Tremor, commonly known as shaking, is a rhythmic, alternating oscillatory movement caused by repetitive movements of muscle contraction and relaxation. How can doctors determine what causes a patient’s tremor based on its different characteristics? It starts with these different types of tremor: i. Intentional tremor A tremor that occurs during active movement. It is characterized by the most pronounced during purposeful movements or when the target is about to be reached, for example, when we finger our nose or press a button, or when we use chopsticks to pick up food during meals, we find that our hands shake involuntarily. There are various causes of injury, for example, cerebral ischemia, tumors, multiple sclerosis, secondary degeneration, etc. leading to different degrees of damage to the cerebellum. Intentional tremor may not be accompanied by hypotonia, but only occurs during limb movements. Postural tremor is a condition in which some parts of the body appear when they are held in a certain stress position and disappear during movement and at rest. Occasionally, it may be slightly more pronounced during movement, but mostly it is most pronounced when a certain posture is fixed, and it is the most complex type of tremor. For example, tremor of the arms occurs when the hands are held flat in a sitting position, and the entire trunk trembles like a spring when standing. According to the cause of the disease, it is divided into: idiopathic tremor, fluttering tremor, tremor secondary to hyperthyroidism, drug-induced tremor, and physiological tremor. 1. Idiopathic tremor: It accounts for the largest proportion of tremors, mainly the uncoordinated posture of the hands, head, and other parts of the body, which is also the clinical characteristic of idiopathic tremor. The cause of idiopathic tremor is not clear, and most of them are inherited in the family, such as immediate family members also have the same symptoms, which can be easily confused with tremor produced by other diseases. 2. Fluttering tremor is caused by both basal ganglia lesions and cerebellar ataxia. This type of tremor is coarse, slightly slow rhythm, usually symmetrical, involving the upper and lower extremities, with variable muscle tone. When the patient extends the fingers and wrist, the wrist is suddenly bent and then quickly straightened, and the tremor is hyperactive, similar to the flapping of a bird’s wing, so it is called wing-fluttering tremor. It is mostly seen in metabolic diseases, such as hepatomegaly, hepatic coma and uremia; it is also seen in pulmonary encephalopathy in respiratory failure. The main cause of tremor secondary to hyperthyroidism is the symptoms of increased excitability of the nervous system caused by hyperthyroidism, with subtle tremors when the hands are extended, and subtle tremors of the tongue when the tongue is extended. 4, drug tremor is mainly due to taking some drugs for a period of time, such as: anti-anxiety, psychiatric drugs (many drugs such as Dextran, paroxetine, sertraline, risperidone, etc.) and part of the blood pressure (compound hypotensive capsules) drugs, this tremor is mostly in the discontinuation of these drugs after a period of time hand tremor relief. 5, physiological tremor This tremor is manifested as small amplitude shaking, does not affect daily life, mostly caused by anxiety, anger, tension, excitement, fatigue and other mental states, calm hand tremor relief. This is the case of “shaking with anger”. Third, resting tremor is a rhythmic tremor caused by alternating contraction of active and antagonistic muscles, simple understanding, as if two groups of muscles fighting, and equal strength, common finger rubbing pill-like action, appearing at rest, aggravated by tension, alleviated by casual movement, disappeared during sleep; also seen in the jaw, lips and limbs, etc., when the tremor has the above characteristics, more suggests Parkinson’s disease, this tremor is generally more progressive This tremor generally progresses more rapidly, and is accompanied by increased muscle tone and slow movement, such as walking and turning around more slowly than normal people.