Tremor physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Physical examination of patients with tremor varies depending on the cause of tremor. The basis of physical examination is to determine the type of tremor, phenomenological features of tremor, associated neurological signs.

Physical Examination

Physical examination of patients with tremor varies depending on the cause of tremor.

Appearance of the Patient

Vital Signs

Skin

  • Skin examination of patients with tremors is usually normal.

HEENT

Neck

Lungs

Heart

Abdomen

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Genitourinary

Neuromuscular

Assessment of tremor[3].
Position Category Causes
At rest Resting tremors Tremors that are worse at rest include Parkinsonian syndromes and essential tremor if severe. This includes drug-induced tremors from blockers of dopamine receptors such as haloperidol and other antipsychotic drugs.
During contraction (eg a tight fist while the arm is resting and supported) Contraction tremors Tremors that are worse during supported contraction include essential tremor and also cerebellar and exaggerated physiologic tremors such as a hyperadrenergic state or hyperthyroidism[3]. Drugs such as adrenergics, anti-cholinergics, and xanthines can exaggerate physiologic tremor.
During posture (eg with the arms elevated against gravity such as in a 'bird-wing' position) Posture tremors Tremors that are worse with posture against gravity include essential tremor and exaggerated physiologic tremors[3].
During intention (eg finger to nose test) Intention tremors Intention tremors are tremors that are worse at during intention and the patient's finger approaches a target include cerebellar disorders.


Extremities

References

  1. Sharma S, Pandey S (2016). "Approach to a tremor patient". Ann Indian Acad Neurol. 19 (4): 433–443. doi:10.4103/0972-2327.194409. PMC 5144461. PMID 27994349.
  2. 2.0 2.1 Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
  3. 3.0 3.1 3.2 Jankovic J, Fahn S (1980). "Physiologic and pathologic tremors. Diagnosis, mechanism, and management". Ann Intern Med. 93 (3): 460–5. doi:10.7326/0003-4819-93-3-460. PMID 7001967.
  4. Chen W, Hopfner F, Becktepe JS, Deuschl G (2017). "Rest tremor revisited: Parkinson's disease and other disorders". Transl Neurodegener. 6: 16. doi:10.1186/s40035-017-0086-4. PMC 5472969. PMID 28638597.
  5. Alqwaifly M (2016). "Treatment responsive Holmes tremor: case report and literature review". Int J Health Sci (Qassim). 10 (4): 558–562. PMC 5085351. PMID 27833521.