Fine Hand Tremor

CLINICAL DIAGNOSTIC MANUAL

Fine hand tremor is an involuntary, rhythmic, oscillatory movement that affects the hands and can interfere with daily activities such as writing, holding small objects, or eating. This type of tremor is common and can have various etiologies, ranging from physiological causes to pathological disorders. Identifying the underlying cause is crucial to direct appropriate treatment. Tremors can be exacerbated by factors such as stress, fatigue, substance use, or underlying conditions affecting the central or peripheral nervous systems.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Thyrotoxicosis	Fine tremor, tachycardia, weight loss, heat intolerance, hyperreflexia	Clinical history, physical exam, signs of hyperthyroidism	Thyroid function tests (TSH, free T4)
Anxiety	Fine tremor, palpitations, sweating, nervousness, hyperventilation	Clinical history, psychological evaluation	Clinical evaluation, anxiety questionnaires
Alcohol withdrawal syndrome	Fine tremor, sweating, anxiety, nausea, irritability, hallucinations in severe cases	History of alcohol use, withdrawal symptoms	Clinical history, lab tests (liver function, electrolytes)
Secondary to sympathomimetic drugs	Fine tremor, tachycardia, hypertension, mydriasis, sweating	History of sympathomimetic drug use	Toxicology tests
Benign essential tremor	Fine tremor that worsens with action and decreases at rest, no associated neurological symptoms	Family history, clinical history, neurological exam	Clinical diagnosis, exclusion of other causes