Several types of injury can cause someone to develop uneven shoulders. People can also develop uneven shoulders due to particular habits, lifestyle factors, or muscular, bone, or neurological conditions.

 

Causes 

Causes of uneven shoulders can include:

Posture

An article in the Journal of Physical Therapy Science suggests that muscular and skeletal structures can develop into incorrect shapes due to certain postural habits.
If a person maintains poor posture, their shoulders can become uneven, as some sets of muscles become tight, and others become weak. One example is rounded shoulder posture (RSP).
RSP can cause the chest muscles to become tight and the shoulder muscles to become longer. 
Find tips on how to improve posture here.
Exercises may help alleviate any pain resulting from bad posture.

Favoring the dominant side

The authors of an older study in the Journal of Athletic Training state that postural asymmetry is common among athletes.
Among males who played sports involving overhead motions, such as tennis, baseball, and volleyball, the study showed that the scapula (shoulder blade) on the dominant side was more inwardly rotated than the scapula on the nondominant side.
Certain sports, habits, and activities — typically those that involve the heavy use of one arm — can cause imbalances that lead to uneven shoulders.
Depending on the cause and severity of the imbalance, treatment may involve physical therapy and avoiding habits or activities associated with muscular, bone, and joint imbalances.

Scoliosis

People with scoliosis have an abnormal lateral curvature of their spine that can cause the shoulders to become uneven.
According to the American Association of Neurological Surgeons, scoliosis affects an estimated 2–3% of people in the United States, and it usually develops between the ages of 10 and 15 years.
People with scoliosis can wear a spinal brace that slowly corrects the curvature or undergo spinal fusion surgery.
In mild cases, a doctor may choose to monitor the curvature over time to see whether it will correct itself.

Nerve damage or conditions

According to a 2020 article, damage or conditions that affect the nerves responsible for sensations in the shoulder muscles, especially cranial nerve XI, can cause one shoulder to sit higher or lower than the other.
Nerve damage can occur due to injury or neurological conditions, especially those known to cause neuromuscular scoliosis, such as:

· cerebral palsy.

· muscular dystrophy.

· spinal muscular atropjy.

· spina bifida.

· spinal cord trauma.

· a pinched nerve.

Depending on the cause, treatment options can include:

· physical therapy

· surgery

· medication

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