Editing Tremor (section)

==Diagnosis==
[[File:TremorParkinson.gif|thumb|Tremor analysis in [[Parkinson's disease]]]]

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. A detailed family history may indicate if the tremor is inherited. Blood or urine tests can detect thyroid malfunction, other metabolic causes, and abnormal levels of certain chemicals that can cause tremor. These tests may also help to identify contributing causes, such as drug interaction, chronic alcoholism, or another condition or disease. Diagnostic imaging using CT or MRI imaging may help determine if the tremor is the result of a structural defect or degeneration of the brain.<ref>{{Cite journal |last=Fymat |first=Alain L. |date=2020-02-20 |title=Neuroradiology and Its Role in Neurodegenerative Diseases |url=https://www.jneurology.com/articles/neuroradiology-and-its-role-in-neurodegenerative-diseases.html |journal=Journal of Neurology & Neuromedicine |language=en |volume=5 |issue=1}}</ref>

The doctor will perform a [[neurological examination]] to assess nerve function and motor and sensory skills. The tests are designed to determine any functional limitations, such as difficulty with handwriting or the ability to hold a utensil or cup. The patient may be asked to place a finger on the tip of her or his nose, draw a spiral, or perform other tasks or exercises.<ref>{{Cite web |title=Essential tremor - Diagnosis and treatment - Mayo Clinic |url=https://www.mayoclinic.org/diseases-conditions/essential-tremor/diagnosis-treatment/drc-20350539 |access-date=2025-03-03 |website=www.mayoclinic.org |language=en}}</ref>

The doctor may order an [[electromyogram]] to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation. The selection of the sensors used is important. In addition to studies of muscle activity, tremor can be assessed with accuracy using accelerometers .<ref name="Sensors">{{cite journal |vauthors=Grimaldi G, Manto M | year = 2010 | title = Neurological tremor: sensors, signal processing and emerging applications | journal = Sensors | volume = 10 | issue = 2| pages = 1399–1422 | doi=10.3390/s100201399| pmid = 22205874 | pmc = 3244020 | bibcode = 2010Senso..10.1399G | doi-access = free }}</ref>

===Categories===
Tremors are assessed according to amplitude, frequency, affected body parts, and the position or activity in which the tremor manifests.<ref name=":1">{{Cite book |last1=Dover |first1=Anna R. |url=https://books.google.com/books?id=m3iiEAAAQBAJ&pg=PA153 |title=Macleod's Clinical Examination |last2=Innes |first2=J. Alastair |last3=Fairhurst |first3=Karen |date=2023-04-20 |publisher=Elsevier Health Sciences |isbn=978-0-323-84772-8 |pages=153 |language=en}}</ref>  The combination of these four factors indicates likely diagnoses.  For example, early Parkinson's first tends to manifest as a slow tremor in one hand while resting and disappears during intentional movements, but essential tremor appears symmetrically, during intentional movements and disappears while resting.<ref name=":1" />

* [[Amplitude]]:  A '''fine tremor''' is very small or barely noticeable movement; a '''coarse tremor''' is a large movement.  Tremors in between these two may be described as medium amplitude.
* [[Frequency]]:  A slow tremor makes a motion at a few times per second.  A rapid or fast tremor is around 12 [[Hz]] or faster.<ref name=":1" /><ref>{{Cite book |last1=Grimaldi |first1=Giuliana |url=https://books.google.com/books?id=cWreEAAAQBAJ&pg=PA306 |title=Mechanisms and Emerging Therapies in Tremor Disorders |last2=Manto |first2=Mario |date=2023-10-20 |publisher=Springer Nature |isbn=978-3-031-26128-2 |pages=306 |language=en}}</ref>  Tremors in between these two speeds may be described as intermediate speed.
* Affected body parts:  For example, the left hand, or both legs, or the voice.

The degree of tremor should be assessed in four positions. The tremor can then be classified by which position most accentuates the tremor:<ref name="pmid7001967">{{cite journal | pmid = 7001967 | volume=93 | title=Physiologic and pathologic tremors. Diagnosis, mechanism, and management | date=September 1980 |vauthors=Jankovic J, Fahn S | journal=Ann. Intern. Med. | issue=3 | pages=460–5 | doi=10.7326/0003-4819-93-3-460}}</ref>

{| class="wikitable"
|-
! 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 receptor]]s such as [[haloperidol]] and other [[antipsychotic]] drugs.
|-
| During contraction (e.g. 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 physiological tremors such as a hyperadrenergic state or hyperthyroidism.<ref name="pmid7001967" /> Drugs such as [[adrenergic]]s, [[anticholinergic]]s, and [[xanthine]]s (such as caffeine) can exaggerate physiological tremor.
|-
| During posture (e.g. 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 physiological tremors.<ref name="pmid7001967" />
|-
| During intentional movement (e.g. [[finger-to-nose test]]) || Intention tremors|| [[Intention tremor]]s are tremors that are worse during intention, e.g. as the patient's finger approaches a target, including cerebellar disorders.<ref name=":1" /> The terminology of "intention" is currently less used, to the profit of "kinetic".
|}