Last reviewed: September 29, 2026

It can be, but often it is not. Slightly uneven shoulders are common in healthy teenagers.

In a study of 91 healthy teenagers, only 17 had perfectly level shoulders in photographs, even though all of them thought their shoulders were level. The average difference was about 7.5 millimeters, less than a third of an inch. Other studies found that mild differences between the two sides of the trunk and waist are also normal, and that the shape of the back develops mainly during the growth spurt, around ages 12 to 14.

Carrying a bag on one shoulder changes posture while it is being carried. Whether it causes lasting uneven shoulders has not been shown.

A difference in leg length can tilt the pelvis and make the back look uneven. A doctor may check this by placing a block under the shorter leg and seeing whether the tilt goes away. Rarely, one shoulder blade sits higher from birth, a condition called Sprengel deformity. It can be mistaken for scoliosis.

Scoliosis is a sideways curve of the spine. The most common type in children has no known cause and usually shows up between age 10 and the end of growth.

Signs of scoliosis include uneven shoulders, one shoulder blade sticking out more, ribs more prominent on one side, an uneven waist and one hip higher than the other.

Doctors check with the forward bend test. The child bends forward with the arms hanging down while the doctor looks at the back from behind for a hump on one side. If a curve is suspected, an X-ray measures it in degrees.

A review of 239 studies covering more than 46 million children and teenagers found scoliosis in about 1.7%. It was about twice as common in girls, and 87% of the curves were mild. Girls are also more likely to develop curves large enough to need treatment.

Medical groups disagree about screening. A joint statement from orthopedic and pediatric societies recommends checking girls twice, at ages 10 and 12, and boys once, at 13 or 14. A national task force found too little evidence to say whether screening all children does more good than harm.

According to the American Academy of Orthopaedic Surgeons, curves under 25 degrees are usually watched. A brace is considered for curves of 25 to 45 degrees in a child who is still growing. Surgery is considered for curves over 45 to 50 degrees. Curves over 50 degrees tend to keep getting worse even after growth ends.

In general:

  • If you notice uneven shoulders, a hump on one side when your child bends forward, or an uneven waist, ask your child’s doctor to check the back.
  • A small curve usually needs only follow-up visits while your child is growing.
  • If repeat X-rays are needed, ask whether a lower-dose X-ray is available.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

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