Tremor physical examination: Difference between revisions
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[[Physical examination]] of [[patients]] with tremor varies depending on the [[cause]] of tremor. | [[Physical examination]] of [[patients]] with tremor varies depending on the [[cause]] of tremor. | ||
*[[Essential tremor]] is diagnosed according to International Parkinson and Movement Disorder Society (IPMDS) guidelines<ref name="pmid29193359">{{cite journal| author=Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED | display-authors=etal| title=Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. | journal=Mov Disord | year= 2018 | volume= 33 | issue= 1 | pages= 75-87 | pmid=29193359 | doi=10.1002/mds.27121 | pmc=6530552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29193359 }} </ref>: | *[[Essential tremor]] is diagnosed according to International Parkinson and Movement Disorder Society (IPMDS) guidelines<ref name="pmid29193359">{{cite journal| author=Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED | display-authors=etal| title=Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. | journal=Mov Disord | year= 2018 | volume= 33 | issue= 1 | pages= 75-87 | pmid=29193359 | doi=10.1002/mds.27121 | pmc=6530552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29193359 }} </ref>: | ||
*Bilateral action tremor of [[upper limbs]] | **Bilateral action tremor of [[upper limbs]] | ||
*Absence of other [[neurological]] [[signs]] | **Absence of other [[neurological]] [[signs]] | ||
*Long duration, more than 3 years | **Long duration, more than 3 years | ||
*Absence or presence of tremor in other locations | **Absence or presence of tremor in other locations | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
Revision as of 18:06, 31 January 2021
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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
Physical examination of patients with tremor varies depending on the cause of tremor.
- Bilateral action tremor of upper limbs
- Absence of other neurological signs
- Long duration, more than 3 years
- Absence or presence of tremor in other locations
Physical Examination
Physical examination of patients with tremor varies depending on the cause of tremor.
- Essential tremor is diagnosed according to International Parkinson and Movement Disorder Society (IPMDS) guidelines[1]:
- Bilateral action tremor of upper limbs
- Absence of other neurological signs
- Long duration, more than 3 years
- Absence or presence of tremor in other locations
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, tremor with voluntary movement, posture, facial masking, sweating 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[2].
- Eye movement should be assessed for cerebellar disorders and Parkinson's disease could have double vision due to convergence insufficiency[3].
- Action tremor in patients under forty should be examined for Wilson's disease eye changes, Kayser–Fleischer ring in the cornea.
- Assess for nystagmus if cause of tremor is sudden in onset, associated with new onset headache, vertigo, gait changes. possible cause could be a stroke.
- Decreased blinking in Parkinson's disease.
Neck
- Neck examination of patients with tremor is usually normal.
- Hyperthyroidism may have neck swelling, thyromegaly / thyroid nodules[3].
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 tremor is usually normal.
Genitourinary
- Genitourinary examination of patients with tremor is usually normal.
Neuromuscular
- Patients are usually oriented to persons, place, and time. Detailed neuromuscular examination of patients with tremor should include:
- Parkinson's disease[4]:
- Muscle rigidity: Cogwheel rigidity
- Bradykinesia: Slow movement, occurs in Parkinsons disease.
- Abnormal gait: Rombergs test
- Unilateral/bilateral tremor:Frequency, amplitude, pattern, distribution.
- Dysdiadochokinesia (palm tapping test)
- Postural reflexes impaired.
- Essential Tremor:
- Bilateral action tremor
- Effecting hands,forearms
- Absence of other neurological signs
- Cerebellar Tremor:
- Alcohol induced tremor:
- Finger-to-nose test / Dysmetria
Extremities
- Hands should be pronated and resting on the lap to induce resting tremor, it is important to be patient as tremors may take up to thirty seconds to appear. Repositioning hand with little finger down and thumb up can induce Parkinsonian tremor and Holmes tremor[5].
- Parkinson's disease: Shortening of stride length, appendicular bradykinesia
- Essential Tremors: Bilateral action tremor effecting hands and forearms. Other neurological signs are absent.
References
- ↑ Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED; et al. (2018). "Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society". Mov Disord. 33 (1): 75–87. doi:10.1002/mds.27121. PMC 6530552 Check
|pmc=value (help). PMID 29193359. - ↑ Sharma S, Pandey S (2016). "Approach to a tremor patient". Ann Indian Acad Neurol. 19 (4): 433–443. doi:10.4103/0972-2327.194409. PMC 5144461. PMID 27994349.
- ↑ 3.0 3.1 Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
- ↑ Chen W, Hopfner F, Becktepe JS, Deuschl G (2017). "Rest tremor revisited: Parkinson's disease and other disorders". Transl Neurodegener. 6: 16. doi:10.1186/s40035-017-0086-4. PMC 5472969. PMID 28638597.
- ↑ Alqwaifly M (2016). "Treatment responsive Holmes tremor: case report and literature review". Int J Health Sci (Qassim). 10 (4): 558–562. PMC 5085351. PMID 27833521.