Injuries to the clavicle (collarbone) and acromioclavicular (AC) joint are among the most common upper extremity sporting injuries. The clavicle attaches to the chest at the sternoclavicular (SC) joint, and to the scapula and arm at the AC joint.
Fractures of the clavicle are one of the most common fractures of the upper extremity. They occur with a fall directly onto the shoulder or clavicle, and are frequently seen in mountain biking and contact sports. Clavicle fractures can also occur in older patients with a history of osteoporosis. Most fractures occur in the middle 1/3rd (mid shaft) of the clavicle.
Patients with clavicle fractures will have pain, tenderness, and swelling at the site of the fracture. There is usually a bump at the fracture site, and bruising will occur within about 48 hours. Patients with clavicle fractures will often have pain and weakness with attempts to use the arm on the affected side. Rarely, the fracture can compress blood vessels and nerves, causing numbness and tingling in the arm.
In patients with a suspected clavicle fracture, radiographs are taken in order to see if there is indeed a clavicle fracture. Most patients are then placed in a sling or Figure of Eight brace for comfort, until the fracture begins to heal. Ice is used over the area to control swelling and pain.
Oral anti-inflammatories (i.e. ibuprofen) or Tylenol are often used as well to control pain. Follow-up radiographs are usually obtained at 1-3 weeks after the initial injury to make sure that the fracture is well-aligned.
Surgery is not usually necessary for clavicle fractures, but can be recommended for patients with excessive displacement or shortening of the fracture, or if the fracture end is tenting the skin. Recent studies have suggested that patients with excessive shortening or displacement do better with surgical treatment (PubMed). Surgery does decrease the deformity of the fracture, but there will be a scar on the skin. Surgery consists of repositioning the fragments and holding them in place with a plate and screws.
What to expect from a clavicle fracture… Most clavicle fractures take about 6-8 weeks to heal, although pain will subside after 2-3 weeks.
A brace or sling is necessary until a doctor recommends it be discontinued, usually at approximately 6-8 weeks. Return to sports is usually at 8-10 weeks, once strength has been regained in the arm.
The clavicle fracture heals with new bone formation around the fracture site, which often leaves a bump under the skin. This bump will remodel over the course of the following year and will get smaller, but will rarely disappear entirely.
Most people with clavicle fractures have an excellent outcome with return to normal activities and a pain-free shoulder at 3-5 months after injury.
For those people who have surgery, the plate is occasionally bothersome, especially in very thin patients. The plate can be removed after complete healing of the fracture (usually no sooner than 6-9 months after the surgery).