The following are some of the common causes of tremors encountered in clinical practice and their distinguishing features

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⚡️ Parkinson's disease

• resting, “pill-rolling” tremor (as if you are trying to roll a pill with your thumb and index finger)

• idiopathic Parkinson’s disease results in a unilateral tremor (while drug-induced parkinsonism leads to a bilateral tremor)

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⚡️ Essential tremor

• worse if the hands are outstretched

• alleviated with rest and alcohol

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⚡️ Intention tremor

• involuntary, rhythmic muscle contractions that occur when carrying purposeful, voluntary movements

• seen in cerebellar disease due to lesions of the cerebellar hemisphere

• finger-to-nose and heel-to-shin tests are important tests

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⚡️ Asterixis (flapping tremor)

• tremor is pronounced with the arms outstretched

• seen in

  • respiratory conditions such as COPD due to CO2 retention

  • hepatic encephalopathy due to the build-up of ammonia

  • renal failure due to uraemia

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⚡️ Fine tremor

• assessment:

  • ask the patient to stretch their arms out, and then place a piece of paper on the dorsum of both of their hands

• seen in

  • salbutamol use

  • thyrotoxicosis