Introduction:. Shoulder balance after surgery is one main attribute of the cosmetic outcome. It has been difficult to assess on 2D images. The balance results from the interaction of rib cage, shoulder joint and scapular positions, spinal alignment and rotation, muscle size and co-ordination and pain interaction. Attempts have been made to predict shoulder balance from radiograph measurements. There is no consensus on this. Attempt:. To assess whether T1 tilt has any relation to final shoulder balance after surgery. Method:. Retrospective review of radiographs of adolescent idiopathic scoliosis patients from 2009 to 2012. 61 identified with average age of 17 and follow up of 24 months. T1 tilt is measured pre-op, immediately post-op and at the latest follow up. Radiographic shoulder balance based on soft tissue shadow is assessed at the same interval. The balance is based on eyeballed perception, which is what patients do normally. Results:. The average T1 tilt is 3.6° pre-op (−11° to 12°), changing to −2.4° (−14° to 8.2°) immediately post op and to −3.5° (−9.3° to 0.7°) at the latest follow up. The proportion of balanced shoulder improved from 14% pre-op to 14% immediately post op and to 65% at final follow up. No relation of pre-op T1 tilt and the final shoulder balance can be found. Discussion:. Shoulder balance is a dynamic feature. Patients can regain shoulder balance given time. We cannot tell whether this is due to their adaptive process or rotational movement of the spinal construct over time here. Conflict Of Interest Statement: No conflict of interest