Could uneven shoulders indicate any issue?

Brian Yee
Physical Medicine & Rehabilitation

Uneven shoulders can be observed in a couple of planes. One of the most common observations is when one shoulder looks higher than the other. This could indicate either a structural, muscular or neural imbalance.

Structurally, the patient may have a leg length discrepancy or a scoliosis that causes the shoulders to be raised on one side.

Muscularly, the shoulder blade or scapula has multiple muscles that stabilize it in position. Muscular imbalances can easily occur that cause certain muscles of the scapula to pull it in a certain direction. For example, in many single arm-dominated sports such as baseball or tennis, the dominate arm tends to over-develop the latissmus dorsi which is your ‘wing’ muscle. With more muscular development it actually pulls the shoulder blade down. In standing postures, most of these athletes will look like their shoulder is lower on the same side. This can create problem for the lowered shoulder, especially when the arm is required to repetitively raise over their head. With the shoulder lowered it takes greater work of the opposing muscles to raise the arm overhead. Over time, it can cause poor shoulder mechanics and lead to injury of the shoulder.

When someone has chronic nerve symptoms in their neck and arm due to a radiculopathy or pinched nerve in their neck, many times you may see that the shoulder on the same side looks elevated. This is due to the adaptation of the muscles to shorten or spasm to elevate the shoulder girdle and allows more room for the nerve to conduct. Patient’s with this pattern often feel tight in their neck and upper shoulder. When they try to stretching the muscles it makes their nerve symptoms worse. This happens because the muscle is not tight but in protective spasm keeping the nerve from being injured further. In this case it is important to treat the nerve first before trying to lower the shoulder girdle.

Uneven shoulders could indicate many different things.  From scoliosis to a leg length discrepency.  Although, in most situations it is indicative of simply a muscle imbalance in the upper extremities.  I have found people that appear to have a shoulder jammed up into their simply because they sleep on that side, or possibly because they carry a heavy bag or purse or talk on the phone by leaning the head down to that shoulder.  If this is case it could be an easy fix.

The first thing to do is to commit to doing things differently.  Maybe start to sleep on your back or alteast rotate sides, get a smaller purse or bag (who really needs to carry around that much stuff anyway), and get a bluetooth or a hands free device to talk on the phone.

Once you have made the lifestyle change which is contributing to the problem, then you can begin a series of stretching and strengthening exercises to help correct the problem. 

  • First stretch the side of your neck which has the higher shoulder by dropping the opposite ear to the opposite shoulder. You will want to hold this for atleast 20 seconds.
  • Then, you will want to perform strengthening of a muscle called your lower traps.   This can easily be done by an exercise called "scaption raises", with or without dumbbells is fine. You will want to stand tall, turn your thumbs up and move your arms way from your body (at about a 35 degree angle) until they are all the above your head. You should look like a human "Y" at the end.
  • Another great exercise is a simple move.  Called "scapular depressions".  Imagine if you were trying to get up from a chair, you put your hands on the arm rests and push yourself up onto your feet.  The part when you first push, concentrate on pulling your shoulder blades into your back pockets and squeezing them together.

Perform 2-3 sets with 15-20 reps of the above stretching and strengthening exercise for best result. Don't forget to contact your Dr. before beginning any exercise program for a thorough evaluation.  If you are unsure of whether or not your shoulders are even consult a personal trainer for a movement evaluation.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.