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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes tremors in the arms?

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Wed, 24 Aug 2016 in Brain and Spine
Question: For the past several months, i have noticed my arms are shaking, not if i hold my hands out, they are steady, its an internal tremor. If if rest my hands on my knees, there is no involuntary shaking, Its been decidedly worse this past week. I have eliminated caffeine to no effect. Its almost like when i go to reach for something, my hands are uncoordinated/a bit jerky. Yesterday, my left arm felt tingly and heavy all day, like it was tired. When i wake up in the morning this past week, my left eye is sluggish to open. What does this mean?
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

The causes of tremor can be many. It can be due to neurological conditions like Parkinson's, stroke, tumor etc, hormonal issues like increased thyroid function, electrolyte alterations, exposure to toxins, drugs etc. Often no condition is found and it can be simply in the setting of anxiety.

So its evaluation requires some blood tests such as blood count, thyroid function, electrolytes, liver and kidney function. If all results normal a neurological exam to check for other neurological signs and a brain MRI would be the next step. In terms of likelihood I would say that Parkinson's and other brain lesions do not look likely for that presentation so you shouldn't be alarmed. Actually if the neurological exam is fully normal, evidencing no coordination issues or oculomotor signs, the MRI might not be necessary at all. The blood tests I mentioned are cheap routine tests though and should be done.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 4 hours later
I did neglect to tell you that I did have blood work done and it did show some active adrenals, low vitamin B and D. with some potential thyroid issues. I dont know why i didnt remember this, but i'm on 50mg of synthyroid. It may be that i need a slightly higher dose and will discuss this with my naturopath.

I guess my concern was founded in being on the synthyroid, taking the vitamin B and D, and still exhibiting the tremors. This gave rise to concerns that perhaps i was on my way to essential tremors or worse ALS. I am not myself. My body feels out of balance. I have been getting some renewed regular hot flashes lately also (have been in menopause for 3 years) and am on the oestradiol. I am and have been a fairly healthy person, i'm not too much overweight (by perhaps 10lbs) I exercise at least 3-4 times a week. But i am not myself, my body is 'off' and i know it well enough that something is not right. I thought perhaps some of my symptoms might be obvious enough to make a small leap.
The sluggish eye opening the past week or so was odd, the tingling, heavy feeling in my arm yesterday was new and scary. Its a bit better today. I dont drink that much alcohol. I will be taking CBD (no THC) starting next week) to see how if it helps.
doctor
Answered by Dr. Olsi Taka 42 minutes later
Brief Answer:
Read below

Detailed Answer:
Thank you for the additional information.

I understand that you were hoping for the symptoms to be clear enough to make a leap as you say...that is possible though only when individual symptoms or their combination are found in only one specific condition. In your specific case I am afraid the symptoms are as non specific as it gets, meaning can be found in many different conditions. So it is not that easy to pinpoint the cause.

Regarding your concern about ALS though I can confidently say that there is nothing suggesting als in any of your symptoms. It doesn't manifest with tremor, doesn't have sensory symptoms like tingling and doesn't involve eyelids.

Essential tremor on the other hand cannot be excluded. It usually has a family history though and is present when you hold your hands out as well.

For the moment I would say that the hormonal imbalance you have, involving both the adrenal and thyroid issues as well as menopausal changes are most likely responsible for your symptoms.

I understand you got scared by the eyelid and the arm issue I think you should have a neurological exam as I suggested earlier. However when related to the brain a droopy eyelid is usually associated with eye movement abnormalities and double vision as well (same brain centers), so again I would tend to blame a metabolic issue or simply some eye issue such as chalazion (swelling of the eyelid by closed sebaceous gland). The arm as well when dueto a brain lesion such as stroke is usually associated with lower limb and face weakness, but however if that persists a neurological exam is needed.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 18 minutes later
Thank you. That does aleve some concerns! Too much knowledge is sometimes a dangerous thing. I don't have droopy eyelids, and a XXXXXXX kind of stroke did cross my mind, but i don't think i had that either. I suspect I may have some essential tremors, but as you say, it could just be a realm of hormone unbalance.

First i should see about getting my hormones balanced and a neurological exam and if conditions persist an MRI. You have been helpful. It has given me some relief! Thank you.
doctor
Answered by Dr. Olsi Taka 2 minutes later
Brief Answer:
Thank you.

Detailed Answer:
I hope you will feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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