The collar bone (clavicle) is the long bone that attaches your shoulder joint to your breastbone. It helps to keep your shoulder in the correct position and helps to guide motion as you move your shoulder.
A fractured collar bone can be a serious injury. It can cause shoulder pain and limit your ability to move your arm normally. A clavicle fracture can also interfere with normal work, recreation, and activities of daily living.
Causes of a Broken Collar Bone
A broken collar bone almost always occurs after trauma. This may be caused by falling on your shoulder or being struck during athletic activity. Less commonly, an indirect impact, such as falling onto your elbow or on your outstretched hand, causes a collar bone fracture.
The most common location of a clavicle fracture is in the middle of the bone just in front of your neck. Occasionally, a break in the clavicle may occur closer to your shoulder joint.
Signs and Symptoms of a Clavicle Fracture
The signs and symptoms of a clavicle fracture include, but are not limited to:
- Pain and tenderness over the shaft of your collar bone
- Shoulder pain
- A bump or deformity along the shaft of your collar bone
- Discoloration or bruising near your collar bone
- Inability to move your arm
- Numbness, tingling, or a cold feeling in your arm
If you suspect you have broken your collar bone, you must seek medical attention immediately. Contact your doctor or head to your local emergency department right away. Failure to do so may result in significant loss of function in your arm and shoulder.
Diagnosis of a Clavicle Fracture
Diagnosis of a severe clavicle fracture can often be made simply by inspecting the clavicle. A noticeable deformity will be present along the shaft of your collar bone, and touching this deformity will be quite painful. A simple x-ray will most likely be taken to confirm the diagnosis and to determine the extent of the injury. The x-ray can also determine the exact location of the fracture in your clavicle.
Initial Treatment of a Clavicle Fracture
Initial treatment for a broken collar bone is to reduce the fracture by putting the pieces of bone together so that healing can occur. For severe fractures, a surgical procedure called an open reduction internal fixation (ORIF) may be necessary. During this procedure, your surgeon will reposition the bones and hold them in place with plates, screws, or wires.
You may be required to wear a sling to help immobilize your arm while the fracture is healing. Physical therapy may be necessary at this time to help you learn how to put on and wear your sling properly. Immobilization of your arm and shoulder is important to safely allow healing to take place. Be sure to speak with your doctor so you understand what is expected during this time.
What to Expect from Physical Therapy
After some healing has taken place, usually 3-4 weeks after injury, your doctor may refer you to physical therapy. Your physical therapy will most likely begin with an initial evaluation. During this evaluation, your physical therapist will take a detailed history of your injury. He or she may also take measurements to get baseline data and to help guide treatment.
Impairments that your physical therapist may assess and treat include:
Pain. After a clavicle fracture, you will probably experience pain in your collar bone or shoulder that may last for two to four weeks or longer. Your physical therapist may use various treatments or modalities to help control your pain. These may include heat, ice, or TENS (a form of electrical stimulation). Be sure to ask your physical therapist what you should expect from each treatment.
Range of motion. Range of motion (ROM) may be limited in your shoulder after the immobilization period if you suffer a clavicle fracture. Your physical therapist can prescribe exercises to help improve the ROM of your shoulder to ensure that you are able to perform tasks like reaching overhead or out to the side.
Your physical therapist may also help improve the ROM around your shoulder joint by performing joint mobilizations. These are specific techniques to help improve the mobility around a particular joint. Your physical therapist may also teach you self-mobilization techniques that you can perform at home.
Strength. After a clavicle fracture, the muscles around your shoulder may become weak. This is due to immobilization and disuse that occurs as the fracture is healing. Strengthening exercises for your shoulder and arm may be prescribed to help improve the function of your arm. Wolff's law states that bone grows and remodels in response to the stress that is placed upon it, so progressive exercise is important after fracture to ensure that maximum healing takes place.
Scar tissue mobility. If you had surgery to reduce your fractured collar bone, a surgical scar will be present over the fracture site. Your physical therapist may perform scar mobilization and massage techniques to help improve the mobility of your surgical scar. You may also be instructed in self-massage to perform on your own to improve the mobility of your surgical scar tissue.
The overall goals of physical therapy after a clavicle fracture are to decrease pain and improve functional mobility in your shoulder and arm. Normal mobility and strength should be achieved six to eight weeks after injury. Be sure to work closely with your doctor and physical therapist to understand what is expected of you and to safely and quickly return to normal function.
Safran, M., Stone, D., & Zachazewski, J. (2003). Instructions for sports medicine patients. Philadelphia: Saunders.