Physiologic Tremor

Aka: Physiologic Tremor, Enhanced Physiologic Tremor

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II. Exam: Findings

  1. Postural Tremor
  2. Normal variant (present in most normal patients)
  3. Example: Hold paper with outstretched arm
  4. Characteristics
    1. Low amplitude
    2. Frequency
      1. Hands: Rapid (8-12 Hz)
      2. Other parts: Intermediate (6.5 Hz)

III. History: Provocative (Enhanced Physiologic Tremor)

  1. Emotions (Anxiety, Stress, or Fear)
  2. Exercise
  3. Fatigue
  4. Hypoglycemia
  5. Hypothermia
  6. Hyperthyroidism
  7. Alcohol Withdrawal
  8. Benzodiazepine Withdrawal
  9. Medications
    1. Albuterol
    2. Caffeine
    3. Fluoxetine (Prozac)
    4. Haloperidol (Haldol)
    5. Tricyclic Antidepressants (e.g. Amitriptyline)
    6. Lithium
    7. Methylphenidate (Ritalin)
    8. Metoclopramide (Reglan)
    9. Phenylpropanolamine
    10. Pseudoephedrine
    11. Synthroid
    12. Theophylline
    13. Carbamazepine (Tegretol)
    14. Valproic Acid

IV. History: Palliative factors reducing Tremor

  1. Alcohol
  2. Benzodiazepines
  3. Beta Blockers (e.g. Propranolol)
  4. Primidone (Mysoline)

V. Labs: Not indicated unless atypical case or severe Tremor

  1. Chemistry Panel including Glucose
  2. Liver Function Tests
  3. Thyroid Stimulating Hormone (TSH)

VI. Management

  1. Eliminate exacerbating factors
  2. Decrease Caffeine

VII. References

  1. Crawford (2018) Am Fam Physician 83(6): 697-702 [PubMed]

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