for essential tremor in people without the family genes is still unknown.

    The bright side of this is that through genetic testing you can pin point if this is the cause of your tremor and if you don’t have the gene for essential tremor, your doctor can identify other causes for your shakiness that sometimes can be managed or removed (such as caffeine, alcohol, tumors etc. as we’ll see later on).  


    Symptoms and signs of Essential tremor

    The shakiness and trembling can affect people differently, but there are some common symptoms of this condition for all people affected by it. These include:

    • the tremor develops gradually;
    • it is typically more visible on one side of your body;
    • it happens more as you move and less in resting positions;
    • usually, it affects the hands first, either just one of them, or both;
    • it can be accompanied by specific head movements, such as shaking or nodding;
    • it can be worsened by stress, caffeine or fatigue, but it can improve slightly after drinking a small quantity of alcohol;
    • it affects activities performed with the hands (e.g. writing, handling tools or cutlery etc.);
    • sometimes it affects the voice, making it sound shaky.


    Essential tremor diagnosis

    Essential tremor can be diagnosed by a medical professional in the neurological field, as a result of an extended examination of the tremor. Your physician needs to first rule out any other potential causes for your tremor and in order to do so he will conduct a detailed interview regarding your lifestyle and they can also test you for other medical conditions. If they find no other cause for your tremor and you check out the list of symptoms, you will receive the essential tremor diagnosis.


    Treatment for essential tremor

    There are two substances most used in treating essential tremor and they are propanolol and primidone. Both of them affect the way neurotransmitters work, helping with calming and reducing your shakiness. Propanolol has been found to be effective in 40-50% of the cases, but it usually doesn’t help with the voice or head tremor. It also has a lot of side effects and it is not recommended for patients that have other medical conditions such as asthma, heart problems or diabetes. Primidone has been shown to be more efficient, with 60-100% of patients experiencing positive effects. It also has more manageable side effects, the most common one being a reaction following the first dose that consists of nausea and dizziness that don’t last long. If there two substances don’t show any improvement, sometimes the doctors will want to test a combination of the two that has been found to be effective in some cases.

    Some other anti-seizure drugs used in treating the symptoms of essential tremor consist of gabapentin and topiramate, and in some cases even different types of benzodiazepines.

    Another form of treatment that is usually recommended for those who experience severe and intense head tremors is Botox injections that have been found to be extremely helpful in reducing the trembling. Botox works as a relaxing agent for the muscles that are involved in the tremor movement, the injections being designed to target these muscles in particular while avoiding the muscles that don’t take part in the trembling.

    In severe cases of essential tremor, a deep brain stimulator that is surgically inserted in the brain might be recommended.


    Can essential tremor be prevented?

    In short, no. Considering the fact that there are no known causes for essential tremor except for inheriting the genes from one of your parents, there isn’t much you can do to prevent essential tremor. However, some lifestyle changes can make it more manageable so adopt a healthy diet, quit smoking and drinking caffeine, avoid alcohol as much as possible, shy away from stressful situations and give relaxation techniques a try (such as meditation or yoga).  


    Potential complications of essential tremor

    While essential tremor is not a life threatening condition, its symptoms do progress in time which can seriously impair a person’s day to day life activities. This means that usually patients with severe tremors might experience trouble holding things in their hands, eating, writing or even talking.


    2. Parkinson's Disease

    Parkinson’s disease is a medical disorder of the nervous system that affects the ability to move. It can impair coordination and walking and causes shaking and stiffness. Symptoms associated with Parkinson’s disease progress gradually, usually beginning with a small, almost unnoticeable hand tremor. As the condition develops, the symptoms become more serious and numerous.


    What causes Parkinson’s Disease?

    Parkinson’s disease is characterized by the death of brain cells or neurons in the specific part of the brain responsible for controlling the movement. These brain cells are the ones that produce dopamine, a chemical neurotransmitter. If the neurons die, the level of dopamine in the brain decreases which is what causes Parkinson’s diseases’ symptoms. If you’re asking yourself what causes these cells to break down and die, the researchers are still in the dark about that.

    Another process involved in Parkinson’s disease is that patients start to lose the nerve endings responsible for the production of norepinephrine. This is a brain chemical that is involved in almost all physiological functions of the body, such as the activities of the circular and digestive systems. This can explain some of the other symptoms of Parkinson’s disease that are not related to movement, such as dysfunction of the digestive tract, unstable blood pressure or a general state of fatigue.

