What is it?
The clavicle, or collarbone, is a long bone between the sternum (breastbone) and scapula (shoulder blade). A fracture can occur by a direct hit to the clavicle, a fall on the shoulder, or by a fall on an outstretched hand.
Symptoms
Clavicle fractures commonly cause pain and swelling at the fracture site, as well as pain with movement of the affected arm. The fracture may cause “tenting” of the skin at the fracture site, which is the bone pushing against the inside of the skin. Sports Medicine evaluation work-up for a suspected clavicle fracture begins with an examination of the injured clavicle, shoulder, and arm, as well as the uninjured clavicle, shoulder, and arm. This includes an evaluation for tenderness, range of motion of the shoulder, strength testing, and sensation testing. X-rays are often necessary to confirm the diagnosis.
Treatment
Treatment depends on the location of the fracture. Most are mid-shaft fractures (fractures in the middle third of the clavicle), and they can be successfully treated with an arm sling or a figure-of-eight splint for 6-12 weeks. The choice of sling or splint does not affect long term healing. As pain improves, treatment will include rehabilitation exercises to avoid shoulder stiffness. Occasionally, severe mid-shaft fractures, as well as distal clavicle fractures (located closer to the scapula), may require surgical repair.
Injury Prevention
These injuries occur as accidents that cannot necessarily be prevented, but adequate strength and conditioning to participate in a given sport or athletic activity is always recommended.
Return To Play
Return to play should be overseen by a sports medicine physician to ensure safe and timely return to sport. Most physicians will determine return to play based on return of full strength, pain-free full range of motion, and the ability to pad or protect the injury. The amount of time since the injury occurred may be considered, when deciding when to return to more aggressive or contact sports. A repeat x-ray may be ordered to evaluate for healing prior to return to play.
AMSSM Member Authors; Mark Kasmer, MD, Matt Gammons, MD
References
Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine. 4th Edition. Australia: McGraw-Hill Education; 2012.
Lenza M, Belloti JC, Andriolo RB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane database Syst Rev [Internet]. 2014 Jan [cited 2014 Dec 31];5:CD007121. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24879341 Rouzier P. The Sports Medicine Patient Advisor. 3rd Edition. Amherst, MA: Sportsmed Press; 2010.
AMSSM is a multi-disciplinary organization of sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. Find a sports medicine physician in your area at www.amssm.org.
