What is Clavical Fracture?
The clavicle (collarbone) is found on the front of the shoulder and connects the arm to the body by a joint at the sternum, or breast bone (the sterno-clavicular joint), and by a joint at the scapula, or shoulder blade (the acromio-clavicular joint). The clavicle helps stabilize the shoulder during movement, and helps to protect nerves and blood vessels underneath the shoulder.
Clavicle fractures are classified according to the place where the bone is broken. The 3 classifications are:
Midshaft (middle of the bone)
75% to 80% of all clavicle fractures
Usually occurs in younger persons
Lateral-end (near the acromio-clavicular joint)
15% to 25% of all clavicle fractures
Medial-end (near the sterno-clavicular joint)
Rare; 5% of all clavicle fractures
Fractures are classified as:
Nondisplaced. The pieces of the fractured bone remain lined up.
Displaced. The 2 parts of the fractured bone do not line up.
Comminuted. Splinters or multiple small pieces of bone are found at the fracture site. Sometimes the fracture fragments can pierce the skin, causing a compound fracture.
How Does it Feel?
If you break your clavicle (collarbone), you will experience pain in the area of the break. You may see purple bruising in the area that may spread to the shoulder and arm. Swelling will occur at the injury site, and in the arm. You may see a bump in the area of the break from the bone lifting the skin, like a tent. It is common to feel movement of the bone as it shifts. It will feel tender to touch, and most people with this injury will not be able to lift their arm. They will hold their arm close in to the body, and support the arm with the other hand.
Signs and Symptoms
Pain is usually felt in the area of the clavicle. Arm pain or changes in sensation may occur in more severe cases.
Inability to lift the arm.
Grinding sensation with movement.
A bump at the injured area.
How Can a Physical Therapist Help?
Most clavicle fractures are treated without surgery. The involved arm will be placed in a sling or a figure-8 brace to secure it and support its weight for comfort. Physical therapy usually begins early to help reduce pain and swelling. When you can tolerate movement of the arm, your physical therapist will prescribe gentle exercises of the involved shoulder and elbow to prevent stiffness, and to help you begin to recover full movement.
As healing progresses, pain and swelling gradually resolve. When your physician sees adequate healing your physician will ask your physical therapist to help guide you towards reducing the use of your brace. Also under the guidance of your physical therapist, your exercises will be gradually progressed to a more active level to prevent weakness and stiffness, and regain full movement.
After 6 to 8 weeks, or when the bone shows adequate healing, more strenuous strengthening exercises will begin. Your physical therapist will design a return-to-activity training program for you, specific to your activities of daily living, work, and sport.
Healing times vary among individuals due to differences in age, health, and the complexity of the injury. Most patients return to nonstrenuous daily activity after about 6 weeks, and strenuous job duties after 9 to 12 weeks.
Physical therapy rehabilitation after surgery is similar to that provided for nonsurgical cases, but progression of the program will follow a strict schedule set by the surgeon. Physical therapy typically begins immediately following the operation, and continues for 8 to 12 weeks.
The first week after surgery, your physical therapist will help you control pain and swelling, and may begin some gentle motion exercises. You will be wearing a sling or brace for support and comfort. Over the next few weeks, your physical therapist will help you gradually increase your exercise program.
After 4 weeks, if x-rays show good position and stability, your physical therapist will guide you to achieve a full range of motion of your shoulder. At 6 to 8 weeks, if x-rays show adequate healing, treatment will progress to include strengthening and resistance exercises.
These time frames will vary among individuals based on differences in age, health, the complexity of the injury, and the surgical procedure.
How Can a Physical Therapist Help Before & After Surgery?
Not all clavicle fractures can be prevented. However, you can reduce your risk of injury by wearing appropriate protective gear when participating in sports, such as shoulder pads for football. You can also reduce your risk by avoiding falls. To reduce your fall risk, it is important to maintain strength and fitness throughout your life
Real Life Experiences
David is a 16-year-old high-school football star. During a recent game, he was hit from the side and fell hard onto his left shoulder. He heard a crack, and felt sudden and severe pain at the top of his chest by his left shoulder. The team sports physical therapist noted a tent-like deformity in the clavicle area, with swelling. The area was very tender to touch. He suspected a clavicle fracture. He immobilized David’s arm with a sling and applied ice to the painful area.
David was immediately sent to the local hospital’s emergency department for further diagnosis. X-rays confirmed a nondisplaced, midshaft clavicle fracture. David was further assessed for possible nerve and vascular (blood vessel) injury. These tests were found to be negative. Fortunately, David’s injury did not require surgery; his arm was placed in a sling, and he was sent home to rest.
For the first 3 weeks after the injury, David was instructed to keep his arm in the sling and to not move his shoulder. He worked with his physical therapist to control any pain and swelling. The physical therapist taught him some active movements of the elbow, wrist, and hand to prevent stiffness, and isometric exercises (mild resistance of a muscle without movement of any joints) to preserve muscle tone in his shoulder.
After 3 weeks, David’s pain levels were greatly improved and a new x-ray showed the bone was beginning to heal. His physical therapist could now progress his program by adding some mild passive movement (no active or resisted movements) of the injured left shoulder. The physical therapist helped David increase his range of movement of the shoulder, and was careful not to make the pain worse, or force movement too far. David was also allowed to remove his sling for short times throughout the day.
At 6 weeks, another x-ray showed that David’s clavicle had healed enough that he no longer needed the sling. His physical therapist taught him active movement, progressing to resisted exercise, which did not increase his pain or swelling. He also designed an individual home-exercise program that David performed daily. The home-exercise program allowed David to achieve a full range of motion of his left shoulder.
After 9 weeks, David’s fracture was completely healed. He continued to work with his physical therapist on strengthening and conditioning exercises, to prepare him for a return to his normal sports activities. After 11 weeks, he returned to the playing field, and scored a winning touchdown!