    Interestingly, researchers have mapped out some genetic mutations that are thought to cause this medical condition, but this seems to be quite a rare case. Although the risk of developing Parkinson’s disease increases if you have relatives with it, in most cases this disease appears randomly. There are some other researchers who have found an association between exposure to a toxic environment and later onset of Parkinson’s disease, but again, this is a small risk. Some think it is safer to say that Parkinson’s is the result of a combination of genetics and environmental characteristics.


    Who’s more at risk for getting a diagnosis of Parkinson’s disease?

    Parkinson’s disease

    It is extremely rare for young people to be diagnosed with Parkinson’s disease. This condition usually starts to develop at around age 60, the risk increasing with age. There are some cases of people who get it earlier, at around age 50, in which case it is considered early-onset Parkinson’s disease.

    Besides age, heredity might play an important role. Having cases of Parkinson’s disease amongst your family members increases the risk of developing it yourself, although this seems to be more of a risk factor when you have multiple family members with it.

    Some other risk factors are the exposure to a toxic environment and the biological sex, men being approximately 50% more at risk for developing the disease than women.


    What are the symptoms of Parkinson’s disease?

    Parkinson’s disease has an array of symptoms and signs that can be experienced very differently among patients with this diagnosis. The symptoms usually start to become noticeable on one side of the body, the other side becoming affected as the disease progresses. Typically, the side that was affected first will continue to show more severe symptoms compared to the other.

    Some of the most common symptoms and signs of Parkinson’s disease include:

    • tremor – this is usually the first symptom that becomes noticeable, with the tremor beginning typically in one of your hands, even when it’s in resting position; as the disease progresses, the trembling and shaking can occur also in the whole arm, legs or head;
    • bradykinesia – the slowness of movements occurs over time, making day to day activities longer and more difficult;
    • missing automatic movements – some people lose the ability to blink or smile;
    • stiffness of muscles – this can happen anywhere on the body, but it usually affects the trunk and limbs;
    • impaired posture, balance and coordination – this is a dangerous symptom since it’s the one responsible for frequent falls that can cause further injury to the person;
    • voice and speech changes – it can become difficult to speak for some people with Parkinson’s disease who slowly lose the ability to use different inflections and intonations;
    • difficulty writing – because it’s a condition that affects primarily the muscles in the hand and arm, writing can become very difficult, in the more severe cases being even impossible to write intelligibly;
    • emotional changes – people might get stressed, frustrated, anxious and depressed, usually because the symptoms start to affect their capacity to tend to themselves;
    • physiological impairment – because this disease also affects the sympathetic nervous system, more progressed stages of Parkinson’s disease can lead to digestive problems, constipation, urinary dysfunction and also sleep pattern disruptions.

    These symptoms progress at different rates in different individuals and given the onset age for this disease, most people assume that the early symptoms of Parkinson’s disease are just consequences of ageing.


    How is Parkinson’s disease diagnosed?

    Unfortunately, there isn’t a miracle test that can determine the diagnosis of Parkinson’s disease. A medical professional in the neurobiological field can diagnose this disease based on anamnesis and the patient’s medical history and on a neurological exam.

    Another way of diagnosing Parkinson’s accurately is through the patient’s response to treatment. Medication for this disease can be specific and very different from the medication prescribed for other medical conditions with similar symptoms, so if the patient responds well to a treatment plan designed for Parkinson’s disease, the diagnosis can be confirmed.


    Can Parkinson’s disease be cured?

    Considering that fact there hasn’t yet been discovered a way to regenerate neurons, once the brain cells degenerate and die, there’s nothing you can do about it. As a consequence, there is no way you can cure Parkinson’s disease. However, modern medicine offers some help in alleviating some symptoms and making them more manageable.

    The main treatment plan for Parkinson’s disease usually consists of medication that increases the dopamine levels in the brain and medication that helps with the other symptoms of the disease, unrelated to movement. Levodopa and carbidopa are the two main medications used in Parkinson’s disease. Once administered, levodopa can be converted to dopamine, making up for the low levels of dopamine in the brain. However, this drug has many side effects (such as constant nausea, vomiting and low blood pressure). For this reason, alongside levodopa, carbidopa is administered to help preventing the destruction of levodopa before reaching the brain, allowing for smaller doses of levodopa (the drug) needed.

