Why Are My Teenager’s Shoulders Uneven?

Q: My 14-year-old daughter seems to lean to one side, and her shoulders are uneven. What might be causing this?

A: Your daughter should see a physician to be evaluated for possible scoliosis, or curvature of the spine. You mention two of the signs of scoliosis; others include one shoulder blade protruding farther than the other, an uneven waist and a raised hip.

Girls at greater risk

About 2 percent of children develop some degree of scoliosis between ages 10 and 16. Girls are four times more likely than boys to have progression of the condition.

A pediatric orthopaedic surgeon can help determine the severity of the curve, and whether or not it is progressing. The spine may curve to the side in an "S" shape or a "C" shape.

For slight curves, we typically "watch and wait" to see if they worsen; many times, curvatures do not progress at all.

If needed, bracing worn only at night

When curves are moderate and at least two years of growth remain, children may benefit from wearing a back brace at night to halt the curve's progression. However, bracing alone will not make the spine any straighter.

In severe scoliosis, the spine can become rigid and potentially interfere with growth or organ function. In these cases, the most effective treatment is surgery.

Safely correcting severe curves

Surgery begins with realigning the spine using special implants that attach to the bone. This corrects most of the deformity. Fusion is the process by which the spine then "grows together" to maintain a permanent correction. The spinal cord is electronically monitored during surgery, making the procedure much safer than in the past.

The old practice of spending months in a neck-to-waist cast is no longer followed after spinal fusion. Most patients return to school in four to six weeks, and are sturdy enough to resume sports in six months.

By Thomas E. Kuivila, MD, a pediatric orthopaedic surgeon in Cleveland Clinic's Center for Spine Health