Hands and feet

September 2009

FocusHands and feet

My hands shake

Classification and treatment of tremor

Volume 38, No.9, September 2009 Pages 678-683

Dharshana Sirisena

David R Williams


Tremor is the most common movement disorder in the community and is defined as a rhythmic oscillatory movement of a body part. Classification of tremors is helpful for accurate diagnosis, prognosis and treatment. Most tremors can be separated according to the state in which they occur, that is, during rest or action. Other clinical features, including frequency, amplitude and associated neurological signs, further define tremor.


This article describes some of the important clinical clues that reliably separate tremors, including the rest tremors of Parkinson disease and vascular midbrain lesions, or the action tremors of enhanced physiological tremor, essential tremor and dystonic tremor.


Numerous treatment strategies exist for tremor, but focused, selective use of appropriate medications requires accurate clinical diagnosis. Diagnostic certainty is essential as functional neurosurgery (deep brain stimulation) offers a realistic treatment option for many patients with severe tremor.

Tremor describes an oscillatory, rhythmic involuntary movement of a body part and is the most common movement disorder in the community.1–4 Although tremor can involve any part of the body, hands are the most common site. In general, tremor is a descriptive term, but the underlying cause and classification of tremor can usually be determined based on history and observation and aided by investigations when indicated.

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Correspondence afp@racgp.org.au

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