BROKEN COLLARBONE / CLAVICAL FRACTURE

CONDITION

The collarbone (clavicle) is an S-shaped bone on the front of your body that attaches your shoulder bones to your breastbone. When a collarbone is broken (fractured), it usually breaks in the middle (Figure 1), but fractures sometimes occur on either end. Some collarbone fractures require surgery but most will heal without it.

CAUSES

Most clavicle fractures are caused by one of three things:

falling on an outstretched hand where force is passed up through the arm to the collarbone
falling onto the outside of the shoulder where force is passed through the shoulder to the collarbone
direct impact or force to the clavicle.

Clavicle fractures can also happen to babies as they move through the birth canal during childbirth.

SYMPTOMS AND SIGNS

You will have pain over the broken bone.
If the fracture is in the middle of the collarbone (and most are), you will notice a lump or deformity sticking up where the bones are broken.
If the fracture is on the shoulder end of your collarbone, you will usually not notice a lump but you will have swelling over the front of your shoulder and it will hurt to reach across your body.
If the fracture is near the chest end of your collarbone, you will have pain where your collarbone joins with your breastbone. There will sometimes be a lump or depression at the joint, depending on whether the end of collarbone is pushed out or in, and it will hurt to move your arm or shoulder.
If the breastbone end of the collarbone is pushed too far backward (dislocated), it can injure your airway (the tube that goes from your mouth to your lungs), major arteries and/or veins (blood vessels that carry blood to and from your heart to your body) and nerves (the body’s “electric wires” that control body processes and movements). These injuries can be life-threatening and may cause the following symptoms:
- If your airway is compressed, you may feel short of breath, have throat tightness or make wheezing sounds.
- If you have a blood vessel injury, your arm may be pale or grey, you may have decreased or absent pulse in the arm on the side of the fracture or swelling in that arm.
- If you have a nerve injury, your voice may be hoarse and you may have problems swallowing or feel like you are choking.
You will have pain when you try to move your shoulder or lift your arm because this moves the fractured collarbone.
You will notice swelling over the fracture and may have some bruising in the area.
You may find it most comfortable to hold your arm across your chest to minimize movement of the broken collarbone.

WHEN TO CALL YOUR DOCTOR

Call 911 RIGHT AWAY

You are short of breath, have throat tightness or make wheezing sounds.
The arm on the side of the fracture is pale or grey or swollen.
The pulse in the arm on the side of the fracture is decreased or absent.
Your voice is hoarse and you have problems swallowing or a sense of choking.

Call your doctor right now (night or day) if:

You have severe pain and it is hard to move your arm or shoulder.
You have a lot of swelling or a bump or deformity over your collarbone, especially when compared to the normal collarbone on your other side.
You have a lot of bruising around your collarbone
You have any numbness or tingling in your shoulder or arm, because this could be symptom of nerve injury.
You have additional injuries such as neck pain or other shoulder pain.
Your pain started immediately after a fall on your arm or on the shoulder of the injured side or if you took a direct hit over your collarbone.

Call your doctor during regular office hours if:

If you have only mild to moderate collarbone pain without:
- swelling
- a bump or deformity when compared to the other side of your collarbone
- a lot of bruising
- pain when you move your arm or shoulder
- numbness or tingling in your shoulder or arm.

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HOME CARE ADVICE FOR BROKEN COLLARBONE (CLAVICAL FRACTURE)

See your doctor for all suspected collarbone fractures, but until you can get in:

You may take acetaminophen (Tylenol®) to reduce your pain. (see the label for dosing and risks). You may want to avoid taking anti-inflammatory medicines such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) unless you have an okay from your doctor because they can cause more bleeding and can sometimes slow bone healing.
You may place your arm in a sling to decrease pain. Arm slings are often available at local drug stores. You can make a homemade sling by wrapping a sheet or large handkerchief around the arm and your neck and then tying the ends together behind your neck (Figure 2). Trim off any excess material with scissors. Your elbow should be bent at a right angle in the sling.
An ice pack or cold pack placed gently over your injured collarbone can help decrease pain and swelling. You may apply cold once hourly for 20 minutes at a time until you see your doctor. Place a thin washcloth between the cold pack and your skin to minimize the risk of frostbite.
Avoid trying to use your shoulder or lift your arm because this can cause the fracture to move and result in a lot of pain.

FOR MORE INFORMATION

REFERENCES

Denard P, Koval K, Weinstein J: Management of midshaft clavicle fractures in adults. American Journal of Orthpaedics 34(11):527-36, 2006.
Eiff P, Hatch R, Calmbach W: Finger fractures. In: Fracture Management for Primary Care, 2nd edition, Saunders, Philadelphia, 2002.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.