Uneven shoulders may be caused by the following reasons: First, it may be due to some of the patient’s own posture habits. For example, some patients may lie on their side excessively for a long time or have the habit of shrugging their shoulders to one side when standing, which may lead to uneven shoulders. Second, this condition may be caused by old injury to the shoulder. For example, if the patient has a previous old fracture or dislocation of the shoulder, after recovery, there may be a deformity related to the shoulder, which may lead to bilateral asymmetry of the shoulder. Third, this condition may be caused by a lesion of the spine. For example, when a patient has scoliosis, it may lead to bilateral asymmetry of the thorax or shoulders. Fourth, this condition may also be caused by congenital genetic malformations. For example, patients with a congenital sloping neck, or with a congenital high scapula, may have similar symptoms.