Neurology: Hand tremors and Propranolol usage

My dad is 74, and over three years ago, he saw a neurologist because his hand started shaking—and honestly, the tremors have just been getting worse lately.

I’m totally in the dark about what his actual diagnosis is, or if they even landed on one, but since the doctor suspected some kind of neurological issue, he sent him off for more testing, like an MRI and a carotid Doppler.

He never actually went through with those tests, mostly because his primary care doctor basically told him, "There's no point in doing all that extra work; whatever the result is, I'm going to give you the same medication anyway, so it's all pretty much the same thing."

And then he just handed him a prescription for Propranolol.

1. question: was the doctor being totally irresponsible by not following through with the diagnostic testing, and would it actually be smart to go back and get those scans done now?

Dad took the meds for a little while, but then he decided to just stop on his own after reading the fine print that said the drug could be dangerous for the heart and potentially the lungs—which is a big deal since Dad smokes and deals with COPD.

When he mentioned to his doctor that he quit the meds because of those side effects, the doctor supposedly just shrugged and said, "No complaints here."

2. question: is there any real merit to being afraid of these side effects? If the concerns are valid, should he maybe look into a different medication instead of just walking away from treatment entirely?

I can't help but think that if this underlying neurological condition isn't treated, it might end up causing some serious health problems down the road. My gut feeling is that he really needs to get a full diagnostic workup so they can figure out exactly what's going on and then pick the right medication based on his entire medical history.

Thanks in advance for sharing your thoughts.

copperrider59 said:My father is 74 years old. Over three years ago, he consulted a neurologist regarding a tremor in his hand. That tremor has persisted ever since, and quite frankly, it seems to be worsening.

I am currently uncertain as to whether an official diagnosis has actually been established. However, due to a suspicion of an underlying neurological condition, my neurologist has referred me for further diagnostic testing—most likely involving an MRI and a color Doppler scan.

He likely never bothered with those tests in the first place. Most probably, his primary care physician simply told him, "There's no point in running these diagnostics; whatever the results show, I'm going to prescribe the exact same medication anyway—it's all essentially the same."

And he was prescribed Propranolol.

Is it irresponsible for a physician to forgo ordering additional diagnostic tests, or would pursuing those investigations independently be a prudent course of action?

My father was taking his medication for a while, but he eventually decided to stop on his own initiative. His reasoning? He read the patient information leaflet and became convinced that the drug could pose serious risks to both his heart and his lungs. Given that he is a smoker and already struggles with COPD, he felt it wasn't worth the potential danger.

When a patient informs his doctor that he has discontinued his medication based solely on some research he read online, the physician supposedly responded with nothing more than: "I have no objections."

Is the fear of medication side effects actually justified? If we determine that the risk is indeed disproportionate to the benefit, should the logical conclusion be to abandon treatment entirely, or should we instead pivot toward finding an alternative pharmaceutical option?

I suspect that if he fails to address this neurological condition, the health consequences could be quite severe. In my amateur estimation, the only logical course of action would be to undergo a comprehensive diagnostic workup first. Only after obtaining such a diagnosis—and carefully weighing it against his entire medical profile—should a decision be made regarding which medication is appropriate to prescribe.

I appreciate your insights in advance.

This approach toward patient care is nothing short of irresponsible. Specifically, when you consider that your primary care physician prescribed Propranolol despite being fully aware of your father’s history with COPD—a condition where such a prescription is strictly contraindicated. Furthermore, I find myself questioning why the physician would even consider prescribing Propranolol without conducting any preliminary diagnostic testing. While I am not suggesting an immediate referral for a CT scan or an MRI, surely a basic physical examination and standard laboratory workups should have been performed? Such tests are essential to validate or refute a patient's claims within the scope of what clinical diagnostics can actually offer for these types of conditions. One must remember that a tremor is almost never the root cause; rather, it is a symptom of an underlying pathology. This could range from simple glucose metabolism issues or hyperthyroidism to far more severe neurological conditions involving damage to the peripheral or central nervous systems.

