What causes shaky hands and how to treat them?

The other day, while lighting the birthday candles on her birthday cake, my friend's hands trembled terribly. Perhaps, her chain smoking caused it, I thought. Often when our ageing folks grasp the cellphone to talk, you notice their shaky hands. People often talk about their limbs going numb after a long spell of driving, squatting, working at the desk or simply lying on their side. Sometimes, when you talk while holding your mobile phone for too long, that hand turns numb. When you wake up after a nap, a hand feels is numb. When you board long-distance flights, or keep driving for long, your legs fall asleep.

If any of the above is happening to you, and you are wondering what the trigger is — whether it is a vitamin deficiency, a genetic development, or an age-related disorder — look no further, as experts and doctors give a low-down on its causes and treatment:

Un-Comfortably Numb

Dr Pavan Pai, consultant interventional neurologist, Wockhardt Hospitals, Mira Road, Mumbai, says, “The most common reason behind experiencing pins and needles in your limbs include multiple sclerosis, hyperthyroidism, alcohol withdrawal, excess caffeine intake, high levels of stress, low blood sugar count, insufficient sleep, aggressive smoking, liver disorders, and insufficient vitamin B 12 levels in the body.” “It could also be due to anxiety, fatigue, vigorous exercise, and the side effect of certain medications,” adds Dr Ravindra Srivastava, director of neurosciences, Primus Super Speciality Hospital, Delhi NCR.

But are slight tremors normal? All of us experience a tiny bit of natural tremor called the physiological tremor. You can experience and identify it when you stretch your hands out in front of you, and realise they do not stay completely still. This physiological tremor is usually unnoticeable, unless it gains an enlarged, prominent dimension. Essential tremor (ET) is a neurological disruption that can cause your limbs, or voice to shake rhythmically. Sometimes, this is mistaken to be a Parkinson's affliction.

Dr Ishu Goyal, associate consultant, Neurologist, Sir HN Reliance Foundation Hospital, Mumbai, says, “There are various causes of tremors like essential tremors, physiological tremors, drug-induced, and other degenerative diseases like spino-cerebellar ataxias, to name a few. Tremors due to Parkinson's disease, typically affect one hand first and are usually present at rest. Tremors predominantly on holding objects or pouring tea, may not be because of Parkinson's disease. Vitamin B12 plays an important role in maintaining the overall health of our nervous system. Its deficiency may lead to various neurological disorders, including tremulousness of hands. This requires a careful evaluation and timely correction. Often anxiety emerges as the most common cause of tremors of the hand – these are enhanced physiological tremors. A small dose of anti-anxiety pill before any stress-related situation helps in relieving these tremors. Certain individuals experience a family history of tremors, that is shared across the family tree. Such a situation may be owing to the genetic makeup and can be suppressed with appropriate medication.”

Pins and Needles

Prickling and tingling sensations, numbness, and shaking of hands are some of the symptoms that need timely intervention in terms of a neurological check up. The definition of numbness changes from person to person. “Numbness is a vague term commonly used to describe any abnormal sensation felt by a person. It may be pins and needles sensation, ant crawling feeling, heaviness of a body part or even weakness of hand/ leg. Most often, it is secondary to a period of immobilisation like after sleeping or any abnormal posturing of arm/ leg for long, but it is generally short lasting for only seconds and reverts spontaneously on mobilisation,” says Dr Goyal. “However, if it is constant, throughout the day, longer lasting or increase in severity, it indicates a neurological disorder like peripheral neuropathy. It may be because of nerve compression, nerve damage due to metabolic factors like diabetes or more sinister demyelinating disorders. If you experience persisting symptoms, worsening over time or associated weakness with difficulty in gripping objects, it needs immediate medical attention with at least monthly to three-monthly follow-ups depending on physician’s assessment.”

Is the limb falling asleep a marker for concern, too? “Pins and needles (paresthesia) refers to a sensation of uncomfortable tingling, prickling, or itching in the hands or feet. The affected area falls asleep. If there is pressure on the nerves of the hands, nerve injury, or reduced blood supply to the hand then this condition can occur,” says Dr Pai. There are cases emerging post the pandemic, of the right hand in many people experiencing this development of a tingling sensation. Most common is a deficiency of Vitamin D, or B 12. Often it is the setting in of the carpal tunnel syndrome which is a common occurrence and brings with it numbness, tingling, and pain in the hand and forearm. “Numbness in the hands while sleeping often stems from the compression of blood vessels or nerves in the hands due to the sleeping position. But it may also result from carpal tunnel syndrome or other underlying nerve damage.  You may experience numbness in your feet or legs during a flight and it can be the result of poor circulation. Your blood circulation is restricted when you are seated; once you move around, the numbness should subside. Similarly, our feet may fall asleep when we drive due to compression of the nerve or stretching of blood vessels that supply the nerve,” says Dr Srivastava.

“Paresthesia is a sensation of uncomfortable tingling, pricking, itching or skin crawling, usually felt in the hands or feet. Some reports suggested that people who tested positive for the coronavirus in the early months of the pandemic also experienced peripheral neuropathy — pain, tingling and numbness in the hands and feet — during their bouts with Covid-19. However, as most people did their household chores themselves, overworking could have brought in the sensation of pins and needles. This is because when overworked tendons become irritated, they can develop small tears causing pain and muscle weakness,” adds Dr Srivastava.

Get on your nerves

Keep an eye out for consistent tell-tale signs in problems with balance and/or hand-eye coordination, seizures, slurred speech, blurred vision, headache, changes in behavior, and changes in hearing and/or your ability to smell. Mental confusion, fogginess in your earlier mental ability, weakness, fatigue, and fever must also be paid heed to.

Can this trembling be corrected, or does it persist lifelong and develop further? Says Dr Srivastava, “Some people with essential tremors do not require treatment if their symptoms are mild. However, if trembling or shaking hands are making it difficult to work or perform daily activities, one can discuss treatment options with their healthcare provider. As part of medicine treatment, beta blockers, anti-seizure medicines, and tranquilisers are used. Physical and occupational therapy is also used to treat patients. Nerve stimulation devices have also evolved as a newer treatment option for people with essential tremors. Surgery might be an option if your tremors are severely disabling, and you fail to respond to medicines. Apart from that, there are lifestyles and home remedies to deal with the condition.”

In this urban age with our synthetic lifestyles and tendency to pop in pills for quick-fix resolution of health issues, Dr Goyal cautions, “People should also avoid over-the-counter medications without prescription as many of these may have extrapyramidal side effects and may lead to tremors. Prevention is equally important by maintaining an active lifestyle in this era of gadgets where abnormal shoulder, neck and postures are common leading to generalised aches and pains.”

Light Right

Eat vitamin D-rich foods, such as salmon, tuna, and sardines, and vitamin B12-rich foods, such as eggs, and dairy products.

Get 7-8 hours of quality sleep everyday

Skip smoking and alcohol consumption

Make exercise a part of your daily routine

Practise yoga and meditation for removing stress

The B-town Fix

Vitamins B1, B6, and B12 have been found to be beneficial for treating neuropathy. While Vitamin B1, also known as thiamine, helps to reduce pain and inflammation, vitamin B6 preserves the covering on nerve endings.

Neurologists also recommend a balanced brain-healthy diet, including complex carbohydrates, essential fatty acids, amino acids, and vitamins and minerals.