Sports Medicine
Sports Injury Prevention & Rehabilitation

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Clavicle Fracture

(Also known as Broken Collar Bone, Broken Clavicle, Fractured Clavicle, Fractured Collar Bone, Collar Bone Fracture)
What is a clavicle fracture?
A clavicle fracture (or broken clavicle) is one of the most common fractures seen in sport and is characterized by a break in the collar bone (clavicle) of the shoulder.
Following a fall onto the shoulder or outstretched arm, or, due to a direct impact to the point of the shoulder, stress is placed on the clavicle. If these forces are beyond what the clavicle can withstand, a break in the bone may occur. When this occurs it is known as a clavicle fracture and can vary from a small undisplaced fracture to a severe displaced fracture with obvious deformity.

Causes of a clavicle fracture

A clavicle fracture usually occurs either following a fall onto the point of the shoulder (e.g. in horse riding, a tackle in football, or cycling), or, due to a collision with another player during contact sports such as rugby or football (e.g. a 'hip & shoulder' bump). A clavicle fracture may also occur following a fall onto an elbow or outstretched arm. In these instances, forces are transmitted through the shoulder to the clavicle and if the forces are severe enough, may cause the clavicle to break.

Signs and symptoms of a clavicle fracture
Patients with a clavicle fracture typically experience a sudden onset of sharp, intense pain at the time of injury. Pain is usually located somewhere between the neck and the point of the shoulder. Pain may increase when attempting to perform movements of the upper limb such as arm elevation, overhead activities, taking the arm across the chest or heavy pushing, pulling or lifting activities. Pain may also increase when lying on the affect side, applying pressure to the shoulder, or on firmly touching the clavicle at the site of injury. An ache in the clavicle may also be present that is particularly prominent at night or first thing in the morning (especially during the first few days following injury).
Patients with this condition may notice an audible sound at the time of injury such as a 'click', 'pop' or 'snap'. There is usually localized tenderness and swelling at the site of injury, and, depending on the severity, a bony deformity may be evident.

Diagnosis of a clavicle fracture

A thorough subjective and objective examination from a physician is important to assist with diagnosis of a clavicle fracture. An X-ray is typically required to confirm diagnosis.

Treatment for a clavicle fracture

A clavicle fracture is usually treated successfully with conservative management (i.e. without surgery), even in severe cases where a gross bony deformity is present. The initial aim of treatment is to provide pain relief (including the use of pain medication) and to immobilize the fracture. This typically involves the use of a sling or figure-of-8 bandage for approximately 3-4 weeks. During this time, the patient should perform pain-free self-assisted shoulder elevation exercises to a maximum of 90 degrees to prevent stiffness in the shoulder from developing. The treating physical therapist can advise which exercises are appropriate for the patient and when they should be commenced.
It is also important that patients with this condition rest sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the clavicle should also be avoided, particularly lying on the affected side and direct pressure or impact to the shoulder or clavicle itself. Resting from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physical therapist.
Physical therapy treatment and progressive exercises to strengthen and improve flexibility of the shoulder should be performed to ensure an optimal outcome. The treating therapist can advise which exercises are appropriate and when they should be commenced. A gradual return to activity or sport is usually appropriate when pain settles and should be guided by the treating therapist.
Occasionally, patients with certain clavicle fractures (particularly severe ones) or in cases that do not respond to conservative treatment, surgical intervention may be indicated to stabilize the fracture and ensure an optimal outcome.

Prognosis of a clavicle fracture
Patients with a clavicle fracture usually make a full recovery with appropriate management. Patients whose injury is appropriate for conservative management can usually return to activity or sport in a number of weeks although care must be taken when returning to contact sports. A visible lump in the clavicle may remain, however this is merely a cosmetic issue and usually does not cause any other complications. In those cases where surgery is indicated or in cases that do not respond to conservative management, recovery may take longer.

Physical therapy for a clavicle fracture
Physical therapy treatment for patients with this condition is important to ensure an optimal outcome and allow a safe return to activity. Treatment may comprise:
  • education
  • rest from aggravating activities
  • the use of a sling or figure-of-8 bandage
  • electrotherapy (e.g. ultrasound)
  • protective and postural taping
  • exercises to improve posture, flexibility and strength
  • activity modification advice
  • a graduated return to activity plan
  • soft tissue massage
  • joint mobilization (usually following completion of fracture healing)

Other intervention for a clavicle fracture
Despite appropriate management, some patients with a clavicle fracture do not improve and require other intervention to ensure an optimal outcome. The treating therapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan or MRI or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. In rare cases, surgery may be considered to stabilize the fracture and ensure an optimal outcome. This may involve reduction, fixation or bone grafting.