With all due respect to primary care physicians, the treatment plans prescribed by a specialist are often entirely disconnected from what a family doctor might suggest. If a neurologist suspects a specific underlying condition, those diagnostic tests must be performed—regardless of whether the family physician disagrees or thinks they are unnecessary. You have to consider the reality of medical documentation: there is likely no written record of the family doctor's initial recommendations. Therefore, if a serious condition actually exists and was missed because you bypassed the specialist's orders, you will find yourself in an impossible position. How exactly do you intend to hold a doctor liable? Every single medical entry serves both a clinical and a legal purpose; you cannot simply ignore the specialist's findings and expect to have any recourse later.

After reviewing the entirety of this discussion, I find myself questioning why your father even bothered consulting with a general practitioner in the first place. If a specialist has already reached a definitive conclusion regarding necessary diagnostic procedures, what purpose does a primary care visit serve? It seems redundant. Regarding the Propranolol, you must consider the broader clinical picture. Provided that all potential underlying pathologies causing the tremor are ruled out, Propranolol remains the gold standard. However, given your father’s specific contraindications, one should realistically explore alternative beta-blockers that might be more appropriate for his physiology. Furthermore—and I say this with the utmost respect for your father—his age is a significant factor. At his stage of life, the development of essential tremor without an identifiable cause is a very real possibility. This is something that warrants serious consideration in your deliberations. Best regards.

Thanks a ton for such a massive, detailed breakdown.

I’m not entirely sure which sub I should drop this in without cluttering up the board with a redundant thread.

So, here’s the situation: it feels like a nerve has completely snapped—either right in my elbow or somewhere in that stretch between my elbow and wrist. The ends of the nerve seem totally mangled, forming these palpable lumps on my forearm. One knot is near my hand and the other is up by the elbow, with about an 8-inch gap between the two mess-ups.

My hand looks mostly normal to the eye, but it keeps seizing up on me. It gets to the point where I can’t even open my palm, and occasionally I can’t even squeeze a pair of nail clippers to trim my nails with my other hand. Even just washing dishes causes these spasms—not constantly, but often enough that I’m terrified to do anything strenuous with it. I’ve managed to lift some heavier objects a few times without a total meltdown, but it’s a gamble.
I have this persistent, dull numbness running through my pinky and ring finger. Sometimes the ring finger just curls inward from the spasm itself, and I’m left staring at it because I’ve lost all control over the movement. Honestly, the whole hand tends to cramp up all five fingers whenever it catches itself in a bad position.

Is there actually a way to "patch" a nerve like this, or am I looking at a permanent loss of function in this hand?

It is absolutely essential that you consult with a specialist as soon as possible to determine what further steps can be taken!

You guys might think we're moving at a snail's pace here, mostly because I actually first brought up my dad's situation back in September last year (and pathology22 gave a super detailed and expert breakdown on it), but he finally just got his brain MRI done. I’m going to paste the report right here because I really need a professional "translation" into plain English—basically, I just want a straight answer to one simple question: "How bad is his health situation?"

BRAIN MRI

T1 SE, T2 TSE, Flair, T1-Gadol sequences

Native and post-contrast brain MRI in axial, sagittal, and coronal planes shows normal positioning and symmetrical cerebellar and cerebral hemispheres, with an appropriate distribution of white and gray matter. The ventricular system is normally positioned, with width at the upper limit of normal. In the high right parietal, subcortical region, there is a larger, irregular area that is hyperintense on T2 and Flair and hypointense on T1, showing no mass effect on surrounding structures. No enhancement seen post-contrast. Otherwise, there are some slightly punctate, bilateral periventricular demyelinations of non-specific (vascular) nature. Cortical sulci are diffusely somewhat prominent.
The sella turcica, cavernous sinuses, and both cerebellopontine angles show no pathological changes. The craniocervical junction is normal.
Conclusion: Findings are consistent with vascular encephalopathy, with a more pronounced area of ischemic lesion in the right parietal region.

(I'll post the neurologist's official findings and the recommended treatment plan later, but I’d love for you all to weigh in on this MRI first, just so their opinion doesn't bias yours)