Movement Problems: Types, Causes and Diagnosis

Types of movement problems

Neurologists group movement problems by what they look like.

Too much movement (hyperkinetic)

Too little movement (hypokinetic)

• Bradykinesia: slowness and difficulty starting movements, with movements getting smaller with repetition.
• Rigidity: stiffness throughout the range of movement of a limb.
• Freezing: feet seem stuck to the floor when starting to walk or turning.

These are the hallmarks of parkinsonism, most often caused by Parkinson's disease but also by medicines (antipsychotics, some anti-nausea drugs), multiple small strokes, and rarer conditions such as progressive supranuclear palsy.

Coordination and balance problems

Ataxia is clumsy, uncoordinated movement with a wide, unsteady walk, often from problems in the cerebellum. Causes include alcohol, stroke, multiple sclerosis, vitamin B12 or E deficiency, medicines such as some anti-seizure drugs, and inherited ataxias.

Weakness

Weakness is reduced strength, not a coordination problem, but it is often described as "trouble moving." It may come from the brain (stroke, multiple sclerosis), spinal cord, nerves (neuropathy, Guillain-Barré), the nerve-muscle junction (myasthenia gravis) or muscles (myopathy).

Movement limited by pain or joints

Arthritis, frozen shoulder, back problems and muscle injuries limit movement because of pain or stiffness in the joint, not the nervous system. Doctors separate these from neurological causes during the exam.

Common causes

• Essential tremor: shaking of both hands during use (holding a cup, writing), often inherited and improved by a little alcohol. See essential tremor.
• Parkinson's disease: a resting tremor, usually starting on one side, plus slowness, stiffness, small handwriting, a soft voice, reduced facial expression and loss of smell.
• Stroke: sudden weakness or clumsiness; can leave lasting movement problems.
• Multiple sclerosis: episodes of weakness, numbness, unsteadiness or vision problems in young adults.
• Medicines: antipsychotics, anti-nausea drugs (metoclopramide, prochlorperazine), lithium, valproate, some antidepressants and asthma inhalers.
• Metabolic problems: low blood sugar, thyroid disease, kidney or liver failure, electrolyte imbalance.
• Alcohol: intoxication, withdrawal tremor and long-term cerebellar damage.
• Functional movement disorder: genuine movement symptoms caused by a problem in how the brain controls movement, not structural damage. Common and treatable with specialized physical therapy.

How doctors diagnose movement problems

Most movement disorders are diagnosed by careful observation. A doctor or neurologist will:

• ask when it started, how it has changed, family history, medicines, alcohol and other symptoms such as sleep, smell, mood, memory and bladder changes
• watch you at rest, holding your arms out, doing finger-to-nose tests, writing and walking
• check tone, strength, reflexes, sensation and balance

Video of the symptom on your phone is very helpful if it comes and goes.

Tests depend on the suspected cause:

• Blood tests: thyroid, blood sugar, kidney and liver function, B12, copper and ceruloplasmin (for Wilson's disease in people under 50).
• MRI of the brain or spine: for stroke, MS, tumors and structural causes.
• DaTscan: a nuclear scan that can support a diagnosis of Parkinson's disease when it is unclear.
• Nerve conduction studies and EMG: for nerve and muscle problems.
• Genetic testing: for Huntington's disease and inherited ataxias or dystonias, with counseling.

Treatment

Treatment depends on the cause:

• Parkinson's disease: levodopa and other dopamine medicines, exercise, physical therapy, and deep brain stimulation for selected people.
• Essential tremor: medicines such as propranolol or primidone; focused ultrasound or deep brain stimulation for severe cases.
• Dystonia: botulinum toxin injections, medicines, and deep brain stimulation in some cases.
• Medicine-induced problems: stopping or changing the drug, under medical guidance.
• Stroke and MS: acute treatment, disease-modifying therapy and rehabilitation.
• Rehabilitation: physical, occupational and speech therapy help almost all movement problems.

Practical tips

• Remove trip hazards, add grab bars and use night lights to prevent falls.
• Use weighted utensils, cups with lids and wide-grip pens for tremor.
• Keep active: regular exercise such as walking, cycling, tai chi and dancing improves mobility and balance in Parkinson's disease and many other conditions.

Frequently asked questions

What are the main types of movement disorders?

Movement disorders are grouped into those with too little movement, such as Parkinson's disease, and those with too much, such as essential tremor, dystonia, chorea, myoclonus, tics and restless legs syndrome. Ataxia, a coordination problem, is also usually included.

What causes sudden movement problems?

Sudden movement problems are often caused by stroke, medicine reactions, low blood sugar, infections, head injury or toxins. Sudden weakness, clumsiness or slurred speech is an emergency. Call 911 immediately, because stroke treatments work best in the first few hours.

Can anxiety cause movement problems?

Anxiety can cause tremor, muscle tension and restlessness. Functional movement disorder, in which the brain's control of movement is disrupted, is sometimes triggered by stress. Both are real and treatable, but other causes should be ruled out by a doctor first.

Which doctor treats movement disorders?

A neurologist, ideally one specializing in movement disorders, diagnoses and treats them. Your primary care doctor can do the first assessment and blood tests. Physical, occupational and speech therapists are important parts of treatment.