    Just like in the case of essential tremor, deep brain stimulation can also be recommended for improvement of movement-related symptoms caused by Parkinson’s disease. Speech and occupational therapies, exercise and a balanced diet can also be of help for the non-movement related symptoms.


    Parkinson’s disease versus essential tremor

    By now, you might be getting a sense of deja-vu, Parkinson’s disease seeming very similar to essential tremor disease. However, there are a few main characteristics that help clinicians make the distinction between the two medical conditions. Firstly, shakiness in essential tremor typically occurs while the person is using her hands, while in Parkinson’s disease the tremor is mostly visible while the hands are resting. Secondly, Parkinson’s disease leads to numerous other health conditions, while essential tremor doesn’t. Lastly, Parkinson’s disease can affect the upper and lower limbs, the head and other parts of the body, while essential tremor affects the hands and the head in most cases.


    3. Multiple Sclerosis

    Multiple sclerosis is a disease that affects the central nervous system (brain and spinal cord) causing permanent damage to the nerves. The signs and symptoms usually affect movement and vision. One of the movement symptoms is tremor in different parts of the body. The most common type of tremor in multiple sclerosis is the intention tremor which means that there is no shakiness while resting. The trembling starts as the person tries to move, reach something or walk, being the most debilitating form of tremor in patients with multiple sclerosis.


    4. Hyperthyroidism

    This is a condition of the thyroid in which there is an excess in the production of thyroid hormones. One of the symptoms caused by this intense activity of the thyroid is hand tremor or hands shaking. The tremor can either be very small, almost unnoticeable, or so intense that the person can’t hold anything in her hands.


    5. Caffeine


    Caffeine acts as a stimulant agent for the nervous system which means that in big doses it can overstimulate the brain, causing your hands to shake. While drinking coffee is mandatory for some people, it’s important to keep in mind that it can also cause damage to your body if consumed in large quantities. However, caffeine can also be found in drugs or foods, so beware of how much caffeine you ingest.


    6. Alcohol

    Hands shaking after drinking alcohol are called alcohol tremors and are part of the list of symptoms that characterize alcohol withdrawal. The mechanism responsible for this type of tremor is this: alcohol acts as a depressant of the nervous system which means that it slows down the neuronal activity. Recurrent alcohol consumption gets the brain used to a low level of stimulation. Once the alcohol leaves the body and the brain activity becomes more intense, the nervous system activates and leads to the tremors in the hands. Experts say that alcohol tremors might be a sign of alcohol dependence.


    7. Side effect to Medications

    Hands shaking as a side effect to certain medication is known as drug-induced tremor. This is the response of the nervous system to certain drugs such as medication for cancer, seizure, asthma, immunity, mood, depression, heart conditions, thyroid etc.  


    8. Hands Shaking Anxiety

    Anxiety represents the body’s response to stress, this response being either fight, flight or freeze. In a stressful situation, the levels of adrenaline and noradrenaline in the body increase and this can lead to twitching, shaking or trembling of the muscles. These tremors that are a result of the body’s response to stress are called psychogenic tremors. We’ve discussed earlier about other medical conditions that can cause hand tremor and are also associated with mood disorders, such as essential tremor or Parkinson’s disease. What’s important to keep in mind is that anxiety per se doesn’t make your hands shaky, but if you have a pre-existing condition, anxiety can exacerbate the tremors.


    9. Intense Physical Activity

    Hands shaking after workout. Shaking after an intense workout is quite normal. During a workout, the nervous system is under fire, sending constant signals between the brain and the muscles at an intense rate. This can lead to fatigue after a while. The feeling of tiredness in the muscles after a workout is a result of the levels of adrenaline going down, similar to a withdrawal syndrome, that can cause twitches and trembles in the muscles. Especially if it was arms day, your hands might start to shake after some intense physical effort so make sure to rest and hydrate to allow them to recuperate.   

    Hands shaking after boxing. The mechanism is identical, boxing being an extremely intense sport, especially for the arms. Fatigue of the muscles can be prevented by having a healthy and consistent diet that has the proper energetic value for your muscles to function properly in case of intense effort.


    Hands shanking can be a common condition in the day to day life if we don’t take care of our bodies with enough sleep, a healthy and balanced diet and a lifestyle that is as much as possible caffeine and alcohol free. However, hand tremor can be become a serious condition as a result of nerve degeneration and damage that is permanent. An active lifestyle with a constant exercise regimen can help delaying this process in some cases.