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Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. Essential tremor put Roger Frisch’s violin career in jeopardy. To save his music, neurosurgeons at Mayo Clinic implanted an electrical stimulator in his brain. COVID-19: What you need to know. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information. Find Tremors Latest News, Videos & Pictures on Tremors and see latest updates, news, information from NDTV.COM. Explore more on Tremors.

Authors
Meredith A Spindler, MD

Meredith A Spindler, MD

  • Assistant Professor of Clinical Neurology, Parkinson's Disease and Movement Disorders Center
  • University of Pennsylvania School of Medicine
Daniel Tarsy, MD

Daniel Tarsy, MD

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  • Professor of Neurology
  • Harvard Medical School
Section Editor
Howard I Hurtig, MD

Howard I Hurtig, MD

  • Section Editor — Movement Disorders
  • Professor of Neurology
  • University of Pennsylvania School of Medicine
Deputy Editor
April F Eichler, MD, MPH

April F Eichler, MD, MPH

  • Senior Deputy Editor — UpToDate
  • Deputy Editor — Neurology and Sleep Medicine
  • Assistant Professor of Neurology
  • Harvard Medical School

INTRODUCTION

Tremor is defined as an involuntary, rhythmic, and oscillatory movement of a body part [1]. It is caused by either alternating or synchronous contractions of antagonistic muscles. Tremor is the most common of all movement disorders, occurring from time to time in many normal individuals in the form of exaggerated physiologic tremor [2].

This topic will provide an overview of the classification, clinical features, diagnostic evaluation, and treatment of tremor, including essential tremor (ET), which also is discussed in greater detail separately. (See 'Essential tremor: Clinical features and diagnosis' and 'Essential tremor: Treatment and prognosis' and 'Surgical treatment of essential tremor'.)

CLASSIFICATION

Tremors have been variably defined and categorized over time, and classification is made difficult by overlapping clinical characteristics and etiologies. The most common distinction is based on the activating conditions (ie, at rest versus action), but other clinical characteristics, such as frequency and body distribution, also guide the evaluation and etiologic diagnosis.

A clinical and etiologic classification scheme has been proposed by the International Parkinson and Movement Disorder Society [1]. It provides a framework upon which currently recognized and new tremor syndromes can be defined.

Clinical characteristicsClinical classification of tremor is based on history, tremor characteristics, associated neurologic and systemic signs, and, in some cases, additional testing.

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Literature review current through: Dec 2020. This topic last updated: Dec 22, 2020.
The content on the UpToDate website is not intended nor recommended as a substitutefor medical advice, diagnosis, or treatment. Always seek the advice of your own physician orother qualified health care professional regarding any medical questions or conditions. Theuse of this website is governed by the UpToDate Terms of Use©2021 UpToDate, Inc.

Tremor is the most common movement disorder.[1] It is defined as an involuntary rhythmic oscillation of ≥1 body parts, mediated by alternating contractions of reciprocally acting muscles.[2] It commonly affects the upper extremities but can also affect the head, chin, voice, or legs. Tremor, if severe, may impair activities of daily living or occupation, and may lead to embarrassment and social withdrawal.

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Its rhythmicity differentiates it from other involuntary movements such as myoclonus, clonus, chorea, dystonia, and tics, although patients with these other conditions may complain of 'shaking' or 'tremulousness'. For appropriate diagnosis and treatment, it is critical to determine the positional properties that make the tremor most noticeable. Most tremors can be classified as 'rest' or 'action'.

  • Rest tremors occur when the body region is relaxed (i.e., not actively moving, contracting, sustaining a position, or opposing gravity). Examples include tremor in a hand relaxed by the side when walking or resting in a lap when sitting.

  • Action tremors occur during voluntary muscle contraction. They are further divided into postural, kinetic, isometric, or task-specific sub-types.

    • Postural tremors occur during maintenance of a posture, usually against gravity (e.g., holding up a newspaper).

    • Kinetic tremors occur during active movement. A sub-type of kinetic tremor, intention tremor, is seen with a goal-directed movement (e.g., finger-to-nose testing). Action tremors are often both postural and kinetic.

    • Isometric and task-specific sub-types are uncommon. Isometric tremors occur during muscle contractions without movement (e.g., fist-clenching or standing). Task-specific tremors occur with a specific activity (e.g., writing or playing an instrument).