Coarse Hand Tremor

CLINICAL DIAGNOSTIC MANUAL

Coarse hand tremor is an involuntary, rhythmic, oscillatory movement affecting the hands with a larger amplitude compared to fine tremor. This type of tremor can be more disabling, significantly impairing the ability to perform both fine and gross motor tasks.

The causes of coarse tremor are diverse, including neurological, metabolic, and toxicological conditions. Accurate identification of the underlying cause is essential to provide appropriate treatment and improve the patient’s quality of life.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Liver failure	Asterixis (coarse tremor), jaundice, encephalopathy, ascites, confusion	Clinical history, physical exam	Liver function tests, abdominal ultrasound
Carbon dioxide retention	Asterixis, confusion, dyspnoea, headache, hypercapnia	Clinical history, arterial blood gases	Arterial blood gases, capnography
Cerebellar disease	Intention tremor, ataxia, dysmetria, dysarthria, nystagmus	Clinical history, neurological exam	Brain MRI, cerebellar coordination tests
Parkinsonism	Resting tremor, rigidity, bradykinesia, postural instability	Clinical history, neurological exam	Neurological evaluation, response to levodopa therapy
Benign essential tremor	Tremor worsens with action, decreases at rest, no associated neurological symptoms	Family history, clinical history, neurological exam	Clinical diagnosis, exclusion of other causes