Clavicle Fracture
1. Introduction
The clavicle (collarbone) is a bone that connects the sternum (top of the ribcage) to the acromion (tip of shoulder blade). The clavicle provides the only bone-to-bone connection of the shoulder to the body. Therefore, it is important in shoulder stability and helps to provide the large range of motion the arm requires (1).
Clavicular fractures are relatively common and account for approximately 4% of all fractures in adults (5). There are different parts of your clavicle you can fracture, which include; the mid shaft (middle of bone), proximal (close to chest) and distal (close to shoulder). Mid shaft fractures are the most common, followed by distal and then lastly proximal (2,3).
Clavicle fractures most commonly happen due to a direct fall onto the shoulder or a direct blow to the shoulder. It can also occur from a fall onto an outstretched hand. There are different types of fracture that can occur. Non-displaced (break in the bone with no loss of bone position), displaced (break in the bone which causes the two ends of bone to not line up) and comminated (break or splinter of the bone into two or more parts). Also, fractures can be either ‘open’, breaking through the skin due to fragment of the bone pushing through, or ‘closed’ which means it hasn’t broken through the skin (2).
Treatment is either conservative or surgical depending on various factors. These include the location and type of the fracture, whether it is ‘open’ or ‘closed’, the age of the person and if there is any nerve and blood vessel damage (2).
Frequently Asked Questions
- A clavicle fracture is a break in the collarbone, one of the bones that helps co-ordinate shoulder movement.
- They make up 44-66% of all shoulder fractures (2,7).
- They are 2-3 times more likely to occur in children than in adults (1,7).
- Clavicle (collarbone) fractures are a very common type of fracture that are characterised by a complete or partial break usually in the middle third of the bone (2,3).
- Moderately as the collarbone is a key part of shoulder stability.
- Most fractures will heal with no complications and bones will correctly fuse together (2).
- Open fractures (where the bone exits the skin) require immediate surgery to reduce the chance of infection (2).
- Rare possible complications such as pneumothorax (punctured lung), brachial plexus (nerves supplying your arm) or blood vessel injury must be fully evaluated by medical staff (2).
- Most common in direct falls on outs stretched hand, cycling road traffic accidents and contact sport such as rugby (4, 5).
- Individuals younger than 50 years (1,5).
- Most common in males – 68% of cases are male (2,5).
- Sharp pain in collarbone region.
- Swelling or tenderness around the injured area.
- Bruising to the skin.
- Reduced shoulder movement.
- Bleeding if the bone has damaged the tissue and skin (this is rare).
- Numbness or pins and needles if nerves in the arm are injured (again rare).
- If you have sustained trauma and suspect you may have fractured your collarbone you should visit your local minor injuries unit or A&E.
- The time needed to return to work or sport varies depending upon patient age, fracture location and severity (5,7).
- Most patients return to pre-injury levels within 6-8 weeks (8), although this can be longer after surgery.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
A fractured clavicle can be quite painful. There may also be (2):
- swelling or tenderness around the injured area
- bruising to the skin
- an obvious deformity
- bleeding if the bone has damaged the tissue and skin (this is rare)
- numbness or pins and needles if nerves or blood vessels in the arm are injured
3. Causes
Common causes of clavicle fracture include:
- Falls onto the shoulder (4)
- Sports in which direct falls or direct impact can occur to the shoulder such as cycling or rugby (5,6)
- Road traffic accident involving either, car, motorcycle or bicycle (5)
- As a birth injury, when the newborn passes through the birth canal (6)
- Reduced bone density (Osteoporotic) fractures due to impact (1, 5)
4. Risk Factors
The following groups are at higher risk of clavicle fracture:
- Teenagers – This is due to the bone not completely hardening until the age of 20 (1).
- More common in males (68%) than females (5,7).
- Cyclists – due to increased risk of direct trauma (8) .
- Sports – involving the risk of falling onto hard surfaces or risk of direct blows to the shoulder (4, 8).
- Osteoporosis – the risk of fracture increase for people with this condition due to reduced bone density (1).
5. Prevalence
Clavicle fractures make up 4% of adult and 10-15% of childhood fracture. They make up 44-66% of all shoulder fractures (1, 7).
Of all types of clavicle fractures, the most frequently seen are mid shaft. A 2017 study found that 69-82% occur in the mid shaft, followed by distal (12-26%) and 1-4% happen in the proximal clavicle (5).
Up to 55% of clavicle fractures are not displaced (the bones remain lined up), 48% are displaced (break where the bones do not line up) and approximately 18% are comminuted (break where the bone is in many parts) (7).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified health care professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures.
If you have injured your clavicle, go straight to your GP surgery and if they suspect a fracture, they will refer you for an x ray to confirm the fracture. If this is not possible, go to your nearest minor injuries clinic, walk in centre or ring 111 for urgent medical advice.
If the fracture is severe and the pain is unbearable, or there is a break to the skin, go directly to accident and emergency or call emergency services.
