Tremor physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical Examination
During a physical exam a doctor can determine whether the tremor occurs primarily during action or at rest. The doctor will also check for tremor symmetry, any sensory loss, weakness or muscle atrophy, or decreased reflexes. The degree of tremor should be assessed in four positions. The tremor can then be classified by which position most accentuates the tremor: [1]
| Position | Name | Description |
| At rest | Resting tremors | Tremors that are worse at rest include Parkinsonian syndromes and essential tremor if severe. This includes drug-induced tremors from blockers of dopamine receptors such as haloperidol and other antipsychotic drugs. |
| During contraction (eg a tight fist while the arm is resting and supported) | Contraction tremors | Tremors that are worse during supported contraction include essential tremor and also cerebellar and exaggerated physiologic tremors such as a hyperadrenergic state or hyperthyroidism[1]. Drugs such as adrenergics, anti-cholinergics, and xanthines can exaggerate physiologic tremor. |
| During posture (eg with the arms elevated against gravity such as in a 'bird-wing' position) | Posture tremors | Tremors that are worse with posture against gravity include essential tremor and exaggerated physiologic tremors[1]. |
| During intention (eg finger to nose test) | Intention tremors | Intention tremors are tremors that are worse during intention, e.g. as the patient's finger approaches a target, including cerebellar disorders. |