1. Examine the outstretched arms, palm down, and fingers open.
  2. Ask the patient to close his or her eyes and count backward again.
  3. Ask patient to adopt the wing-beat position with the hands facing one another in the midline, and then to slowly supinate and pronate the arms, looking for position specificity of the tremor.
  4. If postural tremor is present during sustained arm extension, the examiner should assess the following: Which joints are involved (eg, elbow, wrist, metacarpophalangeal joints) and
  5. In what direction is the tremor? (eg, for the wrist, flexion-extension, pronation-supination)
  6. Whether the tremor is accompanied by abnormal postures.