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Clavicle Fracture

claviclefractures

A clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. This type of fracture is fairly common—accounting for about 5 percent of all adult fractures. Most clavicle fractures occur when a fall onto the shoulder or an outstretched arm puts enough pressure on the bone that it snaps or breaks. A broken collarbone can be very painful and can make it hard to move your arm.

Most clavicle fractures can be treated by wearing a sling to keep the arm and shoulder from moving while the bone heals. With some clavicle fractures, however, the pieces of bone move far out of place when the injury occurs. For these more complicated fractures, surgery may be needed to realign the collarbone.

Anatomy

The clavicle is located between the ribcage (sternum) and the shoulder blade (scapula). It is the bone that connects the arm to the body.

The clavicle lies above several important nerves and blood vessels. However, these vital structures are rarely injured when a fracture occurs.

 

Shoulder anatomy

The clavicle is part of your shoulder and connects your arm to your ribcage.
Reproduced and adapted from JF Sarwak, ed: Essentials of Musculoskeletal Care, ed. 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010

description

Clavicle fracture

This illustration shows a clavicle fracture close to where the bone attaches to the scapula (shoulder blade).
Reproduced and adapted from Nuber GW, Bowen MK: Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg 1997; 5(1): 11-18.

 

Cause

Clavicle fractures are most often caused by a direct blow to the shoulder. This can happen during a fall onto the shoulder or a car collision. A fall onto an outstretched arm can also cause a clavicle fracture. In a baby, a clavicle fracture can occur during the passage through the birth canal.

Symptoms

A clavicle fracture can be very painful and may make it hard to move your arm. Other signs and symptoms of a fracture may include:

  • Sagging of the shoulder downward and forward
  • Inability to lift the arm because of pain
  • A grinding sensation when you try to raise the arm
  • A deformity or “bump” over the break
  • Bruising, swelling, and/or tenderness over the collarbone

Doctor Examination

Physical Examination

Your doctor will want to know how the injury occurred and will ask about your symptoms. He or she will then carefully examine your shoulder.

In a clavicle fracture, there is usually an obvious deformity, or “bump,” at the fracture site. Gentle pressure over the break will bring about pain. Although it is rare for a bone fragment to break through the skin, it may push the skin into a “tent” formation.

 
Tenting of skin over clavicle fracture

In a clavicle fracture, the broken ends of the bone may cause tenting of the skin over the fracture site.

Your doctor will also perform tests to ensure that no nerves or blood vessels were damaged when the fracture occurred.

Imaging Studies

X-rays. X-rays provide images of dense structures, such as bone. Your doctor will order an x-ray to help pinpoint the location of the fracture and to learn more about the severity of the break.

He or she may also order x-rays of your entire shoulder to check for additional injuries. If other bones are broken, your doctor may order a computerized tomography (CT) scan to see the fractures in better detail.

 
Displaced clavicle fracture

X-ray shows a fracture in the middle of the clavicle. Note how far out of place (displaced) the broken ends of the bone are.

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