Collarbone (clavicle) fracture

What is a collarbone fracture?

When a bone breaks or cracks, the injury is called a fracture. In the collarbone (clavicle), fractures can happen in three separate areas:

• The outer third of the collarbone is near the tip of the shoulder. Fractures here usually are caused by an accidental fall or some other type of direct impact (football tackle, hockey check, car collision) that transmits force to the side or top of the shoulder. Fractures in this area account for about 15% of all collarbone fractures.
• About 80% of all collarbone fractures occur in the middle third of the bone. A fracture here usually is related to a fall on an outstretched arm. This area also can be fractured by a direct impact to the middle of the collarbone, especially during stick sports, such as hockey or lacrosse.
• The third nearest the breastbone rarely fractures. Fractures in this part of the collarbone almost always are caused by a direct blow to the front of the chest, often from a steering wheel impact during a car crash.

The collarbone is one of the most commonly fractured bones. In most collarbone fractures, the ends of the fractured bone do not move apart widely, and the area of tissue damage involves only the collarbone. In rare cases, a sharp portion of the fractured bone either will pierce the surface skin (an open fracture) or cut into one of the large nerves or blood vessels that travel through the shoulder. In severe impact injuries, it is also possible for a portion of the fractured collarbone to penetrate the upper part the lung, causing serious breathing problems.

Symptoms of a collarbone fracture

Common symptoms of a fractured collarbone include:

• pain, swelling, and tenderness along your collarbone
• pain when you try to move your shoulder or arm
• slumping of your shoulder downward, forward and inward
• abnormal contour of your collarbone — the fractured area may cause an abnormal bump along the length of your collarbone, or it may poke forward to produce a sharp point under the skin at the front of your shoulder. In rare cases, the end of the broken collarbone may penetrate through the surface skin and be exposed.
• bruising or abrasions along your collarbone, or at the top or side of your shoulder.

Diagnosing a collarbone fracture

Your doctor will examine your collarbone, shoulder, and upper chest for swelling, deformity, abrasions, bruising and tenderness along the length of your collarbone. Your doctor also will press and feel the injured area gently to determine the position of any broken bone fragments under the skin.

To determine whether blood vessels or nerves were injured by the fractured collarbone, the doctor will check the strength of your pulse at your wrist and elbow and will check the feeling and strength in your arm, hand, and fingers. The doctor will also check your upper chest with a stethoscope to determine if your lungs have been damaged.

If the results of your physical examination suggest that that you have a fractured clavicle, your doctor will order x-rays to confirm the diagnosis.

Expected duration of a collarbone fracture

Soreness at the fracture site typically resolves and movement around the shoulder returns to normal within six to 12 weeks. If your fracture is treated without surgery, you probably will be able to return to your normal level of physical activity six weeks after your shoulder strength and range of motion have returned to normal. In some cases, x-rays may be necessary to confirm that your collarbone has healed completely.

If you need surgery to repair your fractured collarbone, it may take four to six months before you can return to strenuous activities at work or on the playing field.

Preventing a collarbone fracture

It is hard to prevent collarbone fractures that happen on the playing field or because of accidental falls. To help prevent fractures caused by a steering wheel impact, wear a seat belt and shoulder harness when you drive, and only drive cars that have air bags.

Treating a collarbone fracture

If your collarbone has separated widely at the site of the break, the doctor will carefully move the ends of your fractured clavicle back into their normal position after giving you medications to ease your pain and relax your shoulder muscles. This treatment is called closed reduction. Once the ends of your fractured collarbone are realigned, you will wear a bandage or sling to reduce movement of the collarbone and  to keep the broken bone in place while it heals.

Acetaminophen or a nonsteroidal anti-inflammatory drug such as ibuprofen may be recommended to control pain.

Gradually, you will begin a program of physical therapy to restore the normal strength and range of motion in your shoulder joint. Once soreness at the fracture site resolves and movement around the shoulder returns to normal (typically within six to 12 weeks after the injury), wearing the sling may no longer be necessary.

If the collarbone has not separated widely, the manipulation (closed reduction) will not be necessary, and only the sling, medications for pain, and exercises will be recommended.

Most collarbone fractures do not require surgery. However, surgery may be recommended if the fracture:

• cannot be treated with closed reduction
• breaks the skin
• damages a lung or nearby blood vessels or nerves.

When to call a professional

Call your doctor immediately if you cannot move your shoulder after a fall or other traumatic injury or if your collarbone is painful, swollen, tender or deformed.

Remember that a fractured collarbone sometimes can pierce a lung or damage nerves and blood vessels. For this reason, it is especially important to call for emergency help if you feel short of breath, begin to cough up bloody fluids, or have numbness or tingling in your arm or hand.

Prognosis

Most collarbone fractures heal within three months. Although there is often a slight bump in the contour of the collarbone at the healed fracture site, this tends to become smaller with time, especially in young people.

Additional info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov/

American Academy of Orthopaedic Surgeons (AAOS)
https://www.aaos.org/