The clavicle or collarbone is one of a pair of slender bones that connects the shoulder blade, or scapula, to the sternum, or breastbone. It is a thin and slender bone that lies right beneath the skin. Because of this, the clavicle is one of the most common bones to suffer a fracture. Commonly the result of sports injuries, clavicle fractures usually heal within six to twelve weeks.
Definition & Facts
The clavicle's function is to keep the shoulder blade in the correct position. It is near many important nerves and blood vessels. Therefore, whenever the clavicle is fractured there's a risk that these structures can also be damaged, though this risk is small.
Symptoms & Complaints
The shoulder may also sag. Bruising and redness are also noticeable, and the patient won't be able to lift his or her arm without extreme pain. If the fracture has injured a nerve, the patient may also experience numbness and tingling down the arm and into the hand.
Collarbone fractures are common sports injuries where the player falls on their shoulder or the clavicle itself suffers a blow that fractures it. Equestrians and bicyclists are very much at risk for this type of fracture if they fall off of their mount. An outstretched arm that suffers a blow in a sport such as football can also result in a fracture to the collarbone.
Diagnosis & Tests
A physician who suspects that their patient has suffered a fractured collarbone can make a diagnosis through a physical examination and confirm it with an X-ray. The X-ray also shows where the break is in the bone and can detect other injuries. The doctor may also order up a CT scan for an even clearer picture. A CT scan is a series of X-rays that result in three-dimensional pictures of the affected area.
Treatment & Therapy
It's possible that if the ends of the fracture are lined up, the bone will heal by itself if it is given support. Nevertheless, one should seek prompt medical attention. In the immediate aftermath of the fracture, the patient should apply ice packs to the injured area, keep it elevated and compress it if it is not too painful to do so. After this, the arm should be put in a sling or figure eight wrap for between three and six weeks. This supports the arm and reduces the pain. It also keeps the fracture stable, which enables it to heal properly. The doctor will also prescribe pain medication.
It is important that the patient wear the sling or wrap for as long as the doctor recommends and makes sure to keep doctor's appointments. Even if the ends of the fracture are lined up, it is possible for them to be displaced if the patient goes back to strenuous activity before the collarbone is fully healed. This can result in a deformed shoulder and/or arthritis in the shoulder.
If the ends of the collarbone are displaced, the doctor may recommend surgery to line up the ends of the bone. This surgery can involve:
- Pins - Pins are inserted through the skin to hold the realigned ends of the bone in place. They're taken out after the bone has healed.
- Plates or screws - After the bones are realigned, they're held in place with surgical plates or screws. They are usually left in place even after the bone heals, but can be removed if the patient finds them uncomfortable.
After any surgery, the patient's arm is put in a sling for three to six weeks. The doctor monitors the patient and occasionally takes X-rays to make sure that the collarbone is healing. Even if the bones are not displaced, the surgeon often sends the patient to a physical therapist. In the early stages of physical therapy, the physical therapist may apply electrotherapy to the area to reduce the inflammation and put the shoulder through movements to check its range of motion.
The patient may also be given exercises to do such as scapular clocks. This helps them to control the shoulder blade. During a scapular clock, the patient holds a Swiss ball against the wall and moves the palm of their hand to the 12, 3, 6 9 and 12 o'clock positions while keeping their arm straight. The ball should not move. The patient is also given exercises to strengthen the shoulder and the arm as well as the wrist and fingers.
As the bone heals, the physical therapist will check to see that there's no more swelling in the injured area and evaluate the patient's range of motion in the hand, arm, and shoulder. The patient's grip will also be evaluated and they may start such exercises as side-lying Ls. As the healing progresses, other exercises may include medicine ball chest throws, four point kneels and dumbbell bench presses. These should be able to be completed without pain or with little pain.
Many athletes find they can return to their sport after about 12 weeks, though this depends on the patient and the seriousness of the fracture. Patients who have had surgery tend to be able to return to their sport of choice more quickly.
Prevention & Prophylaxis
Proper equipment is also a must. For example, shoulder pads should be worn in football, mats need to be placed under gymnastic equipment, and a horse’s tack needs to be put on the right way and secured. Equipment should also be checked to make sure it functions properly.