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Hand tremor


Hand tremor

Hand tremor

Man is not a mechanical machine, in which a certain position of its elements is supported by rigid mounts, created by pressure cylinders and other ways. Our body is a complex consisting of thousands of elements that interact with each other. Moreover, each muscle can not stiffen motionless, and the bones and joints are not able to fix for a long time without the slightest movement.

If you look closely at the hand, you can see how the tips of her fingers barely noticeably fluctuate. For each person, these movements for some time increase their amplitude for various reasons: fatigue, anxiety, keeping the hand in one position, etc. Unfortunately, sometimes such fluctuations become uncontrollable, very pronounced and significantly reduce the quality of human life. Yes, it does not represent a threat to life, but in some cases people are forced to leave their beloved profession because they can no longer cope with their duties: the violinist will not be able to perform the work, the surgeon will perform a difficult operation, etc.

Tremor is a rhythmic, rapid movement of the limbs, carried out with a frequency of about 10 Hz. They are caused by involuntary muscle contractions associated with delayed afferent impulsation, which normally comes from the central nervous system and has a corrective effect. As a result, the body begins to automatically adjust to a certain average value, due to which posture is maintained. Tremor is physiological and pathological, depending on the reasons that caused it.

Classification and causes

This condition is classified according to several criteria, as a result of which several classifications exist at once.

Phenomenological classification

  • Rest tremor - is noted in the patient at a time when the muscles are in a state of relative rest and active movements are not made. When a person begins to make movements - all symptoms disappear. Such a variety most often indicates that the patient has Parkinson’s disease, although it is not its only manifestation.
  • Tremor action - appears in the patient at the moment when he begins to make arbitrary muscle contractions, not necessarily associated with the movement. It is also called promotional and is divided into several varieties:

- postural - appears in a person, a relatively long time holding the body in one position;

- kinetic - occurs when active movements and when approaching the goal (a classic example - a difficult attempt to touch the tip of the nose with a finger).

Etiological classification

  • Primary - develops independently and is not associated with another disease.
  • Secondary - is a complication of other diseases (hepatic and renal failure, excess production of thyroid hormones, brain tumor, traumatic brain injury), intoxication of the body, side effects of drugs.
  • Tremor resulting from the progression of degenerative diseases of the brain tissue (Parkinson's disease, cerebellar degeneration, hepatolenticular degeneration).

Etiopathogenetic classification

Physiological tremor

Frequent hand shake that is not associated with any disease. In most cases, it provokes emotional stress, physical fatigue, or holding the hand in one position.

  • If a person is very emotional, then his hands can tremble almost constantly in the presence of other people or when performing work under the supervision of someone else. At rest, however, all manifestations disappear, but only until a new emotional outburst. A few visits to the psychologist can solve all the problems and save the person from tremor.
  • Tense training, hard physical work by the end of the day can be completed with a strong hand tremor.
  • Depression is not a physiological condition, but can sometimes cause shaking hands. However, the elimination of depression leads to the elimination of tremor without a trace.
  • Hypothermia leads to involuntary muscle contractions, which are manifested by trembling and tremor of the hands.

Despite the fact that all of the above mentioned does not apply to diseases and goes away without specialized treatment, you should not delay visiting the doctor for a long time. Probably, under such a mask lies another pathology, much more dangerous. Two weeks is a deadline after which you need to ask for help and undergo an examination, provided that, apart from tremor, nothing bothers the person all this time.

Essential tremor

This species is a hereditary form of the disease and can be observed from several close relatives at once. It is most pronounced in the hands and in most cases is observed from two sides. In more severe cases, a person's head, lips, vocal cords and torso are trembling. 25% of patients have difficulty writing (writing spasm).

Parkinsonian tremor

A fairly common condition that develops in patients with Parkinson's disease. Its characteristic feature is that the manifestations are not expressed during active movements, but are aggravated at rest, when walking or distracting attention. Hands make circular motions, as if balls are rolling. In most cases, people over the age of 50 fall ill. There are frequent cases of unilateral defeat, in which only one arm becomes uncontrollable.

Cerebellar tremor

The cerebellum is the center of coordination of movements in our body. If it is defeated, the person is not able to perfectly control the peripheral parts of the body, including the hands. In this case, a person in most cases starts to shake hands when trying to touch something small (intentional tremor). Somewhat less trembling occurs when the body is held in one constant position.

Rubral tremor

This is one of the most difficult varieties of the disease, since the cause then lies in the midbrain or thalamus. In humans, rest tremor, postural and intentional tremor are combined.

