Uneven shoulders: Causes, treatment, and exercises

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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.

In this article, we discuss the causes of uneven shoulders, exercises to stretch and strengthen the shoulder muscles, and when to see a doctor.

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.

Learn about exercises to help improve posture here.

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.

Learn more about scoliosis here.

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 atrophy
• spina bifida
• spinal cord trauma
• a pinched nerve

Depending on the cause, treatment options can include:

• physical therapy
• surgery
• medication

Some exercises to help stretch and strengthen the shoulder muscles include:

The pendulum

1. Lean forward with a flat back and slightly bent knees and put one hand to the side on a table or counter, letting the other arm hang freely.
2. Gently swing the arm back and forward, then side to side, and then in a circular motion.
3. Repeat steps 1 and 2 with the other arm.

Perform 2 sets of 10 repetitions, five or six times per week.

The crossover arm stretch

1. Relax the shoulders and gently pull one arm across the chest as far as possible without causing discomfort, holding the upper arm in place with the other hand.
2. Hold the stretch for 30 seconds, then relax for 30 seconds before repeating with the other arm.
3. Repeat the two steps above 4 times on each side.

A person should do this exercise five or six times per week. It is important to avoid pulling or putting pressure on the elbow.

Standing row

A person will need an elastic stretch band.

1. Make a loop of about 3 feet in length with the elastic band and attach the loop to a doorknob.
2. Stand facing the doorknob, holding the band with the elbow bent to about 90 degrees.
3. Keeping the arm close to the body, slowly pull the elbow back. The band should become more taut.
4. Slowly return to the start position and then repeat the movement.

Perform this exercise three times a week, completing 3 sets of 8 repetitions each time.

A person can purchase elastic stretch bands here.

External rotation with arm abducted 90º

1. Make a loop measuring 3 feet with the elastic stretch band. Attach the look to a doorknob.
2. Holding the band in one hand, raise this arm out to the side to shoulder height and then bend the elbow to 90 degrees, keeping the forearm in line with the upper arm.
3. Slowly raise the hand until it is in line with the head. The band should become more taut.
4. Return slowly and repeat.

Perform this exercise three times a week, completing 3 sets of 8 repetitions each time.

Internal rotation

1. Making a 3-foot long loop with the band, tie the ends together and attach it to a doorknob. Keep hold of the other end.
2. Stand with the elbow bent as though shaking someone’s hand.
3. Keeping the elbow close to the side, bring the lower arm across the body.
4. Slowly return and repeat.

Perform this exercise three times a week, and do 3 sets of 8 repetitions each time.

External rotation

1. Follow steps 1 and 2 for the internal rotation exercise above.
2. Keeping the elbow close to the side, rotate the arm outward slowly.
3. Slowly return and repeat.

Perform this exercise three times a week, and do 3 sets of 8 repetitions each time.

If a person notices that their shoulders are uneven, they should talk with a doctor.

Anyone with severely uneven shoulders, additional concerning symptoms, or uneven shoulders with no apparent cause should also talk with a doctor or physical therapist.

Uneven shoulders can occur due to several habits and conditions — typically those that affect the shoulders, upper back and chest, or neck.

People with mildly uneven shoulders may respond well to at-home stretches and exercises.

More severe cases require medical attention from a doctor, physical therapist, massage therapist, or other licensed healthcare professional.

Broken or bruised ribs – NHS

Bruised or broken ribs can be very painful, but usually heal by themselves.

Check if you have a bruised or broken rib

Broken or bruised ribs are usually caused by a fall, a blow to the chest or severe coughing.

Symptoms include:

• strong pain in your chest area, particularly when you breathe in
• swelling or tenderness around the affected ribs
• sometimes bruising on the skin
• feeling or hearing a crack if it’s a broken rib

Ribs cannot be easily splinted or supported like other bones, so they’re usually left to heal naturally.

There’s often no need for an X-ray.

Things you can do yourself

Broken or bruised ribs heal in the same way and usually get better by themselves within 3 to 6 weeks.

