The collarbone (clavicle) is part of the shoulder. It helps connect the arm to the body. It is a long bone, and most breaks occur in the middle section. Although it lies above several important nerves and blood vessels, these vital structures are rarely injured when the collarbone breaks.
Because the collarbone doesn’t completely harden until the age of about 20 years, a child’s collarbone can easily break from a direct blow or fall.
In athletes, the force of a fall can be transmitted from the elbow and shoulder to the collarbone, causing it to break.
Common symptoms are a sagging shoulder (that sits down and forward), inability to lift the arm because of pain, a grinding sensation when attempting to raise the arm and deformity or a “bump” over the fracture site.
The diagnosis is usually obvious on account of the deformity, or “bump,” at the fracture site. Gentle pressure over the fracture site will cause pain. Sometimes, a grinding feeling can be felt when the patient tries to raise the arm. Although a fragment of bone rarely breaks through the skin, it may push the skin into a “tent” formation.
Clinical examination will also assess for associated nerve or blood vessel damage. An X-ray will pinpoint the location and severity of the break.
Most broken collarbones heal well without surgery. A simple arm sling can immobilize the arm. A child may have to wear the sling for 3 to 4 weeks; an adult for 6 to 8 weeks. Depending on the location of fracture, a figure-of-eight strap may be needed to help maintain shoulder position.
Pain is managed with analgesics such as paracetamol or nonsteroidal anti-inflammatory medications (aspirin or ibuprofen).
A large bump will develop as part of the healing process. This usually disappears over time, although a small bump may remain. Shoulder function and range of movement generally returns to normal with time. Persistent limitation may be seen when fractures are widely displaced (the parts of the broken bones are widely separated).
Range of motion and strengthening exercises can begin as soon as the pain subsides. Sports activities should not be started until full shoulder strength returns.
Occasionally surgery is required to treat fractures that are widely displaced, or associated with a lot of deformity.