Slight, usually bilateral postural or kinetic action tremor, particularly in
the hands and fingers, is a normal phenomenon and does not
indicate a disorder (physiologic tremor ). Physiologic tremor is more
intense in situations of stress or anxiety, after strenuous physical
work or exercise, or after ingestion of caffeine or other stimulants.
More pronounced cases of easily visible and usually reversible tremor
without evidence of neurologic disease reflect enhanced physiologic
tremor. Usually, nonpharmacologic treatment options are sufficient.
However, for some patients, even mild physiologic tremor can lead to
large degrees of embarrassment and functional disability, such as the
violinist at a decisive audition, or any professional giving an important
presentation. The use of a β-blocker (e.g., propranolol) before such a
situation may alleviate the tremor, but the optimal dose should be
found prior to the important event...other causes should be ruled out consult physicians