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What causes severe hand tremors post simple activity in an elderly woman?

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Posted on Thu, 26 May 2016
Question: My 57-year old spouse is exhibiting shaky hands, typically after some moderate work; e.g., moving a chair or lifting some items. She is petite...about 110 lbs...and is in very good health. Her blood pressure is considered normal, but 90 / 70, and a low pulse rate not uncommon. Her skin/extremities are typically cool...I am mentioning this as circulation may be contributing to this problem. After a brief rest, her hands stop shaking; however, this condition seems to be more noticeable. Thanks for your suggestions in advance.
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Answered by Dr. Ajay Panwar (38 minutes later)
Brief Answer:
Essential tremor/anxiety/thyroid disorder/Drugs/Alcohol

Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

If you would have presented to me as an outpatient,I would have asked you the following details in order to answer this query well-

1)Since when he is having tremors?
2)Did the tremors start in both hands symmetrically?
3)Is family history positive for tremors?
4)Are tremors absent at rest?
5)Is there a positive history of frequent alcohol intake/anxiety/thyroid disorder?
6)Are you on any drugs?If yes,please list them.
7)Is there a history of rigidity or slowness?

I shall be glad to have you in follow-up with details so that I can answer this well.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (21 hours later)
Dr. Panwar:
Thanks very much for the substantive feedback. I will speak with my spouse to address your questions and get back to you soon. Thanks very much!
XXXXXXX XXXX
doctor
Answered by Dr. Ajay Panwar (2 minutes later)
Brief Answer:
Of course.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

Pleasure.I shall be waiting for your further response.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (30 hours later)
Dr. Panwar...
Hi! I have spoken to my wife and have the following answer to your questions:
1) Since when is she having tremors...Answer: about 1 year
2) Did the tremors start with both hands...Answer: First the right hand, then left; however, it now seems to correlate with the weight of the item being held; also, when she is tired, the trembling is worse; when she is not tired, there is no tremors;
3) Is the family history positive for tremors..Answer: Her father, deceased at age 88, developed tremors when he was in his 70's; he was not diagnosed with Parkinsons;
4) Are tremors absent at rest; Answer: Correct, no tremors at rest
5) Is there a positive history of frequent alcohol intake / anxiety / thyroid disorder...Answer: there seems to be a correlation with anxiety only (my wife has an alcoholic beverage very infrequently; she has not been diagnosed with any thyroid condition;
6) Is she taking any drugs? Answer - No, just some vitamins; e.g, B6/12 sometimes or Folic Acid;
7) Is there a history of rigidity or slowness? Answer: No.
Thanks for your consideration!
XXXXXXX
doctor
Answered by Dr. Ajay Panwar (8 hours later)
Brief Answer:
Anxiety/Essential tremor

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing further details.

Considering the clinical details,the most likely cause of these tremors in anxiety.These appear to be exaggerated physiological tremors,at times.However,Essential tremors is another possibility which is substantiated by positive family history.

I suggest that she should start on clonazepam for now and response should be observed.If this medicine improves the tremors,then they are likely due to anxiety.If there is no response on clonazepam,then propranolol should be started.If tremors respond to propranolol,then probably they are Essential tremors.

PLEASE TAKE MEDICINES UNDER A PHYSICIAN'S GUIDANCE ONLY.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (17 hours later)
Dr. Panwar:
Thanks very much for the very helpful and lucid response. I will provide your response to my spouse and will also make an appointment with her doctor, along with your advice. I/we appreciate your service very much! I will be closing the account for now and righting a very positive review. Thanks again!
XXXXXXX XXXX
doctor
Answered by Dr. Ajay Panwar (1 hour later)
Brief Answer:
Pleasure.

Detailed Answer:
Hi XXXXX,
Thanks for being in follow-up and appreciating me.

You are most welcome to connect with me,anytime you have a query in future.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Ajay Panwar

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Practicing since :2007

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What causes severe hand tremors post simple activity in an elderly woman?

Brief Answer: Essential tremor/anxiety/thyroid disorder/Drugs/Alcohol Detailed Answer: Hi XXXX, Thanks for being on healthcaremagic.com. I am Dr.Ajay Panwar,a neurologist,here to answer your query. If you would have presented to me as an outpatient,I would have asked you the following details in order to answer this query well- 1)Since when he is having tremors? 2)Did the tremors start in both hands symmetrically? 3)Is family history positive for tremors? 4)Are tremors absent at rest? 5)Is there a positive history of frequent alcohol intake/anxiety/thyroid disorder? 6)Are you on any drugs?If yes,please list them. 7)Is there a history of rigidity or slowness? I shall be glad to have you in follow-up with details so that I can answer this well. Regards Dr.Ajay Panwar, MD,DM(Neurology)