There are some things you can do to help ease pain and speed up healing:

Do

• take painkillers, such as paracetamol or ibuprofen – avoid taking ibuprofen for 48 hours after your injury as it may slow down healing

• hold an ice pack (or a bag of frozen peas in a tea towel) to the affected ribs regularly in the first few days to bring down swelling

• rest and take time off work if you need to

• breathe normally and cough when you need to – this helps clear mucus from your lungs to prevent chest infections

• if you need to cough, hold a pillow against your chest

• walk around and sometimes move your shoulders to help you breathe and clear mucus from your lungs

• take 10 slow, deep breaths every hour to help clear your lungs

• try to sleep more upright for the first few nights

Don’t

• do not wrap a bandage tightly around your chest to stop your lungs expanding properly

• do not lie down or stay still for a long time

• do not strain yourself or lift heavy objects

• do not play any sports or do any exercise that makes your pain worse

• do not smoke – stopping smoking may also help your recovery

Urgent advice: Get advice from 111 now if:

• your pain has not improved within a few weeks
• you’re coughing up yellow or green mucus
• you have a very high temperature or you feel hot and shivery

You might need stronger painkillers or have a chest infection that needs antibiotics.

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Other ways to get help

Get an urgent GP appointment

A GP may be able to help you.

Ask your GP practice for an urgent appointment.

Immediate action required: Call 999 or go to A&E if you:

• have an injury caused by a serious accident, such as a car accident
• have shortness of breath that’s getting worse
• have chest pain that’s getting worse
• have pain in your tummy or shoulder
• are coughing up blood

It could mean a broken rib has damaged something else, like your lung, liver or spleen.

Page last reviewed: 05 January 2021
Next review due: 05 January 2024

Center for Diagnosis and Treatment – Neurology

Intercostal neuralgia, or thoracalgia, is a disease of peripheral nerves, characterized by the presence of pain in the chest caused by compression or irritation of the nerve roots of the intercostal nerves.

Damage to the intercostal nerves sometimes occurs due to various diseases and conditions. In turn, sharp pains may be accompanied, felt as aching, tearing and sharp sensation, wrapping around the upper part of the chest. In this case, the pain may increase with sudden movements.

Symptoms of intercostal neuralgia

Spasmodic pain that is felt around the chest, often in a strip, wrapping from the back to the front, with pain manifesting itself on one or both sides of the chest, may be a symptom of intercostal neuralgia. However, in some cases, the pain may instead be aggravated by straining, twisting the torso, coughing, sneezing, or lifting heavy objects.

The following are additional symptoms that may also be present in intercostal neuralgia:

• pain in the arm, shoulder or back
• limited mobility of your shoulders or back
• tingling
• abdominal pain
• insensitivity
• decreased appetite
• fever

Simple breathing involves movement of the chest, which can exacerbate intercostal neuralgia pain and lead to breathing problems and difficulty breathing. In addition, more severe symptoms of intercostal neuralgia that are accompanied by severe symptoms of chest pain, possibly combined with a feeling of tightness or pressure, should be evaluated in the emergency department to rule out a possible heart attack.

Symptoms to watch out for:

• pain that affects the left arm, shoulder and back
• prolonged cough with yellowish-green sputum
• palpitations
• loss of consciousness or dizziness
• immobility of muscles
• severe pain

Diagnosis

For a competent diagnosis of intercostal neuralgia, attention is mainly paid to complaints of pain in the chest and examination of the patient with accurate palpation of the intercostal spaces. In most cases, the diagnosis becomes from the examination, but often in difficult cases, instrumental diagnostic methods are used to identify the cause of neuralgia:

• electroneurography, especially if nerve injury is suspected;
• CT or MRI of the spine;
• X-ray of the spine and chest organs;
• Cardiac ECG and ultrasound;
• general blood and urine analysis
• blood for antibodies to herpes viruses.

Additional testing will be done to rule out any cause of intercostal neuralgia pathology. This will help diagnose causes such as lung disease or cardiovascular disease. Once a potential cause is found, further tests will be performed looking for confirmation.

Treatment for intercostal neuralgia will depend on the underlying cause, but in most cases the symptoms tend to resolve on their own. Since nerve pain can generally be quite unpredictable and problematic, various methods of dealing with it can be implemented. Various treatments for intercostal neuralgia include:

• non-steroidal anti-inflammatory drugs
• epidural injections
• selective radiofrequency or cryoablation of the nerve
• antidepressants
• intercostal nerve block
• neuropathic pain reliever

Treatment may also take other forms, such as Complementary Medicine or alternative therapies. They are expected to be used in conjunction with traditional forms of treatment to help manage symptoms.

Thoracalgia (chest pain). Causes and manifestations in St. Petersburg