Clavicle fracture What is a clavicle fracture? The shoulder is made up of 3 bones: the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone). The clavicle is the bone which attaches the arm to the chest. The clavicle attaches to the sternum (chest plate) at the sternoclavicular joint and the scapula (shoulder blade) at the acromioclavicular joint through strong ligaments. The collar bone lies right under the skin and can easily be felt (palpated). What causes a clavicle fracture? The majority of clavicle fractures result from a fall onto the shoulder. Because the clavicle lies right under the skin, it can also be broken from a direct blow to the chest. The type of fracture sustained is dependent on several factors including the type and severity of fall. What are the symptoms of a clavicle fracture? Most people who have a clavicle fracture complain of shoulder pain and inability to use that arm. The arm is usually held supported by the opposite hand to unload the painful shoulder. There is may be a deformity of the shoulder area and any attempt to move the limb is painful. The shoulder area at the clavicle is usually tender to touch (palpation). Other signs of a clavicle fracture include swelling and bruising (ecchymosis). However, some clavicle fractures can have much less obvious signs and symptoms, particularly if the fracture is nondisplaced (hairline fracture) How is a clavicle fracture diagnosed? The diagnosis of a clavicle fracture is made based on xrays. The broken bone is usually apparent on standard xrays but occasionally (particularly with hairline fractures) other studies are needed to diagnose the fracture. These studies include a CT and MRI scan. How is a clavicle fracture treated? Normally, clavicle fractures are first seen in the emergency department. After thorough examination of the injury, including the status of the skin and surrounding nerves and blood vessels, x-rays are taken to confirm the diagnosis. Initial treatment involves placement of a simple sling or figure of eight brace. The patient may be admitted to the hospital if surgery is planned. Otherwise, the patient is sent home to be followed up by an Orthopaedist and determine the need for surgical or nonsurgical treatment. This decision (surgical or nonsurgical treatment) is dependent on multiple factors including the type of fracture, amount of deformity present, patient age and activity level and patient preferences. Nonsurgical treatment involves use of a sling or figure of eight device and frequent xray checks to make sure that the bone has not shifted out of position. Surgical treatment involves making an incision and placing a plate and screws or nail (rod) to hold the bone in position while it heals. The type of device used to stabilize the bone is dependent on several variables including the type and severity of fracture sustained. Rehabilitation after clavicle fracture Regardless of treatment (nonsurgical or surgical), it is very important to move the shoulder, elbow, wrist and hand. One should try to make a full fist and can work to bend each finger individually into the palm using the good hand. One can also squeeze a sponge or soft ball (nerf or rubber ball) to help reduce the amount of hand and finger swelling. The physician will also advise when sling use can be discontinued and when one can use the arm to lift and carry objects. Many patients require formal physical or occupational hand therapy to help achieve an optimal result; the decision to visit a therapist is based on several factors including the severity of the fracture and how the patient’s function is progressing over time. Displaced clavicle fracture Clavicle fracture treated with plate and screws