Definition and Overview

The clavicle (collarbone) is the long bone that runs between the shoulder blade and the breastbone. It sits on top of the chest, between the neck and shoulder. It keeps the shoulder blade in position. This allows maximum range of movement of the arm.

Collarbone injuries are very common. Every year, there are about 200,000 cases in the United States alone. This injury results in swelling and bruising in the shoulder and arm area. It can also cause extreme pain when the patient tries to move his or her arm or shoulder.

With prompt treatment, the injury often heals within one to three months. In many cases, it does not result in long-term health or physical problems. In fact, many patients are able to go back to their pre-injury levels of activity, which may include competitive sports.

Causes of Condition

Just like other bones of the body, the collarbone can also be injured or broken. In fact, it is one of the most commonly damaged bones in the body. Many cases are caused by sports injuries. It is often seen in gymnasts, cyclists, and basketball and football players. It often occurs following an impact to the shoulder joint. It can also occur when a person falls onto an outstretched arm. Other common causes are vehicular accidents and falls.

The injury can affect anybody of any age. However, children and teenagers have an increased risk. This is because their bones are not fully hardened until they are about age 20. Older people also have an increased risk because bone strength naturally decreases with age.

Key Symptoms

A clavicle injury results in severe pain that can prevent normal use. Other symptoms include:

  • Bruising, tenderness, and swelling along the collarbone

  • A bulge on or near the shoulder - In rare cases, the broken bone can penetrate the skin and become exposed.

  • Sagging or slumping of the affected shoulder

  • Difficulty moving the affected arm

Who to See and Types of Treatments Available

Patients with a clavicle injury are treated by orthopaedic specialists. These doctors specialise in disorders and diseases of the bones and muscles. The condition is diagnosed using the following tests:

  • Physical exam - The doctor will start by checking the shoulder for any signs of problems. He or she will ask the patient to lift the affected arm overhead to measure its strength. The doctor will also look for signs of nerve damage.

  • X-rays - The doctor will order an x-ray if the results of the physical exam suggest an injury. X-rays are the fastest way for doctors to view and assess bone injuries. They can also show if the bone is broken or dislocated.

  • CT scan - Minor cases of clavicle injuries may not show up on x-rays. In such situations, the doctor may order a CT scan. This test provides more detailed images of the affected area than x-rays. Thus, it helps doctors accurately assess the extent of the injury. In some cases, other imaging tests are also used. These may include an MRI and a bone scan. These tests can help confirm if surrounding tissues are also damaged.

Treatment of collarbone injuries depends on the severity of the condition. Nonsurgical therapies are used if the fragments of the injured bone remain aligned. For this type of injury, doctors focus on making sure that the injured bone stays in place until it is fully healed. Patients need to wear a sling for support for a couple of weeks. They are also given medications for their pain.

Physical therapy (PT) is necessary once the bone starts to heal. This is because bones that are immobile for a period of time tend to lose their strength. This can result in reduced range of motion. With PT, patients will slowly be able to restore normal function, movement, and flexibility.

The injury is treated with surgery if the broken ends of the bone have shifted out of place. Surgery can also be considered if the injury does not improve within 10 weeks of nonsurgical treatment. The goals of surgery are to:

  • Ensure that the broken pieces are aligned as the bone heals

  • Restore the normal length of the bone

When compared to nonsurgical therapies, surgery has more or less the same recovery time. In this procedure, the surgeon creates an incision in the shoulder area to access the broken bone. He or she will then reposition the bone fragments, ensuring that they are aligned. The treated bone is then held in place with plates, pins, and screws. These can be left in place even after the bone has healed. However, they can be removed if they are causing discomfort. Patients will need to wear a sling or similar device after surgery to immobilise the bone. In many cases, the sling has to stay in place between four and six weeks.

Patients often complain of pain following surgery. This is managed with ice compresses and over-the-counter pain relievers. If the pain is severe, patients may be given opioids. These drugs should be used only for a short time. When misused, patients may suffer from opioid overdose, which can be fatal in many cases.

Surgery is also followed by physical therapy. Working with a physical therapist can speed up the healing process. This means that patients will be able to go back to their pre-injury activities sooner.

Surgery to treat collarbone injuries has a number of risks. These include bleeding and infection. There is also a small risk of blood clot formation. This can be a cause for concern because these clots can slow down or block the flow of blood. This increases the risk of a heart attack or stroke. In addition, patients with diabetes and those who smoke may have problems with delayed wound healing after surgery.

All the risks and benefits of surgery must be thoroughly explained to the patient before the procedure. The surgery is only carried out if the benefits outweigh its risks.

With prompt treatment, patients are able to recover within one to two months. Many are able to regain the strength of their shoulder. They also do not develop any lasting bone problems.

References:

  • Clavicle fracture (broken collarbone). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00072. Accessed November 13, 2017.

  • Clavicular fractures in adults. DeLee J, Drez D, eds. DeLee and Drez’s Orthopaedic Sports Medicine: Principles and Practice. 2nd ed. Philadelphia, Pa: Saunders; 2003. 958-68.

  • Kim W, McKee MD. Management of acute clavicle fractures. Orthop Clin North Am. 2008 Oct. 39(4):491-505, vii.

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