Tremor physical examination

Tremor Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Physical examination of patients with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

• Patients with tremor may present with variable appearance depending on the cause of tremor. It is important to observe for gait, apathy, resting tremor, posture, facial expressions when the patient walks in and during history taking.

Vital Signs

• Temperature is usually normal in common causes of tremor.
• Hyperthermia may be present in hyperthyroidism.
• Tachycardia with regular pulse may be found in hyperthyroidism, stress, anxiety
• Tachypnea may be found in stress, anxiety
• Blood pressure with usually normal.

Skin

• Skin examination of patients with tremor is usually normal.

HEENT

• HEENT examination of patients with tremor depends on the cause.
• Look for eye changes characteristic of hyperthyroidism.
• Eye movement should be assessed for cerebellar disorders and Parkinson's disease could have double vision due to convergence insufficiency.
• Action tremor in patients under forty should be examined for Wilson's disease eye changes, Kayser–Fleischer ring in the cornea.

Neck

• Neck examination of patients with tremor is usually normal.
• Hyperthyroidism may have neck swelling, thyromegaly / thyroid nodules.

Lungs

• Pulmonary examination of patients with tremor is usually normal.

Heart

• Cardiovascular examination of patients with tremor is usually normal.

Abdomen

• Abdominal examination of patients with tremor is usually normal.

Back

• Back examination of patients with [disease name] is usually normal.

OR

• Point tenderness over __ vertebrae (e.g. L3-L4)
• Sacral edema
• Costovertebral angle tenderness bilaterally/unilaterally
• Buffalo hump

Genitourinary

• Genitourinary examination of patients with [disease name] is usually normal.

OR

• A pelvic/adnexal mass may be palpated
• Inflamed mucosa
• Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

• Neuromuscular examination of patients with [disease name] is usually normal.

OR

• Patient is usually oriented to persons, place, and time
• Altered mental status
• Glasgow coma scale is ___ / 15
• Clonus may be present
• Hyperreflexia / hyporeflexia / areflexia
• Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
• Muscle rigidity
• Proximal/distal muscle weakness unilaterally/bilaterally
• ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
• Unilateral/bilateral upper/lower extremity weakness
• Unilateral/bilateral sensory loss in the upper/lower extremity
• Positive straight leg raise test
• Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
• Positive/negative Trendelenburg sign
• Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
• Normal finger-to-nose test / Dysmetria
• Absent/present dysdiadochokinesia (palm tapping test)

Extremities

• Extremities examination of patients with [disease name] is usually normal.

OR

• Clubbing
• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities
• Muscle atrophy
• Fasciculations in the upper/lower extremity