What are the main causes of uneven shoulders. How can uneven shoulders be treated effectively. Which exercises help correct shoulder asymmetry. When should you see a doctor about uneven shoulders. What lifestyle factors contribute to shoulder imbalance.

Understanding the Anatomy of Shoulder Asymmetry

Shoulder asymmetry, commonly referred to as uneven shoulders, is a condition where one shoulder appears higher or lower than the other. This misalignment can stem from various factors, ranging from postural habits to underlying medical conditions. To comprehend the intricacies of this issue, it’s crucial to delve into the shoulder’s anatomical structure and the mechanisms that can lead to imbalance.

The shoulder complex comprises several bones, muscles, and joints working in harmony. The main components include:

• Clavicle (collarbone)
• Scapula (shoulder blade)
• Humerus (upper arm bone)
• Rotator cuff muscles
• Deltoid muscle

When these elements are not in proper alignment or one side is more developed than the other, shoulder asymmetry can occur. This imbalance may result in discomfort, reduced range of motion, and even long-term complications if left unaddressed.

Common Causes of Uneven Shoulders

Several factors can contribute to the development of uneven shoulders. Understanding these causes is the first step in addressing the issue effectively.

Postural Habits and Their Impact

Poor posture is a significant contributor to shoulder asymmetry. Prolonged periods of incorrect posture can lead to muscular imbalances, with some muscles becoming overly tight while others weaken. This imbalance can cause one shoulder to appear higher or more rounded than the other.

Rounded shoulder posture (RSP) is a common postural deviation that can result in uneven shoulders. In RSP, the chest muscles tighten while the shoulder muscles elongate, leading to an imbalance in the shoulder complex.

Dominance-Related Asymmetry

Athletes and individuals who frequently engage in activities that heavily rely on one arm are prone to developing uneven shoulders. Sports such as tennis, baseball, and volleyball, which involve overhead motions, can cause the scapula on the dominant side to rotate inward more than its counterpart on the non-dominant side.

This asymmetry is not limited to athletes; it can also affect individuals whose professions or hobbies involve repetitive unilateral arm movements.

Scoliosis and Shoulder Imbalance

Scoliosis, an abnormal lateral curvature of the spine, can significantly impact shoulder alignment. This condition affects approximately 2-3% of the U.S. population, typically developing between ages 10 and 15.

The spinal curvature in scoliosis can cause one shoulder to appear higher than the other, creating a visible asymmetry. The severity of the scoliosis often correlates with the degree of shoulder imbalance.

Neurological Factors

Nerve damage or conditions affecting the nerves responsible for shoulder muscle control can lead to uneven shoulders. Cranial nerve XI, in particular, plays a crucial role in shoulder muscle function. Damage to this nerve or other neurological conditions can result in one shoulder sitting higher or lower than the other.

Conditions that may cause neuromuscular scoliosis and contribute to shoulder asymmetry include:

• Cerebral palsy
• Muscular dystrophy
• Spinal muscular atrophy
• Spina bifida
• Spinal cord trauma
• Pinched nerves

Diagnosing Uneven Shoulders: When to Seek Medical Attention

While minor shoulder asymmetry is common and often benign, significant or sudden changes in shoulder alignment warrant medical attention. But how can you determine if your uneven shoulders require professional evaluation?

Here are some signs that indicate you should consult a healthcare provider:

• Noticeable difference in shoulder height or position
• Pain or discomfort in the shoulder, neck, or back
• Difficulty performing everyday tasks due to shoulder imbalance
• Visible curvature of the spine
• Sudden onset of shoulder asymmetry
• Asymmetry accompanied by muscle weakness or numbness

A healthcare professional can perform a thorough physical examination and may order imaging tests such as X-rays, MRI, or CT scans to determine the underlying cause of the shoulder asymmetry. Early diagnosis can lead to more effective treatment and prevent potential complications.

Treatment Options for Uneven Shoulders

The treatment approach for uneven shoulders depends on the underlying cause and severity of the condition. A comprehensive treatment plan may include a combination of the following options:

Physical Therapy

Physical therapy is often the first line of treatment for shoulder asymmetry. A skilled physical therapist can design a personalized exercise program to address muscle imbalances, improve posture, and increase shoulder mobility. These exercises typically focus on strengthening weak muscles and stretching tight ones to restore proper shoulder alignment.

Bracing

In cases of scoliosis-related shoulder asymmetry, bracing may be recommended. A spinal brace can help correct the curvature of the spine over time, potentially improving shoulder alignment. The effectiveness of bracing depends on the severity of the scoliosis and the age of the patient.

Surgical Interventions

For severe cases of shoulder asymmetry, particularly those caused by significant scoliosis or structural abnormalities, surgical intervention may be necessary. Spinal fusion surgery is one option for correcting severe spinal curvatures that contribute to shoulder imbalance.

Medication

In cases where shoulder asymmetry is accompanied by pain or inflammation, medications may be prescribed to manage symptoms. These may include over-the-counter pain relievers, anti-inflammatory drugs, or muscle relaxants.

Lifestyle Modifications

Making changes to daily habits and activities can play a crucial role in managing and preventing shoulder asymmetry. This may include:

• Improving workplace ergonomics
• Adopting proper sleeping positions
• Balancing activities that involve repetitive arm movements
• Incorporating regular stretching and strengthening exercises into daily routines

Corrective Exercises for Uneven Shoulders

Exercise plays a vital role in correcting and preventing shoulder asymmetry. Here are some effective exercises that can help stretch and strengthen the shoulder muscles:

The Pendulum Exercise

1. Lean forward with a flat back and slightly bent knees.
2. Place one hand on a table or counter for support.
3. Let the other arm hang freely.
4. Gently swing the hanging arm back and forth, side to side, and in circular motions.
5. Perform 2 sets of 10 repetitions for each movement.
6. Repeat with the other arm.

