Overview

A clavicle fracture is a break in the clavicle bone (also called the collarbone). It connects the sternum (breastplate) to the shoulder. The clavicle can fracture in three different places:

• middle third
  This is the middle portion of the clavicle and the most common site for a clavicle fracture.
• distal third
  This is the end of the clavicle connecting to the shoulder.
• medial third
  This is the end of the clavicle connecting to the sternum.

A clavicle fracture is caused by trauma to the clavicle bone. The trauma is usually caused by:

• a direct blow to the clavicle
• falling on an outstretched arm
• newborn babies passing through the birth canal

Risk factors that increase your chances of fracturing your clavicle include:

• advancing age
• postmenopause
• osteoporosis
• poor nutrition
• certain congenital bone conditions
• participating in contact sports
• violence

Diagnosis

Symptoms of a fractured clavicle include:

• pain, often severe
• sagging shoulder, down and forward
• inability to lift the arm because of pain
• a lump or visible deformity over the fracture site
• tenderness and swelling of the affected area

The doctor will ask about your symptoms, physical activity, and how the injury occurred. He will also examine the injured area. Tests may include:

• x-rays
  This test uses radiation to take a picture of structures inside the body, especially bones. It is used to look for a break in the bone.

Treatment Options

Treatment will depend on the severity of the injury. Treatment involves:

• putting the pieces of the bone back in position, which may require anaesthesia and/or surgery
• keeping the pieces together while the bone heals itself

Brace or Sling

Most clavicle fractures can be treated with a figure-eight strap, which is wrapped around the body and the shoulders, or a sling. These devices help hold the shoulder in place while the clavicle heals. The doctor may prescribe pain medication.

Surgery

Very rarely, surgery may be needed to set the bone. The doctor may place pins, a plate, or screws in the bone to hold it in place. You will need to wear the sling or figure-of-eight strap while you heal.

Exercises

When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises. Do not return to sports activity until your shoulder is fully healed.

Healing Time

• A child may heal as quickly as 3-4 weeks.
• An adolescent may take 6-8 weeks to heal.
• An adult who has stopped growing may require 8-10 weeks to heal.

Prevention

To help prevent clavicle fractures:

• Do not put yourself at risk for trauma to the clavicle bone.
• Eat a diet rich in calcium (pdf file) and vitamin D.
• Build strong muscles to prevent falls and to stay active and agile.

How can I prevent a clavicle fracture?

Since clavicle fractures are nearly always results of falls or blows, there is not much that can be done to prevent them. However, use of proper protective equipment, such as shoulder pads, is preventive.

The best way to prevent reoccurrences of a clavicle fracture is to only return to practice and competition when all symptoms of the injury are gone and strength has returned to normal. Furthermore, the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability of the injured area.

Other preventive techniques include:

• Eating a diet rich in calcium and vitamin D.
• Building strong muscles to prevent falls and to stay active and agile.

Improving Sports Performance

The key to improving sports performance after recovering from a clavicle fracture is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone. Keep in mind that a clavicle fracture is most often the result of a fall or blow, and you can better prepare yourself for these incidences by paying close attention to the rehabilitation exercises listed above. These will not only keep you in the game, but will also help you perform better and with more confidence.

Clavicle fracture rehabilitation for athletes

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for a clavicle fracture often includes the following:

• rest during the acute phase
• ice the injury multiple times per day
• compression of the injured shoulder with a secure wrap or ACE bandage
• elevation of the injured shoulder above heart level
• use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed up recovery

Most clavicle fractures can be rehabilitated with a figure-of-eight strap, which is wrapped around the body and the shoulders, or a sling. These devices help hold the shoulder in place while the clavicle heals. Your doctor also may prescribe pain medication and rehabilitation exercises once the strap is removed.

The major objectives of rehabilitation from a clavicle fracture are to increase flexibility, establish pain-free range of motion, and strengthen the muscles of the shoulders, upper back, front chest, and upper arms. In severe cases, you should avoid activity that causes shoulder pain altogether.

Keep in mind that rehabilitation for a clavicle fracture may be different when the injury requires surgery to put the pieces of the bone back in position. In these cases, your doctor may prescribe special physical therapy. Recovery time will vary.

