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What Causes Trembling Of Arms And Hands?
Question: I have had trembling in my arms and hands for a few months now. Sometimes it is really bad and it never fully goes away. I have twitches in my neck too when I am sitting still. These are usually worst in the morning and get much worse with anxiety or worry. Now I have had a patch of numbness on the front of my leg from my right knee to about my calf for 3 days. I also get random numbness in my hands and feet. I also get a feeling of lightheadness randomly. I am taking 20mg of Prozac which I have been on for almost 2 years. My doctor suggested I go off it to see if that's what's causing the tremor. I have been off it for 4 days and have noticed no difference. Please help. Do I need to see a neurologist.?
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at that description of your symptoms there doesn't look to be an anatomical relation to your symptoms, meaning they do not seem to be tied together by a lesion to a certain brain or spinal cord area or peripheral nerve. That is a good thing because it indicates that there is no serious lesion.
Coupled with your own perception of being caused by anxiety and worry I would say that anxiety is to be blamed for these symptoms. I wouldn't expect Prozac interruption to lead to an improvement, if anything it might worsen it in the case of anxiety. Prozac is not a bad anti-anxiety medication, but apparently it is not effective enough, at least not at that dose.
As for which specialist you need to see I would say it would be either a neurologist or a psychiatrist. I would say a psychiatrist is more appropriate to manage anxiety, but if you feel still worried to have some neurological condition then you may start by a neurological consult first to rule them out, do not see any indication of neurological lesions though as I said.
Before consulting a specialist though it would be advised to have some routine blood tests for possible metabolic causes of tremor (trembling) such as electrolyte panel and thyroid hormone level, as metabolic or hormonal alterations may produce tremor.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at that description of your symptoms there doesn't look to be an anatomical relation to your symptoms, meaning they do not seem to be tied together by a lesion to a certain brain or spinal cord area or peripheral nerve. That is a good thing because it indicates that there is no serious lesion.
Coupled with your own perception of being caused by anxiety and worry I would say that anxiety is to be blamed for these symptoms. I wouldn't expect Prozac interruption to lead to an improvement, if anything it might worsen it in the case of anxiety. Prozac is not a bad anti-anxiety medication, but apparently it is not effective enough, at least not at that dose.
As for which specialist you need to see I would say it would be either a neurologist or a psychiatrist. I would say a psychiatrist is more appropriate to manage anxiety, but if you feel still worried to have some neurological condition then you may start by a neurological consult first to rule them out, do not see any indication of neurological lesions though as I said.
Before consulting a specialist though it would be advised to have some routine blood tests for possible metabolic causes of tremor (trembling) such as electrolyte panel and thyroid hormone level, as metabolic or hormonal alterations may produce tremor.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer. I do not believe this is an anxiety issue as I feel for the most part my anxiety is very well managed. What I meant about it getting much worse is such as a sudden scare or something I may be worrying about. Almost unrealistically as if my body is completely overreacting to my thoughts. As I mentioned it is usually worse in the morning and when I am very tired. . I notice it the most when I am sitting still. Sometimes my hearbeat is very heavy too. I already was seen by a doc who did bloodwork and everything came back clear. Hence the suggestion regarding the Prozac. One other thing I should mention is that I have had a slightly elevated rheumatoid factor at two different occasions.
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional information.
I must say though that still your description about sudden scare, body overreacting to thoughts etc is very much indicative of anxiety as the cause. It doesn't indicate any neurological lesion, neither of the brain and spinal cord nor of the spine.
Regarding the heartbeat issue while an EKG may be done alongside your blood tests, if it results normal then still it may be related to anxiety, palpitations are a common manifestation of anxiety.
As for the elevated rheumatoid factor, it doesn't have any relation to these symptoms (even if you actually had rheumatoid arthritis). However for a diagnosis of rheumatoid arthritis other criteria starting with arthritis signs are needed. Simply elevated rheumatoid factor doesn't mean to have the condition as such slightly raised levels are found in 4% of the individuals.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Thank you for the additional information.
I must say though that still your description about sudden scare, body overreacting to thoughts etc is very much indicative of anxiety as the cause. It doesn't indicate any neurological lesion, neither of the brain and spinal cord nor of the spine.
Regarding the heartbeat issue while an EKG may be done alongside your blood tests, if it results normal then still it may be related to anxiety, palpitations are a common manifestation of anxiety.
As for the elevated rheumatoid factor, it doesn't have any relation to these symptoms (even if you actually had rheumatoid arthritis). However for a diagnosis of rheumatoid arthritis other criteria starting with arthritis signs are needed. Simply elevated rheumatoid factor doesn't mean to have the condition as such slightly raised levels are found in 4% of the individuals.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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