Involuntary movements like a tremor can feel awkward or cause anxiety, and many people choose to hide them out of fear of how others might perceive them – an experience that Canadian-American actor Michael J. Fox has spoken about publicly and knows all too well.
However, seeking professional help is one of the best things you can do, as tremors can be a sign of a neurological condition, such as Parkinson's disease.
Ahead of World Parkinson's Day (April 11), Laura Phillips, senior adviser for the helpline at Parkinson's UK, shared some advice on when to seek help for a hand tremor.
What is a tremor and how can it affect someone's daily life?
Health experts define a tremor as an uncontrollable, repetitive movement that affects a part of your body, such as your hand or arm.
Having a tremor can significantly interfere with a person's ability to carry out daily tasks, says Phillips.
"For example, doing something quite simple without a tremor, like opening a zip, buttons or shoelaces, can be quite difficult for someone who is experiencing a tremor," says Phillips.
"Additionally, many people express concern about how their tremor might affect their ability to drive safely, and a diagnosis of Parkinson's disease would need to be reported to the DVLA immediately."
Is a tremor always a sign of Parkinson's disease?
"A tremor is one of the most common types of motor symptoms people experience with Parkinson's disease, but a tremor is not always a sign of Parkinson's disease," clarifies Phillips. "Some people with Parkinson's disease never even experience a tremor."
"It's also important to add that some other neurological conditions, such as multiple sclerosis (MS), can also lead to tremors."
A tremor often becomes more noticeable under specific physiological and emotional stress, for example, when you are stressed, tired, anxious or angry, after consuming caffeine or alcohol, after smoking, as you age, or if you are very hot or cold.
"Fatigue, stress and anxiety can have a significant impact on people who have symptoms of Parkinson's disease," says Phillips. "People with tremors who have Parkinson's disease often say that their tremor is much worse when they experience any period of stress or anxiety or if they have had a bad night's sleep."
Some medications and health conditions can also cause tremors, but health experts recommend speaking with your doctor before discontinuing any prescribed medication.
What might indicate that a tremor could be a sign of Parkinson's disease?
While everyone experiences Parkinson's disease differently, many people living with this condition experience a resting tremor.
"With Parkinson's disease, someone will typically experience a resting tremor, as opposed to an action tremor (which occurs during voluntary muscle movement) or an intention tremor," says Phillips.
A resting tremor often affects your hands and feet and usually appears as a "pill-rolling" tremor, which looks as if you are trying to roll a pill between your thumb and adjacent finger (index finger).
While a resting tremor is a distinctive sign of Parkinson's disease, it is rarely the only symptom. Therefore, it is important to note any other accompanying symptoms you are experiencing.
"Other less obvious symptoms include softening of speech, reduction in handwriting (often referred to as micrographia) and loss of sense of smell," says Phillips. "Problems with balance, pain, stiffness and fatigue are also very common, but more subtle, symptoms of Parkinson's disease."
When should someone seek medical help for a tremor?
Health experts recommend visiting a doctor if you have tremors or hand shaking and it worsens over time and affects your daily activities.
"You know yourself better than anyone else, so it's important to seek help if something isn't normal for you," says Phillips. "It may not be Parkinson's disease, there may be other reasons for the symptoms you are experiencing, but it's always good to go and get checked."
Noting any symptoms that occur frequently and when they occur can be helpful.
"Keeping a timeline of symptoms can really help medical professionals distinguish any pattern and identify whether it looks like a typical pattern for Parkinson's disease or if something else is potentially happening," says Phillips.
What questions is a doctor likely to ask?
"First, a doctor will want to ask many different types of questions about your general health, to rule out key things like dehydration and medical infections that can cause similar symptoms," says Phillips.
"It's also likely they will ask questions about when you first noticed the tremor and when it tends to occur. For example, is it happening when you are sitting watching TV, or is it happening when you are reaching for something in a cupboard? Is it worse or better at different times of the day?"
If a doctor suspects Parkinson's disease, they will refer you to a specialist.
"The consultant will continue to rule out other things and may send you for specific types of scans, such as CT scans or MRI scans to see if there is anything underlying that could be causing the symptoms," says Phillips.
"Some people will also have a type of specialised scan, called a DAT scan (Dopamine Transporter Scan), which helps identify dopamine activity in a person's brain, which is the neurotransmitter that is lacking in a person's brain when they have Parkinson's disease."