What Causes Tremors In Fingers?

Brief Answer:
Diagnosis is tricky.Needs additional history.

Detailed Answer:
Hi XXXXXX,
Thanks for being on Healthcaremagic.com.
I am Dr.Ajay Panwar, a neurologist, here to answer your query.

First of all,I want to reassure you and make you believe that there is nothing to get depressed here.
Of course,the history you are giving is atypical for either of them.Let us interpret it:

Two important points you mentioned in your history are-
1)Asymmetric onset of tremor(first on left side and then after a few years in right also)-This is classical for a 'parkinson's disease' but against 'essential tremor'.
2)Head tremors-This is classical for 'Essential tremor' but against 'Parkinson's disease'.

So,while one point is hallmark of each of them,another point is against each one.However,atypically,head tremor can be seen in parkinson's disease and rarely 'essential tremor' may start with a mild asymmetry.

So,it becomes important to discuss other hallmark points of each of them,based on which I would like to ask you some questions-
1)Do you have stiffness in limbs or rigidity(tightness in moving or folding limbs)-If yes,it goes for parkinson's disease
2)Do you have history of slowness while doing tasks of daily routine-if yes,it goes for parkinson's disease
3)Do you have mainly rest tremor?or kinetic tremor(while moving hands for doing something)?or postural tremor(tremor while keeping your hand stable in a posture for a few seconds)?-Predominant rest tremor is in favour of parkinson's disease while kinetic and postural tremor are in favour of 'essential tremor'.
4)Do your other family members have similar tremors?-If yes,it goes in favour of 'essential tremor'.
-Essential tremor improves with alcohol intake(in case,if that is applicable in your case)

Even in the biggest of confusion,we can try to make diagnosis with therapeutic trials.We can first start a therapeutic trial of propranolol-if the patient responds to it,it is an essential tremor.If not,we can start therapeutic trials of 'levodopa/carbidopa' and 'trihexyphenidyl'-if patient responds,it goes in favour of parkinson's disease.

That way,one thing is sure that your diagnosis will be done and there is nothing to get depressed.
Hope I have answered your query.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
It is likely Essential tremor.Lupus is very rarely associated with tremor.

Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
You are welcome for the day.

Certain hallmark features rule out parkinson's disease in your case and they are-
1)Absence of rest tremors
2)Lack of stiffness
3)Lack of slowness

Postural or kinetic tremors with head tremors with a likely positive family history(if you are calling tremors as palsy)-makes 'Essential tremor' as the likely diagnosis.

Lupus is very rarely associated with tremors in clinical practice.

Plan of management-If you would have been my outpatient,I would have put you on a therapeutic trial of propranolol(starting 40 mg once a day) and kept under observation.PLEASE DISCUSS WITH YOUR PHYSICIAN REGARDING THIS.

Obviously,Lupus should be kept under good control.

Hope I have answered your query.If you have some follow-up queries,I shall be glad to answer else,please close the thread,rate it- and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

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