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What causes hand shaking? Related conditions and treatments

Medically reviewed by Gerardo Sison, Pharm.D.
Licensed Pharmacist
Updated May. 8, 2024  •  Published Jun. 5, 2023
Fact Checked
What causes hand shaking?
In this article:

Overview: What does hand shaking look like?

All people’s hands shake. A natural tremor, also known as a physiological tremor, is the result of the nervous system keeping the hands steady by contracting opposing muscles in the arm. It’s so subtle that it may be barely visible. 

However, the process might not work as it normally should at times. Caffeine, anxiety, certain drugs, or emotional stress can amplify the body’s natural hand tremor. In most cases, that’s nothing to worry about. The shaking is usually not severe, and it goes away. 

In other cases, the tremor doesn’t go away, or it’s severe enough to be highly visible and make normal daily tasks hard. Sometimes, hand shaking is due to more serious problems that need a medical diagnosis and treatment. Serious problems may also cause other noticeable symptoms, such as muscle stiffness or impaired coordination.

Key takeaways:

  • Hand shaking is a common symptom that may be caused by anxiety, stress, mental health problems, drugs, essential tremor, alcohol withdrawal, low blood sugar, electrolyte imbalances, hormone disorders, vitamin deficiencies, Parkinson’s disease, or other issues with the central nervous system.

  • Typically, hand shaking does not require immediate medical attention.

  • Hand shaking generally does not require treatment unless there are other symptoms or it’s severe. Most of the time, it goes away on its own, but not always. With treatment, hand shaking may or may not resolve depending on the cause. 

  • Treatment options for hand shaking vary by cause. Hand shaking may be managed by limiting caffeine and alcohol intake, eating a healthy diet, managing stress, practicing good sleep hygiene, and doing hand and wrist exercises.

  • Using coupons for hand shaking treatments, like Mysoline (primidone), Inderal LA (propranolol), and Lopressor (metoprolol tartrate), might save you up to 80% on costs.

What causes hand shaking?

There are several different causes of hand shaking. Most people who experience hand shaking will either have enhanced physiological tremor or benign tremor. Other causes may be more serious, but other symptoms are typically involved.

Enhanced physiological tremor is a normal hand tremor that’s more obvious. Typically, the causes can be easily managed or corrected. These causes include:

  • Anxiety

  • Stress

  • Drug side effects

  • Metabolic disorders

The most common drugs that may cause enhanced physiological tremor include:

Exposure to heavy metals like mercury and lead can also bring on hand shaking.

Metabolic disorders that can lead to hand tremors may include:

  • Low blood sugar (hypoglycemia)

  • Overactive thyroid (hyperthyroidism)

  • Overactive parathyroid

  • Low electrolyte levels

Hand shaking due to essential tremor is usually an age-related neurological condition. This type of tremor is not typically due to another disease or condition, and it's not harmful in itself, but it can be frustrating and may interfere with daily activities. Besides the hands and wrists, shaking can affect the neck, feet, legs, and voice box.

The more serious cases of hand tremors may be caused by nervous system disorders, particularly problems with the cerebellum or the midbrain. They usually involve more than just shaky hands. People with these neurological disorders may often notice other types of tremor and other more concerning symptoms:

  • Parkinson’s disease

  • Stroke

  • Multiple sclerosis

  • Brain tumors

  • Traumatic brain injury

  • Dystonic tremor

  • Wilson disease

RELATED: Parkinson’s symptoms: what are the early signs of Parkinson’s??

Should I be worried about hand shaking?

Most problems with hand shaking are temporary and relatively harmless. Even so, you may want to see a healthcare provider to make sure everything is okay. Medical attention may be warranted if hand shaking is severe, interferes with daily life, or is accompanied by other symptoms. Symptoms you might experience with a tremor might include muscle stiffness, slow movements, a shuffling walk, weakness, muscle rigidity, or involuntary movements, such as muscle contractions in other parts of the body. Hand tremor by itself is not usually life-threatening or an emergency.

How is the cause of hand shaking diagnosed?

Since hand shaking has so many causes, diagnosing the cause of hand shaking requires a bit of detective work. A healthcare provider will take a thorough medical history and perform a physical examination to look for clues. Expect questions like:

  • Is the hand shaking on one or both sides of the body?

  • When did the shaking start?

  • What happened before the shaking started?

  • Does the hand shaking sometimes get worse?

  • What makes it get worse?

  • Does it go away or improve?

  • What makes it improve?

  • Are any other parts of your body affected?

  • What medications are you taking?

The clinician will probably have you put your hand in a variety of positions:

  • Resting the arm on your lap with your palm up to observe any resting tremor

  • Holding the hand out in front of you

  • Pushing the hand against a stationary object

  • Holding out your hand and tapping your finger to your thumb

  • Holding out your hand and touching your nose

The clinician may also perform a neurological assessment to look for other abnormalities of nerve functioning. Blood tests can help identify other problems, such as low electrolytes or high thyroid hormone levels.

