What is the clavicle and what is its role in the shoulder?
The clavicle, or “collarbone” is an important strut bone connecting the sternum (large bone in the center of your chest) and the scapula (i.e. shoulder blade). It functions to provide a rigid support for the shoulder and the upper extremity. The clavicle also serves to protect several large nerves and blood vessels that sit directly underneath it.
What causes a clavicle fracture?
A clavicle fracture is most commonly caused by a fall onto an outstretched hand or directly onto the outside of the shoulder. A direct blow to the shoulder secondary to contact sports or a motor vehicle accident can also cause a clavicle fracture.
The most common symptom associated with a clavicle fracture is pain and swelling that is worsened with shoulder movement. Depending on the amount of fracture displacement, a noticeable deformity or tenting of the skin may also be present.
An x-ray is the study of choice when first evaluating a clavicle fracture. A CT scan may also be ordered if the x-ray does not provide enough information about the fracture.
Treatment of clavicle fractures depends on the location of the fracture and the amount of displacement (i.e. how far apart the broken pieces of bones are). Most clavicle fractures with no displacement or minimal displacement are able to be treated nonoperatively with a shoulder sling. Gentle range of motion exercises under the guidance of a physical therapist are usually around 3-4 weeks. Strengthening is usually started around the 6-8-week mark, which is when significant fracture healing normally occurs. Contact sports and heavy manual labor type activities may require up to 12 weeks of healing, depending on the fracture pattern.
Significantly displaced fractures, fractures toward the end of the clavicle, fractures that cause greater than 2 cm of shortening, those that are causing significant tenting of the skin, and old fractures that have not healed usually require surgery. Surgery normally consists of a placing a metal plate and screws across the fracture site. This plate maintains proper reduction (i.e. holds the bones in their normal anatomic alignment) and allows the fracture to properly heal. Patients undergoing surgery for an old fracture that has not healed may require a bone graft to further assist in the healing process. Learn more about scheduling surgery.
The patient's incision site is sutured and dressed and they are placed into a shoulder sling after surgery. Patients are instructed to stay in the sling until their first post-op appointment 7-10 days after surgery. Sutures are usually removed at the first post-op appointment and patients are usually instructed to remain in the sling for an additional 4-6 weeks. Physical Therapy is usually started around 5-6 weeks surgery. Patients will initially remain in the sling when not doing Physical Therapy and can expect to slowly wean use of the sling as Physical Therapy progresses. Full activity including playing contact sports of manual labor can take up to 12 weeks or more to heal.
Learn more about post-operative care.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.