7. Self-Management
As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your clavicle fracture. This will include activity modification strategies as well as other useful treatments aimed at reducing discomfort. Regular adherence to a condition specific rehabilitation program is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix but if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.
8. Rehabilitation
For un-displaced fractures, management usually involves sling immobilisation and subsequent rehabilitation, involving exercises prescribed by a musculoskeletal physiotherapist (4, 5). For displaced fractures (break causing bone to not line up), up to 10% will not fuse correctly. Therefore surgery (using metal plates or screws) may be indicated, especially in the sporting population (2,4). Subsequent rehabilitation is similar in both cases. However, in the surgical group a further operation may be required to remove metal fixation (5, 8).
Below are three rehabilitation programs created by our specialist physiotherapists targeted at addressing this condition. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programs provide an excellent starting point as well as clearly highlighting exercise progression.
9. Clavicle Fracture
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
Aim to perform this programme a minimum of once per day unless prescribed otherwise. As with any new exercise, start slowly (repetitions as able) and build up as you are able within the guidelines below.
Pain should not exceed 4/10 whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
Aim to perform this programme a minimum of once per day unless prescribed otherwise. As with any new exercise, start slowly (repetitions as able) and build up as you are able within the guidelines below.
Pain should not exceed 3/10 whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
Aim to perform this programme a minimum of once per day unless prescribed otherwise. As with any new exercise, start slowly (repetitions as able) and build up as you are able within the guidelines below.
Pain should not exceed 4/10 whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
The time needed to return to work, or sport varies depending upon patient age, fracture location and severity. Most patients return to pre-injury levels within 6-8 weeks (9). For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage (10)
As part of a multi-modal treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
Depending on the severity of the injury and the involvement of the soft tissue, clavicle fractures can require surgery. Individualised treatment following assessment from a specialist is recommended to ensure the best care (9).
12. Links for Further Reading
References
- Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ 3rd. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res. 2014;29:581-589.
- Bentley TP, Hosseinzadeh S. Clavicle Fractures. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507892/
- Hoff, W. S., Bonadies, J. A., Cachecho, R., & Dorlac, W. C. (2011). East Practice Management Guidelines Work Group: Update to Practice Management Guidelines for Prophylactic Antibiotic Use in Open Fractures. The Journal of TRAUMA® Injury, Infection, and Critical Care, 70(3), 751.
- Housner, J. A., Kuhn, J. E., Harmon, K. G., & Rubin, A. (2003). Clavicle fractures: individualizing treatment for fracture type. The Physician and sportsmedicine, 31(12), 30-36.
- Kihlström, C., Möller, M., Lönn, K., & Wolf, O. (2017). Clavicle fractures: epidemiology, classification and treatment of 2 422 fractures in the Swedish Fracture Register; an observational study. BMC musculoskeletal disorders, 18(1), 82.
- Nishimi, A. Y., Belangero, P. S., Mesquita, R. S., Andreoli, C. V., Pochini, A. C., & Ejnisman, B. (2016). FREQUENCY AND RISK FACTORS OF CLAVICLE FRACTURES IN PROFESSIONAL CYCLISTS. Acta ortopedica brasileira, 24(5), 240–242. https://doi.org/10.1590/1413-785220162405157391
- Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg. 2002 Sep-Oct;11(5):452-6. doi: 10.1067/mse.2002.126613. PMID: 1237816
- Robertson, G. A. J., & Wood, A. M. (2016). Return to sport following clavicle fractures: a systematic review. British medical bulletin, 119(1).
- Von Rüden C, Rehme-Röhrl J, Augat P, Friederichs J, Hackl S, Stuby F, et al. Evidence on treatment of clavicle fractures. Injury 2023 -05-12;54.
Other Conditions in
Shoulders, Orthopaedics
Whiplash Disorders
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Thoracic Outlet Syndrome
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
Shoulder Osteoarthritis (OA)
Age and activity related changes to the joints of the shoulder which can lead to pain and stiffness.
Shoulder Impingement
Shoulder impingement is an umbrella term used to describe a variety of conditions that can cause pain in the shoulder.
Shoulder Dislocation
An injury in which your upper arm bone ‘pops out’ of the cup-shaped socket of your shoulder blade.
Rotator Cuff Tendinopathy
Pain and weakness affecting the shoulder and limiting function.
Frozen Shoulder
An insidious (no clear cause), painful/stiff condition of the shoulder persisting for more than 3 months.
Calcific Tendinopathy
A rare condition causing pain and loss of free movement in tendons and joints.
Biceps Tendinopathy
A tendon-related issue affecting the long bicep tenon at the front of the shoulder.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Acute Torticollis
Sometimes referred to as “wry neck”, this is a condition causing muscle spasms and associated neck pain.
Acromioclavicular Joint Injury
Injury to a small joint at the end of the collar bone (clavicle)/top of your shoulder.