Uneven shoulders may be caused by the following reasons: 1. congenital lordosis, which occurs after birth and is often characterized by a lordosis of the neck to one side and a high shoulder on that side. 2. congenital hypertelorism, which is often caused by a bony deformity of the scapula, resulting in a high scapula on the affected side and limited upper arm abduction and elevation activities. 3. 3. It may be caused by spine related pathologies, such as congenital scoliosis, hemivertebrae, cuneiform vertebrae, vertebral agenesis and a series of cervical and thoracic vertebrae related deformities, which may cause shoulder imbalance. 4. It is caused by poor posture of the patient, such as poor sitting or lying posture, which may cause muscle spasm on one side over time and lead to shoulder imbalance. 5, It is caused by old injury of the shoulder, such as previous old clavicle fracture or scapula fracture, which may remain this symptom after its recovery.