Have your neck and shoulder areas been twitching lately? “For almost everyone – particularly young healthy persons -- a simple twitch of a muscle anywhere in the body is completely normal and nothing to worry about,” says Anthony P. Geraci, MD, Founder and Director of neurOasis Neurology, Clinical Assistant Professor of Neurology, NYU School of Medicine.
This could very well be the case of “Nedo,” a strength training enthusiast who posted about his shoulder twitching in a bodybuilding forum. One person suggested dehydration was a cause, but Nedo reported that the shoulder twitching continued after drinking a gallon of water a day.
A twitching shoulder can be caused by dehydration, caffeine, magnesium deficiency, stress and exercising, including after an absence. Lactic acid builds up from exercise in the muscle cell, says Dr. Geraci.
As this occurs, “a chain of events takes place that injures the cell and destabilizes its cell membrane. Normally, the membrane is kept stable by the single nerve fiber attached to it.”
Exercise affects the “chemical soup” inside a muscle fiber that sets off an “electrical impulse, referred to as depolarization,” says Dr. Geraci. “This is the basic process that leads to muscle fiber contraction.” This fiber contraction is the twitching.
What if both the neck and shoulder are twitching?
“I see some patients who tell me about twitches of neck or shoulder muscles,” says Dr. Geraci. “Advice on this subject would be lacking if I didn’t discuss the possibility that the ‘twitch’ is something else.
“Neck muscles generally are not stressed or worked out” from exercise, “so something else could be going on. Muscles of the shoulder can have twitches just from bench pressing for example, but from a neurologist’s point of view, neck and shoulder muscles can, in some instances, be considered as one anatomical unit.
“Two conditions should be considered if neck and shoulder muscles are ‘twitching.’ One possibility is that the person is having tics. Tics are brief jerks of groups of muscles and generally will therefore move a limb or the neck, sometimes ever so slightly that you would call it a twitch.”
Tics in adults can be caused by sleep deprivation or stress, or have no known cause.
Dystonia (involuntary muscle contractions) is the other condition, says Dr. Geraci, that can ever so slightly move a muscle in the neck that it seems like a twitch.
Because I’m aware that serious conditions can cause neck dystonia like brain cancer and Parkinson’s disease, I asked about this.
Dr. Geraci explains that “dystonia can be caused by a brain tumor, PD and Huntington's, but two points: Exceedingly rare in brain tumor, and the other two are manifest diagnoses before dystonia sets in. In young people with neck dystonia it is practically always cervical dystonia alone.”
Back to neck twitching, Dr. Geraci says, “Benign tremor is fairly common and usually is inherited, so you would start by thinking about your parents and grandparents. Did they have twitching or movements of the neck or arms?
“The most common example of dystonia is something most people have heard about: writer’s cramp. Dystonia can be difficult to diagnose, especially in its early stages, even for a neurologist.
“It can cause the muscle to contract, again usually in groups and therefore one might notice movement of the limb or neck. The movement in the neck can be so subtle as to look like a brief twitch or even a rhythmic tremor.”
Dr. Geraci recommends having a neurologist examine you if you’re having excessive movements or twitching in the shoulder or neck muscles. Tics and cervical dystonia are treatable, so early diagnosis is important.