Doctor, my hands are trembling since one week. I can’t write properly. I even find it difficult to hold a cup of tea steady.
Is he alcoholic? Or is it simple anxiety?
Ask the patient to sit and raise the arms horizontally with relaxed fingers. Observe the fingers fro tremors.
Is it associated with tensions like giving a speech, talking to the boss or competition? "Yes"
Do you take alcohol? "Yes, but only occasionally." (occasional drinking does not produce be obvious)
Are you taking any drugs? "No" (salbutamol for asthma, imipramine as anti-depressant, Reserpine for hypertension are common examples)
First check the pulse rate. If there is tachycardia, it is anxiety or Thyrotoxicosis
The patient has a very tense or anxious look. It must be anxiety.
Is there breath smell of alcohol?
Examine the neck in sitting position. Ask the patient to swallow.
If goiter is seen, palpate for thyroid thrill and look for the eye signs of Thyrotoxicosis.
If clinical examination findings are normal and tremors are atypical (Eg. Tremors involving only one limb, coarse tremors, increasing in front of other people), then think of Hysterical tremors. Divert the patient’s attention by talking or engaging by talking or engaging her n same test. And hysterical tremors will reduce or disappear.
Key points for Tremors: Anxiety, alcoholism, breath smell, Drug induced, Thyrotoxicosis (if tachycardia). Hysteria in elderly – senile & Parkinson’s.
Action:
Tab. Propranolol, Tranquiliser, Reassurance.
If alcoholic, high dose B-complex, & tranquilisers.
If Thyrotoxicosis, ask for T3, T4, TSH. Give neo-mercazole, Propranolo, Tranquiliser.
