The collarbone (clavicle) is one of two long, slender bones found on either side of the chest. Each clavicle is attached to the breastbone (sternum) at one end and to the shoulder blade (scapula) at the other end. They connect the arms to the trunk of the body.
Most clavicle fractures occur in the middle of the bone.
Because the clavicles do not completely harden until around the age of 20, a broken collarbone is a fairly common injury amongst young people. Because bones become more brittle with age, elderly people are also more at risk of this injury. Occasionally, a high birth weight causes an infant to break a collarbone during labor and delivery.
Usually, a fracture happens as a result of a fall onto the shoulder, or occasionally a fall onto an outstretched arm. Vehicle accidents are a common cause of clavicle fractures, as are injuries sustained while playing sports.
Conditions such as osteoporosis, cancer, or a genetic defect causing weak bones will increase the risk of breaking a collarbone.
If you are experiencing any of the following symptoms, seek medical attention as soon as you can. Delaying treatment of a broken collarbone can result in imperfect healing.
- Pain, which can be severe, made worse with movement of the shoulder
- Holding arm close to the body and supporting it with the other hand
- Diminished ability to move the shoulder due to pain
- Shoulder on damaged side sagging down and forward
- Tenderness, swelling and bruising over the injured area
- A bulge along the line of the collarbone
- A crunching or grinding sensation (crepitus) on movement of the shoulder
Diagnosis of a fractured clavicle is relatively straightforward. Your doctor will ask you questions relating to the circumstances of the injury, and your symptoms. Your shoulder and collarbone will be physically examined, including gently palpating along the line of the collarbone. Your doctor will listen to your chest in order to rule out damage to the lungs, check for any possible nerve damage and order X-rays to view the bones and determine the location and severity of the fracture. He or she will also be looking at the joints to see if they have suffered any damage.
If it is considered necessary to view the injury in greater detail, a CT (computerized tomography) scan will be performed.
Treatment depends on the location and severity of the fracture. If the broken ends of the bone have not shifted out of place, conventional (non-surgical) treatment will be sufficient.
An open (compound) fracture, where the broken bone has pierced the skin, will require immediate surgery and antibiotics to reduce the chance of developing an infection.
A displaced fracture, where the two pieces of bone are misaligned, may need surgery to position the pieces so that they heal together in correct alignment.
If the collarbone has been broken into several pieces (comminuted fracture) surgery may well be necessary in order to realign the bone.
Surgical treatment usually involves fixing the pieces of broken bone together with the aid of screws, rods or plates. These fixation devices are normally left in place, although they can be removed after healing if they are causing discomfort.
If immediate surgery is not required, ice, crushed in a bag and wrapped in a towel, can be applied to the injured area for as long as is comfortable, several times a day for the first few days after the injury. This will help reduce swelling and therefore relieve pain.
Over-the-counter pain medication such as acetaminophen (Tylenol) or NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve) or aspirin can be used, although there is some evidence to show that using NSAIDs may inhibit bone repair. Your doctor may prescribe stronger medication if the pain is severe.
In order that the collarbone can begin to heal, it must be immobilized. This is normally achieved by wearing a sling or, often, a figure-of-eight strap that effectively prevents movement of the clavicle. This strap may need to be worn for up to 12 weeks, depending on the severity of the fracture.
After you have finished wearing the strap, some rehabilitation for the shoulder will be necessary. Your doctor will advise you on when to start gently moving the shoulder. An exercise program that gradually increases range of motion, strength, and flexibility will be developed for you. You may be advised to work with a physical therapist. It is important to follow medical advice carefully, as trying to do too much, too soon may result in improper healing or broken fixation devices, and mean that treatment has to begin again.
You can expect to resume your normal daily and sporting activities within three months of the initial injury.
When your doctor advises that it is safe to do so, you may begin some gentle rehabilitation exercises. These should be done on a daily basis. You may be prescribed specific exercises, but you can begin with the following:
Bend forward at the waist and allow your injured arm to hang straight down towards the floor. Gently move your hand in small circles, both clockwise and anticlockwise. The momentum will cause your arm to move.
Hold a small ball in the hand of your injured arm. Squeeze the ball gently and evenly several times.
Standing, hold a stick in both hands with your palms facing down. Slowly, keeping your elbows straight, lift your arms above your head. Hold the stretch for 5 seconds then lower your arms. Repeat 10 times.
Standing, hold a stick behind your back, using both hands. Slowly lift the stick away from your back. Hold the stretch for 5 seconds then lower. Repeat 10 times.
Scapular range of motion:
Standing, shrug your shoulders up. Hold for 5 seconds. Squeeze your shoulder blades back towards each other. Hold for 5 seconds. Drop your shoulder blades down as though putting them in a back pocket. Hold for 5 seconds. Repeat exercise 10 times.