Despite being considered as a benign, genetic and monosymptomatic disorder, ET 
is a poorly understood entity with etiological and pathological heterogeneity. 
The aim of the present study was to examine the relation between proximal and 
distal muscle strength and upper limb functionality and tremor severity in 
patients with essential tremor (ET). The study enrolled 25 tremor patients 
followed at the neurology clinic of a university hospital and 19 healthy 
controls. Demographic data, risk factors, disease duration and dominant hand of 
the participants were recorded. Back and leg strength was assessed using a back 
and leg dynamometer and hand dynamometer and pinchmeter were used to determine 
hand strength. Functional ability of the participants was evaluated using the 
Minnesota Manual Dexterity Test (MMDT), Perdue Pegboard (PPBT) and Nine Hole Peg 
Test (NHPT). Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor 
Rating Scale (FTMTRS) and the Lower Extremity Clinical Tremor Assessment Scale 
(LECTAS). A significant difference was found in the average back and leg muscle 
strength between ET patients and healthy controls (p < 0.05). The mean values 
for right/left hand muscle strength were not significantly different between the 
two groups (p > 0.05). Among the upper limb functional ability tests, 
significant differences were found between the two groups in the mean time to 
complete NHPT, Minnesota placing subtest and PPBT test (p < 0.05). While gender 
and risk factors were not significantly different between the two groups 
(p > 0.05), there was a significant difference with respect to the educational 
level (p < 0.01). No significant difference was found between back and leg 
muscle strength and FTMTRS and LECTAS (p > 0.05). A negative correlation and a 
significant association were found between average strength measurements 
obtained with the left hand dynamometer and FTMTRS in the ET group (p = 0.030, 
r = - 0.434). A positive correlation and a significant association were found 
between left hand strength and mean turning time in the MMDT in the control 
group (p = 0.041, r = 0.473). ET patients experience loss of proximal muscle 
strength and functional disability. Further studies are planned to investigate 
the effects of physical therapy modalities targeting increased proximal muscle 
strength on tremor severity and functional ability in ET patients.