The clavicle (collarbone) is a bone located on the top of the chest. The clavicle sits right below the skin and has very little soft tissue coverage. The clavicle is a “strut” that helps keep the upper limb away from the chest area, providing the arm/shoulder with tremendous range of motion. The clavicle also protects various nerves and arteries in the upper chest. Clavicle fractures are common and usually occur following a direct impact. They often occur in cyclists, contact athletes, and in people involved in motor vehicle accidents.
- Sharp pain on top of the shoulder
- Skin swelling and redness
- Cosmetic deformity with prominent bone
Diagnosis And Treatment
Dr. Keller considers each patient’s symptoms, as well as a detailed physical examination and x-rays to make the diagnosis of a clavicle fracture. Most patients with a clavicle fracture can be treated successfully without surgery. Dr. Keller usually recommends a sling for comfort. It is important to come out of the sling multiple times a day to promote range of motion in the elbow and to perform gentle range of motion exercises in the shoulder. Dr. Keller also recommends a dedicated physical therapy program that helps strengthen the muscles and ligaments around the shoulder. Physical therapy usually starts four weeks following the injury.
Some clavicle fractures are worse than others. There are a number of studies demonstrating that certain types of clavicle fractures do not heal reliably and may also lead to chronic weakness and pain if treated without surgery. Those fractures that are in multiple pieces (comminuted) and that are overlapped (shortened) tend to have worse outcomes without surgery. Dr. Keller may recommend surgical treatment for patients with these types of fractures. Surgery involves an open incision in which Dr. Keller positions the fracture appropriately and then usually fixes the fracture with a plate and screws.