Another type of tremor may also be associated with damage to the cerebellum. Termed “cerebellar postural tremor,” it is prominent with both action and posture. 4 In its most severe form, cerebellar postural tremor has a frequency of to 4 Hz and may wax and wane in amplitude, increasing progressively with prolonged posture. It persists and worsens with goal-directed movement. 4 The milder form of the tremor has a more rapid frequency, approaching 10 Hz, and appears more distally, making it harder to identify than the severe type. 4
— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at or by calling 800-367-2447.
In the examination of a patient with resting tremor, the physician checks for rigidity and bradykinesia by flexing and extending the patient's arms, seeking signs of cogwheel rigidity. Tremor and rigidity may become more pronounced if patients perform voluntary movements with the opposite limb (., the patient draws a circle in the air with the opposite hand). The patient is asked to stand and to walk, thus displaying evidence of difficulty initiating movement, reduced arm swing, or shuffling gait. If PD is suspected, a trial of therapy with a dopaminergic agent such as levodopa-carbidopa (Sinemet) is appropriate. Referral to a neurologist is indicated when patients fail to respond to the medication or demonstrate an atypical presentation.