Muscle tremor

Introduction The muscles are continuously and rhythmicly contracted and relaxed at a frequency of 4 to 6 times per second, called muscle tremor, which is a symptom of central nervous system diseases. Mainly due to the lesions of the substantia nigra and nigrostriatal pathways, common diseases include encephalitis, craniocerebral injury, arteriosclerosis, basal ganglia tumors, and certain chemical poisoning. Chronic poisoning of mercury and manganese may cause muscle tremors. The toxic effect. The tremor can start from the distal end of one side of the upper limb and then affect the ipsilateral lower limb and the contralateral upper limb. The lip, tongue, jaw and head are finally involved. Emotional excitement can aggravate the tremor and completely stop during sleep anesthesia. The disease needs to find the cause to treat the primary disease.

Cause

Physiological tremor: In some cases, most normal people have subtle rapid tremors on their hands when the upper limbs are stretched forward. Intensification of physiological tremor can be seen in anxiety, stress, fatigue, metabolic disorders (eg, alcohol withdrawal, thyrotoxicosis), or the use of certain drugs (eg, caffeine and other phosphodiesterase inhibitors, beta- Adrenergic agonist, adrenocortical hormone).

Primary (benign hereditary) tremor is a subtle to coarse slow tremor that usually affects the hands, head and vocal cords. There are autosomal dominant genetic factors in 50% of cases. The tremor can be unilateral. The tremor is very slight or does not occur at rest, and can cause tremor when the patient performs delicate movements, and the primary tremor is enhanced under the influence of any of the factors that can enhance the physiological tremor. As the age increases, the incidence of primary tremor increases, and is occasionally mistakenly referred to as senile tremor.

Static tremor of Parkinson's disease

The tremor-induced tremor of cerebellar disease (as seen in multiple sclerosis and other cerebellar efferent disorders) occurs when the moving limb approaches the target. Supportive (positional) tremor is a large, rotational tremor at the proximal end of the limb that is most pronounced when the patient attempts to maintain a fixed posture or load. Titubation is a large tremor of the head and body. It is also a kind of supportive tremor. It is obvious when maintaining an upright posture and disappears after lying down. Flap-like tremors are seen in cases of hepatic encephalopathy and other metabolic encephalopathy. When the patient stretches out his hands forward, a large, slow, non-rhythmic movement occurs. Using electromyography records, it can be observed that when the patient tries to maintain a fixed posture, intermittent electromyography is present in the antigravity muscle, causing flapping tremor; therefore, it is not true tremor, but a kind of Myoclonus, a negative myoclonus.

Intentional tremor and resting tremor can occur in Wilson's disease (hepatic nucleus degeneration - see Section 4). The most characteristic is the rhythmic slap at the distal end of the limb or the flapping-like action at the proximal end of the limb.

an examination

Related inspection

Electromyography neurological examination of liver tremor test

The tremor can start from the distal end of one side of the upper limb and then affect the ipsilateral lower limb and the contralateral upper limb. The lip, tongue, jaw and head are finally involved. Emotional excitement can aggravate the tremor and completely stop during sleep anesthesia.

(1). The location of the tremor: usually starting from the distal end of the upper limb of one side, with the thumb, index finger and middle finger as the main body, which is characterized by the movement of the finger like a ball or a few banknotes. It then gradually spreads to the ipsilateral lower limbs and contralateral limbs, which can affect the lower jaw, lips, tongue and head. In the early stages of the disease, the patient does not care much about tremors, often when the finger or limb is in a particular position, and disappears when changing posture. Later, it develops only when the limb is still, for example, when watching TV or talking to others, the limb suddenly appears involuntary tremor, and when the position changes or the movement trembles to reduce or stop, it is called static tremor, which is Parkinson The most important feature of tremors. Sometimes the lower limbs are more obvious or the tremors in other parts are more prominent. Some patients have tremor late, mainly tonic, often misdiagnosed as hemiplegia.

(2). Tremor frequency: The tremor frequency of Parkinson's disease is 4-8 times/second, which is generally slower than simple tremor, slightly larger, and faster than the frequency of action tremor, slightly smaller. This feature can also help us distinguish other diseases, such as diseases caused by chorea, cerebellar disorders, and hyperthyroidism.

(3). Tremors have volatility: they are sometimes obvious, sometimes they are alleviated or disappeared. Mental stress, emotional excitement, and tremors at the start of the movement are obvious, and are relieved when exercising at random, and disappear after sleeping.

(4). The effect of tremor on exercise: When the tremor is light, it may not affect the motor function, or the life can take care of itself; as the disease progresses, the tremor can affect some of the motor function. If writing is more and more difficult, even if you can't write, you can't take care of yourself.

(5). Signs associated with tremor: tremor with increased muscle tone, more common in Parkinson's disease, can be found in the examination of "gear-like" rigidity, easy to find when the head and neck stretch and flexion, elbow, wrist joint passive activity. This type of resting tremor is not associated with ataxia, and there is no significant change in tendon reflexes, nor with pathological reflexes and sensory disturbances.

Differential diagnosis

Muscle contracture: the fascial fibrosis of the fascia where muscles and muscles are located, contractures, and clinical symptoms of specific gait and signs manifested by limited joint function. Muscle contracture, positional deformity at the contracture site, severe pain around the joint, depression on the skin, and abduction and flexion of the joints of the extremities.

Muscle tone pain is a clinical manifestation of neurasthenia. Neurasthenia is a neurosis characterized by brain and physical dysfunction. It is characterized by emotional excitement but fatigue. It is often accompanied by symptoms such as nervousness, trouble, irritability, and other physiological symptoms such as muscle tension pain and sleep disorders. Intentional tremor: refers to tremor that occurs when exercising at random. It is characterized by the most obvious in targeted movements or when the target is to be achieved, often in the cerebellum and its efferent pathway lesions. Intentional tremor can be accompanied by a decrease in muscle tone and occurs only during limb movement.

Muscle tremor: is the spontaneous discharge of one or more motor units during muscle rest, resulting in muscle fibrillation, a brief single contraction, seen in a variety of lower motor neuron damage diseases and some normal people. Electromyography can be seen in the self-generated position, and the nerve conduction velocity is normal. The tremor can start from the distal end of one side of the upper limb and then affect the ipsilateral lower limb and the contralateral upper limb. The lip, tongue, jaw and head are finally involved. Emotional excitement can aggravate the tremor and completely stop during sleep anesthesia.

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