The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 31-year-old woman has noticed intermittent tremors in her right hand and arm over the past month. She is left-handed and says that she has noticed that her right arm shakes when she carries grocery bags in each hand. She also says that when she carries large or heavy objects using both hands, her right arm begins to shake even though her left arm is doing most of the lifting. She occasionally develops a fine tremor in her right hand when she drives.
She is otherwise in good health and has not needed to see a doctor in years. About a year before her current appointment, she was scheduled to see a doctor but canceled because she got busy and her symptoms resolved. When describing her symptoms at that time, she explains that she had low energy and felt sleepy almost every day after work for several months. This especially bothered her because her bout of low energy occurred during the summer, when she likes to play tennis outdoors. When she regained her energy after a few months, she resumed playing tennis in the fall at an indoor club that she joins for the cold months. Her current tremor has not been a problem for her when she plays tennis, but she says that she has been using her left arm more than usual when she plays.
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Cite this: Heidi Moawad. A 31-Year-Old Woman With Right Arm Tremors - Medscape - May 01, 2019.