|Paul Benfanti, MD|
Clavicle fractures are often caused by a direct blow to the shoulder. This can happen from a fall onto the shoulder, like falling off your bike or having the shoulder hit directly, like in football or hockey. Sometimes a baby's clavicle can break during the birth process.
Clavicle fractures are painful and cause pain when you try to move your arm. The shoulder may have a sagging appearance and there may be a bump over the break. The area over the break may be swollen, bruised and tender. You may actually feel the bones moving when you move your shoulder.
Clavicle fractures are diagnosed with physical exam and an x-ray.
The treatment of clavicle fractures depends on patient age and the severity of the fracture. Most clavicle fractures can be treated without surgery. The arm is placed in a sling for 3-4 weeks until the bone ends become fused together and then activities can slowly be resumed. There may be a permanent bump on the clavicle where it healed together but this is rarely a functional problem. Physical therapy may be needed to help strengthen the muscles around the shoulder and regain motion. Pain medications are used for the first week or so.
Surgery may be needed if the fracture is severe. That is, if it goes through the skin or there is any nerve or blood vessel damage. Also, some fractures are so badly broken and displaced that they will not heal well without lining them back up with surgery. Surgery usually involves putting the ends of the bone back together as close as possible and holding it with a plate and screws. Most people who have surgery will have numbness around the scar and may feel the plate under the skin. This is usually not a problem but may cause discomfort with backpacking or seatbelts. If this is a significant problem the plate and screws can be removed after the fracture is well healed. Physical therapy may be needed as well.