From the Research
To evaluate hand tremors when holding objects, observe the tremor's characteristics during specific tasks, such as having the patient hold a cup, pen, or spoon, and note if the tremor worsens or improves with this action, as this approach is supported by the most recent and highest quality study on essential tremor management 1. When assessing hand tremors, it is essential to consider the type of tremor, whether it is an action tremor, intention tremor, or resting tremor, as differentiating between these types can guide diagnosis and treatment.
- Key characteristics to assess include:
- Amplitude (severity) of the tremor
- Frequency (fast or slow) of the tremor
- Regularity (rhythmic or irregular) of the tremor
- Parts of the hand affected by the tremor
- Comparison of both hands to identify asymmetry For quantitative assessment, standardized rating scales like the Fahn-Tolosa-Marin Tremor Rating Scale can be used, which scores tremor severity from 0-4 while performing tasks like drinking from a cup or writing, as recommended in recent studies on essential tremor diagnosis and treatment 2. The spiral drawing test is also a useful tool, where the patient traces a pre-drawn spiral, and tremor-related deviations are observed, providing valuable information on the tremor's impact on fine motor skills, as discussed in a recent review on essential tremor therapeutics 1. Physiological tremors, which are normal and can be enhanced by caffeine or anxiety, typically have high frequency and low amplitude, whereas pathological tremors, such as those seen in Parkinson's disease or essential tremor, have distinct patterns, as noted in a study on the mechanisms of tremor-modulating effects of primidone and propranolol in essential tremor 3. Recording video of the tremor can help track changes over time and response to treatment, allowing for more accurate monitoring and adjustment of treatment plans, as suggested in a recent article on the diagnosis and treatment of essential tremor 2.