Rehabilitation exercises

Rehabilitation exercises often prescribed by your doctor may include:

• Shrugs
  Stand with hands at sides with no weight in either hand. Raise shoulders to the point of pain and hold for five seconds. Relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, hold dumbbells of equal weight in each hand while performing this exercise. Add weight by using hand-held dumbbells as pain permits.
• Bicep curls
  Stand with arms fully extended at sides while grasping 2- to 5-pound weights in each hand, held palm forward. Flex the arms at the elbow to approximately 100 degrees, or to the point of pain, whichever comes first. Hold this position for 5 to 10 seconds. Return to the start position. Rest for 5 seconds. Repeat this exercise 10 times. Increase the weight as pain allows and strength develops.
• Triceps curls
  Stand with elbows directed upward over the shoulders and with arms relaxed. Extend arms at the elbow so that the hands proceed upward to the point of pain. Hold this position for five seconds. Return to the starting position and relax for five seconds. Perform this sequence 10 times, 3 times daily. As pain permits, add weight by using hand-held dumbbells.
• Chest raises
  Lie on belly with hands extended along sides of the body. Raise the upper chest from the floor to the point of pain and hold this position for 5 seconds. Return to the start position and relax for 10 seconds. Repeat this sequence 10 times, 3 times daily.
• Saws
  Reach out and place the unaffected side hand on a corner of a table. Bend at the waist. Flex the injured side arm at the elbow and pull the injured side arm backward and upward as if sawing wood. Slowly bring the shoulder blades as close together as pain will permit. Slowly bring the injured side arm down to its beginning position. Repeat this sequence 10 times, at least three times daily.
• Pendulum swings
  Stand with the hand of the unaffected arm resting on the corner of a table and supporting some of the body weight. Slightly bend the knee on the unaffected side and extend the other leg sideways. Allow the injured arm to hang loosely over the unaffected side foot. By shifting the body weight, cause the relaxed injured arm to swing in circles to the fullest extent possible as limited by pain. Perform 25 swings in a clockwise direction. Pause. Perform 25 swings of the injured arm in a counterclockwise direction. Repeat this sequence at least three times daily.
• Shoulder rotation
  Stand in a doorway with affected side arm bent at the elbow and the palm of the hand against the door frame. Turn the body away from the injured side hand until a stretching sensation is experienced in the injured shoulder. Hold this position for 10 seconds. Return to the starting position. Relax for 10 seconds. Repeat this sequence 10 times at least three times a day.
• Shoulder flexion
  Stand close to a wall. With the palm of the injured side arm turned so as to face you, slowly slide the forearm and then the upper arm up the wall by moving closer to the wall. Slide the arm upward to the point of initial significant pain. Hold this position for 10 seconds. Return to the starting position and relax for 10 seconds. Repeat this sequence 10 times, at least three times daily.
• Towel stretch
  Roll a towel lengthwise. While standing erect, dangle the rolled towel down the back, holding it with the unaffected side hand. Reach behind the back with the hand of the injured side and grasp the rolled towel. Gently pull upward on the towel, raising the injured side arm until first significant pain in the injured shoulder is felt. Hold this position for 10 seconds. Relax the arms while maintaining the grasp on the rolled towel for ten seconds. Repeat this sequence 10 times at least three times daily.
• Flexed elbow pull
  Bend and raise the injured side elbow to shoulder height. Grasp the injured side elbow with the uninjured side hand. Gently pull the injured side elbow toward the opposite shoulder until limited by first significant pain. Hold this position for 10 seconds. Relax for 10 seconds. Repeat this sequence 10 times at least three times daily.

Depending on the severity of the injury, some of the above exercises, and perhaps others of similar nature intended to increase the range of motion of the injured shoulder, may be prescribed to be done in water or a warm whirlpool apparatus. Water relieves the arm of some of its weight, thus allowing a greater pain-free range of motion, while warm water and a water massaging effect may also be effective.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• water running
• stationary bicycle (add resistance gradually from one session to the next, as pain allows)

Rehabilitation after surgery

Surgery is rarely needed to set a broken collarbone - putting the pieces of the bone back in position. Your doctor may place pins, a plate, or screws in the bone to hold it in place, and you will need to wear a sling or figure-of-eight strap while you heal.

When your doctor decides you are ready, you may start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises. Under no circumstance should you return to sports activity until your shoulder is fully healed.

A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates strength training, aerobic and muscular endurance, flexibility, and coordination drills.

How long will the effects of the injury last?

To some extent, the time to fully recover is influenced by your dedication to your rehabilitation program. A child may heal as quickly as 3 to 4 weeks, while an adolescent may take 6 to 8 weeks to heal. Adult athletes who have stopped growing may require 8 to 10 weeks of healing time before returning to their sport.

When can I return to my sport or activity?

Return to full participation should be avoided until your clavicle fracture has healed and you can perform all skills and other requirements of your sport without pain. To return earlier is to invite further injury, making subsequent fractures more likely. This is especially true when the sport involves heavy contact, such as in football, hockey, or rugby.

Generally, the athlete who wishes to return to a contact sport should expect to be out of action for 6 to 12 weeks. Again, the time to return to full activity depends on the dedication toward your rehabilitation program.

Remember: the goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your clavicle fracture recovers, not by how many days or weeks it has been since your injury occurred.