Dystonic tremor

Dystonia is a disease in which a patient spontaneously contracts a muscle or a group of muscles. For this they do not need signals from the brain and the desire of the person himself. Tremor of dystonia in most cases is asymmetric, can affect one arm, or differ significantly on two limbs in the degree of severity and nature of the movements performed.

Neuropathic tremor

Neuropathy is a disease in which nerve damage occurs in a patient’s body. It can be congenital or acquired, due to different reasons. As a result, the muscles are not properly controlled by the central nervous system and begin to contract spontaneously.

Iatrogenic and drug induced

Taking certain medications may provoke or significantly increase the tremor in the hands. This may be due to either a toxic effect on the nervous structures themselves (some strong antibiotics) or simply excessive stimulation of the nervous system.

Sometimes a hand shake occurs after the patient undergoes serious surgical interventions on the organs of the neck and brain. In this case, everything is caused by mechanical damage to the nerves or nerve plexuses.

Other causes of tremor

When used in large quantities of strong tea, coffee, spirits, a person may notice that his hands began to make larger fluctuations than usual. Alcoholic beverages also have a negative effect on the nervous structures of the body. Alcohol withdrawal syndrome is characterized by strong involuntary oscillations of the hands (“the hands are shaking like an alcoholic”). Drugs can not only over-stimulate motor neurons in the brain and spinal cord, causing tremor, but also cause organic brain damage.

Poisoning with heavy metals, carbon monoxide, changing the level of glucose in the patient's body - all this can also be the cause of tremor.

Tremor Diagnosis

It is clear that doctors and so see that the patient has a tremor. Their task is to determine its causes and severity in various situations. For this there are a number of special tests, laboratory examinations and methods of instrumental diagnostics.

Neurological and functional tests

A neurologist examines a person for abnormalities and may decide on additional diagnostic methods.

  • Tendon jerks - determined by irritating the tendons in certain areas. The doctor knows which nerves are responsible for the innervation of each part of the body and, in the presence of a pathology of tendon reflexes, it will determine what is wrong.
  • Checking muscle tone - it is broken in some neurological diseases.
  • Determination of sensitivity in different parts of the body.
  • Assessment of the gait of a person (this way Parkinson's disease can be detected immediately) and coordination of his movements
  • Conducting functional tests, each of which allows you to define different characteristics of tremor.

- A patient is asked to bring a cup filled with water to his lips - this is how intentional tremor is determined (movement towards a specific goal)

- Stretch your arms in front of you and fix them for some time - in case of cerebral pathology, postural tremor will appear (depending on posture).

- Please write something or draw a spiral - an assessment of the severity of tremor and a way to detect writing spasm.

Laboratory and instrumental diagnostics

  • General clinical blood and urine tests, biochemical blood tests - allow the patient to detect a violation of the hormone levels of individual glands, a violation of the glucose level, will indicate to NATO that the drug is not harmless to humans.
  • Magnetic resonance imaging or computed tomography - excellent modern diagnostic methods that allow you to identify even the smallest neoplasm. We are talking about tumors in the brain that can provoke hand shake.
  • Electromyography - a modern diagnostic method that allows you to identify the pathological excitation of peripheral muscles and assess their frequency and severity.
  • A tremograph is a device that can fix tremor in three planes and give a lot of useful information to specialists.

Tremor treatment

As can be seen from everything written above, tremor is not an independent disease, and in most cases it is only a symptom of another disease. Therefore, to eliminate almost always you need not a consequence of the disease, and its root cause.

  • If the tremor appears due to increased excitement - you can visit a psychologist who will help you feel more confident in different situations. Sometimes you may need to take sedatives.
  • Restricting the use of strong coffee or tea, quitting smoking or alcohol - all this will very quickly affect the health of the body and help get rid of tremor.
  • When a Parkinson's disease is found in a patient, doctors will prescribe medications specifically designed for the treatment of this disease. They do not relieve a person from the disease forever, but they can eliminate most of his symptoms, including tremor.
  • Injection of a small dose of a special toxin into the nerve, providing pathological muscle stimulation. Due to this, all unnecessary pulses are eliminated, and everything falls into place.
  • Acceptance of anticonvulsants.
  • Beta-blockers that inactivate receptors in muscle cells.
  • Electrical stimulation of brain structures is a complex and invasive method of treating tremor, during which physicians inject electrodes into brain tissue and give impulses of a given magnitude. Sometimes it is possible to “restart” the pathological focus in the nervous tissue and eliminate the tremor. It is clear that such an intervention carries with it a certain risk of complications, but it can help in cases where other methods have proved to be powerless.

Do not be shy about your condition and postpone a visit to the doctor. Modern methods can prevent the progression of the disease or even get rid of it. Just trust the qualified specialist!

| 20 December 2014 | | 6 773 | Neurology