This exercise helps improve shoulder mobility and can be particularly beneficial for those with frozen shoulder or recovering from shoulder injuries.

Crossover Arm Stretch

1. Relax your shoulders and gently pull one arm across your chest.
2. Hold the upper arm in place with your other hand.
3. Hold the stretch for 30 seconds, then relax for 30 seconds.
4. Repeat 4 times on each side.

This stretch targets the posterior shoulder muscles and can help improve flexibility and reduce tightness that may contribute to shoulder asymmetry.

Standing Row with Resistance Band

1. Create a loop with a resistance band and attach it to a doorknob.
2. Stand facing the doorknob, holding the band with your elbow bent at 90 degrees.
3. Keeping your arm close to your body, slowly pull your elbow back.
4. Return to the starting position and repeat.

This exercise strengthens the muscles between the shoulder blades, helping to improve posture and reduce shoulder imbalance.

Preventing Shoulder Asymmetry: Lifestyle and Postural Considerations

While some causes of uneven shoulders may be beyond our control, many cases can be prevented or minimized through proper lifestyle choices and postural awareness. Here are some key considerations:

Ergonomic Workspace Setup

Ensure your workspace is ergonomically optimized to promote good posture. This includes:

• Adjusting your chair height so your feet are flat on the floor
• Positioning your computer monitor at eye level
• Using a keyboard and mouse at a height that allows your elbows to bend at 90 degrees
• Taking regular breaks to stretch and move around

Balanced Physical Activities

If you participate in sports or activities that heavily favor one side of the body, consider incorporating exercises that work both sides equally. This can help prevent muscle imbalances that lead to shoulder asymmetry.

Sleep Posture

Your sleeping position can significantly impact shoulder alignment. Try to sleep on your back with a supportive pillow that keeps your head, neck, and spine in proper alignment. If you prefer sleeping on your side, use a pillow that keeps your spine straight and avoid tucking your chin to your chest.

Regular Stretching and Strengthening

Incorporate a regular routine of stretching and strengthening exercises for your shoulders, neck, and upper back. This can help maintain muscle balance and prevent the development of postural issues that lead to shoulder asymmetry.

Long-term Management and Prognosis for Uneven Shoulders

Managing uneven shoulders often requires a long-term commitment to treatment and lifestyle changes. The prognosis depends largely on the underlying cause and the individual’s dedication to their treatment plan.

For cases related to postural habits or muscle imbalances, consistent adherence to corrective exercises and ergonomic improvements can lead to significant improvements over time. Many individuals see noticeable changes within a few months of dedicated effort.

In cases of scoliosis-related shoulder asymmetry, the outcome may vary depending on the severity of the spinal curvature and the age at which treatment begins. Early intervention typically yields better results, especially in growing adolescents.

For shoulder asymmetry caused by neurological conditions, the prognosis is more variable and depends on the specific condition and its progression. In these cases, management often focuses on maintaining function and preventing further deterioration.

Regular follow-ups with healthcare providers are crucial for monitoring progress and adjusting treatment plans as needed. It’s important to remember that correcting shoulder asymmetry is often a gradual process that requires patience and persistence.

Innovative Approaches and Future Directions in Treating Uneven Shoulders

As our understanding of shoulder biomechanics and the factors contributing to asymmetry continues to evolve, new and innovative approaches to treatment are emerging. These advancements offer hope for more effective and personalized solutions for individuals with uneven shoulders.

3D Motion Analysis

Advanced 3D motion capture technology is being increasingly used to analyze shoulder movement patterns with unprecedented precision. This allows for more accurate diagnosis of the underlying causes of shoulder asymmetry and enables healthcare providers to develop highly tailored treatment plans.

Wearable Technology

Smart clothing and wearable devices equipped with sensors are being developed to provide real-time feedback on posture and shoulder alignment. These technologies can help individuals maintain proper posture throughout the day and alert them when they slip into problematic positions.

Virtual Reality Rehabilitation

Virtual reality (VR) systems are being explored as a tool for shoulder rehabilitation. VR environments can provide engaging and interactive exercises that encourage proper movement patterns and help correct shoulder imbalances.

Genetic Research

Ongoing genetic studies are investigating the hereditary factors that may predispose individuals to conditions like scoliosis, which can cause shoulder asymmetry. This research may lead to early interventions and more targeted treatments in the future.

Regenerative Medicine

Advancements in regenerative medicine, such as stem cell therapy and platelet-rich plasma (PRP) injections, show promise in treating shoulder injuries and imbalances. These treatments aim to promote tissue healing and regeneration, potentially offering new options for addressing shoulder asymmetry.

As research in these areas continues to progress, individuals with uneven shoulders can look forward to an expanding array of treatment options and more personalized approaches to care. However, it’s important to note that many of these innovative treatments are still in the experimental stages and may not be widely available or suitable for all cases of shoulder asymmetry.

In conclusion, uneven shoulders are a common issue with various potential causes, ranging from simple postural habits to complex medical conditions. By understanding the underlying factors, seeking appropriate medical attention when necessary, and committing to a comprehensive treatment plan, many individuals can successfully address shoulder asymmetry and improve their overall posture and well-being. As research continues to advance, we can anticipate even more effective and tailored solutions for managing this condition in the future.

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