Clavicle Fractures: Causes, Symptoms and Treatment Options

What is a clavicle fracture?

A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. This type of fracture is fairly common, accounting for about 5% of all adult fractures. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. A broken collarbone can be very painful and can make it hard to move your arm.

Anatomy

The clavicle is located between the ribcage (sternum) and the shoulder blade (scapula). It is the bone that connects the arm to the body. The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when a fracture occurs.

Description

Clavicle fractures are fairly common and occur in people of all ages. Most fractures occur in the middle portion, or shaft, of the bone. Occasionally, the bone will break where it attaches at the ribcage or shoulder blade. Clavicle fractures vary. The bone can crack just slightly or break into many pieces (comminuted fracture). The broken pieces of bone may line up straight or may be far out of place (displaced fracture).

Cause

Clavicle fractures are most often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or an accident, like a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In a baby, a clavicle fracture can occur during the passage through the birth canal.

Symptoms

A clavicle fracture can be very painful and may make it hard to move your arm. Other signs and symptoms of a fracture may include:

• Sagging of the shoulder downward and forward
• Inability to lift the arm because of pain
• A grinding sensation when you try to raise the arm
• A deformity or bump over the break
• Bruising, swelling, and/or tenderness over the collarbone

Doctor Examination

Your doctor will want to know how the injury occurred and will ask about your symptoms. They will then carefully examine your shoulder. In a clavicle fracture, there is usually an obvious deformity, or bump, at the fracture site. Gentle pressure over the break will bring about pain. Although it is rare for a bone fragment to break through the skin, it may push the skin into a tent formation.

Treatment

If the broken ends of the bones have not significantly shifted out of place, you may not need surgery. Many broken collarbones can heal without surgery. Nonsurgical treatment may include:

• Arm support. A simple arm sling is usually used for comfort immediately after the break and to keep your arm and shoulder in position while the injury heals.
• Medication. Pain medication, including acetaminophen, can help relieve pain as the fracture heals.
• Physical therapy. Although there will be some pain, it is important to maintain arm motion to prevent shoulder and elbow stiffness. Often, patients will begin doing exercises for elbow motion immediately after the injury.

If the broken ends of the bones have significantly shifted out of place, your doctor may recommend surgery. Surgery typically involves putting the broken pieces of bone back into position and preventing them from moving out of place until they are healed. This can improve shoulder strength when you have recovered.

• Plates and screws. After being repositioned into their normal alignment, the bone fragments are held in place with special screws and metal plates attached to the outer surface of the bone.
• Pins or screws. Pins or screws can also be used to hold the fracture in good position after the bone ends have been put back in place.