You may be referred to a neurologist—a specialist in nervous system diseases—who can perform a thorough neurological examination. They may measure the speed of the tremor by attaching electrodes to the hand, a procedure called electromyography (EMG). Other tests, such as CT or MRI scans, may be used if a serious neurological condition is suspected. 

How long does hand shaking last?

Hand shaking can be temporary or chronic depending on the cause:

  • Drug-induced and stress-induced hand-shaking usually go away when the drug is removed or a person relaxes.

  • Metabolic tremor usually goes away when the underlying condition is corrected.

  • Essential tremor is a chronic and lifelong condition that can get progressively worse over time. 

  • Psychogenic tremor can come and go. It may temporarily stop during certain activities that require focus and attention, such as playing a video game or drawing a picture. It often resolves, but the timeframe is unpredictable.

  • Hand shaking due to medical conditions, such as Parkinson’s disease or stroke, is often chronic and a lifelong symptom.

How to stop hand shaking

Healthcare professionals typically focus on fixing the cause of hand shaking rather than on how to get rid of hand shaking. The clinician may suggest a few lifestyle changes for tremors due to stress, anxiety, and similar causes. They might recommend stopping a medication that is contributing to the shaking.

The underlying neurological problem that causes essential tremor is not curable. However, the hand shaking can be socially stigmatizing and even disabling. Hand shaking treatments are available. A healthcare professional may prescribe medications such as beta blockers, anticonvulsants, or benzodiazepines. Botox injections may help ease certain symptoms, such as shaky hands or voice tremors, for a few months. 

If prescription medications are unsuccessful and the tremor is severely disabling, healthcare professionals can recommend ultrasound treatment, deep brain stimulation, or brain surgery to target the affected area of the brain. For chronic or severe tremors, physical and occupational therapy may help people manage symptoms, perform daily functions, and maintain quality of life.

RELATED: Hand tremors: how to stop shaking hands

Living with hand shaking 

Many people with hand tremors will see it improve with treatment, but sometimes the condition is chronic. Medications and other treatment options can help relieve symptoms, but most people may have to live with some degree of hand shaking. There are various ways to help reduce or minimize chronic hand shaking:

  • Eat a healthy diet

Eat a well-balanced diet that includes sources of vitamin B12, an essential nutrient for healthy nerves. The Mediterranean diet has been shown to improve symptoms of essential tremor.

  • Limit caffeine and other stimulants

Caffeine and other stimulants may worsen an existing hand tremor. 

  • Manage stress

As stress, anxiety, and worry can contribute to hand tremors, stress management and relaxation techniques may help improve tremors.

  • Get plenty of sleep

Fatigue and lack of sleep may worsen tremors, so practice good sleep hygiene and get at least seven hours of sleep each night.

  • Do hand and wrist exercises

A healthcare professional or physical therapist can teach you hand and wrist exercises that may help reduce tremors.

  • Use a weighted glove

An anti-tremor weighted glove may help reduce hand shaking, allowing people to perform daily tasks like writing or using utensils.

RELATED: How to stop hand tremors (shaky hands) naturally

Most importantly, see a healthcare provider

Even though tremor is usually not health-threatening, a doctor should have a look at it. There are three possible scenarios. The first is that the problem is fixable and so is the tremor. The second is that the problem isn’t fixable but not a threat, like essential tremor. In that case, doctors and other healthcare professionals have treatments to reduce or help people manage the shaking. The third is that the problem is serious and requires medical treatment. Getting treatment for those conditions is essential and may be life-saving. Only a healthcare professional can discover the underlying cause of shaky hands and start the appropriate treatment.

FAQs about the causes of hand shaking

Can dehydration cause shaky hands?

Dehydration itself does not directly cause shaky hands or tremors. However, dehydration can lead to muscle cramps. Cramping muscles can sometimes make parts of the body appear to be shaking. In cases of dehydration, there are typically other noticeable symptoms such as thirst, dizziness, low blood pressure, fainting, and heart palpitations.

Does high BP cause shaky hands?

High blood pressure does not generally cause symptoms unless blood pressure gets dangerously high. Even then, symptoms don’t include shaky hands. However, some blood pressure medications like beta blockers cause hand tremors as a side effect.

Can heart problems cause shaky hands?

Heart problems do not generally cause shaky hands. However, some heart problems, such as heart attacks, may lead to feelings of weakness or shaky hands. Several problems that cause hand tremors may also make the heart beat faster or abnormally. These problems include anxiety, stress, panic attacks, and an overactive thyroid.

What’s next? Additional resources for people with hand shaking

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Gerardo Sison, Pharm.D.
Licensed Pharmacist

Gerardo Sison, Pharm.D., graduated from the University of Florida. He has worked in both community and hospital settings, providing drug information and medication therapy management services. As a medical writer, he hopes to educate and empower patients to better manage their health and navigate their treatment plans.

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