Clavicle Fracture (Distal End)

with Rehab

Distal clavicle fractures are breaks in the collarbone(clavicle) that occur in the outer third portion of the bone, near the joint between the collarbone and one of the shoulder bones (acromion). These breaks(fractures) may be complete or incomplete. If the fracture extends into the joint at the top of the shoulder, it may also cause damage to the ligaments there (acromioclavicular and cora-coclavicular). These two ligaments are responsible for attaching the collarbone to the shoulder bone.

SYMPTOMS

  • Pain, tenderness, and swelling on top of the shoulder.

  • Visible deformity or bump over the fracture site, if the fracture is complete and the bone fragments separate enough to distort the appearance of the top of the shoulder.

  • Bruising (contusion) at the site of injury (usually within 48 hours).

  • Loss of strength or pain, with use of the affected arm.

  • Sometimes, numbness or coldness in the shoulder and arm on the affected side, if the blood supply is impaired.

  • Uncommonly, shortness of breath or difficulty breathing.

CAUSES

Distal clavicle fractures are usually caused by direct hit (trauma) to the area of injury. The injury may also occur from indirect trauma, such as falling on an outstretched hand (uncommon).

RISK INCREASES WITH:

  • Sports that require contact or collision (football, soccer, hockey, rugby).

  • Sports with high risk of falling on the shoulder (rodeo riding, mountain bike riding, cycling).

  • Previous shoulder injury.

  • Improperly fitted or padded protective equipment.

  • History of bone or joint disease (osteoporosis, bone tumors).

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

  • Learn and use proper technique, and have a coach correct improper technique (including falling).

PROGNOSIS

If treated properly, distal clavicle fractures usually can be expected to heal. However, surgery may be needed.

RELATED COMPLICATIONS

  • Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, or other tissues.

  • Weakness and fatigue of the arm or shoulder (uncommon).

  • Fracture fails to heal (nonunion).

  • Fracture heals in improper position (malunion).

  • Arthritis, pain, and inflammation of the acromioclavicular (AC) joint.

  • Longer healing time and vulnerable to recurring injury, if usual activities are resumed too soon.

  • Excessive scar tissue at the fracture site, including excessive bone formation, causing pressure on nerves and blood vessels in the neck or arm pit. This may lead to pain, numbness, and tingling in the neck, shoulder, arms, and hands.

  • Infection, if the bone breaks through the skin (open fracture), or at the incision if surgery is performed.

  • Persistent bump (prominence) at the fracture site.

  • Vulnerable to repeated collarbone injury.

TREATMENT

Treatment first involves the use of ice, medicine, and compressive bandages, to reduce pain and inflammation. The shoulder should be immediately restrained. It is important to have an orthopedic specialist look at the fracture, to determine if surgery is needed to realign the bones, if the fracture is out of alignment. Surgery involves repositioning the bones and fixing them in place with screws, pins, and plates. It may be necessary to remove the hardware, after the fracture heals. After the fracture heals, it is important to complete stretching and strengthening exercises, in order to regain strength and a full range of motion, before you are able to return to sports. These exercises may be completed at home or with a therapist. If surgery is required, return to sports can be expected in 2 to 6 months.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

COLD THERAPY

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, swelling, or bruising gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the arm.

  • Blue, gray, or dark color appears in the hand or fingernails.

  • You have increased pain, swelling, or drainage of fluids in the affected area.

  • You experience signs of infection: increased pain, swelling, drainage of fluids, fever, or a general ill feeling.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Clavicle Fracture (Distal End)

These exercises may help you restore your elbow mobility once your physician has discontinued your restraint period. Beginning exercises before your caregiver's approval may result in delayed healing. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds. A stretch should never be painful. You should only feel a gentle lengthening or release in the stretch.

ROM - Pendulum

  • Bend at the waist, so that your right / left arm falls away from your body. Support yourself with your opposite hand on a solid surface, such as a table or a countertop.

  • Your right / left arm should be perpendicular to the ground. If it is not perpendicular, you need to lean over farther. Relax the muscles in your right / left arm and shoulder as much as possible.

  • Gently sway your hips and trunk, so they move your right / left arm without any use of your right / left shoulder muscles.

  • Progress your movements so that your right / left arm moves side to side, then forward and backward, and finally, both clockwise and counterclockwise.

  • Complete __________ repetitions in each direction. Many people use this exercise to relieve discomfort in their shoulder, as well as to gain range of motion.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Seated

  • Sit in a firm chair, so that your right / left forearm can rest on a table or countertop. Your right / left elbow should rest below the height of your shoulder, so that your shoulder feels supported and not tense or uncomfortable.

  • Keeping your right / left shoulder relaxed, lean forward at your waist, allowing your right / left hand to slide forward. Bend forward until you feel a moderate stretch in your shoulder, but before you feel an increase in your pain.

  • Hold for __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Abduction, Supine

  • Lie on your back. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold for __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane, so your hands are about shoulder width apart. Your right / left hand should grip the end of the stick, so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your right / left arm overhead, until you feel a gentle stretch in your shoulder. Hold for __________ seconds.

  • Use the stick to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Standing

  • Stand facing a wall. Walk your right / left fingers up the wall, until you feel a moderate stretch in your shoulder. As your hand gets higher, you may need to step closer to the wall or use a door frame to walk through.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Use your other hand, if needed, to ease out of the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Clavicle Fracture (Distal End)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTH - Shoulder Abductors, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall, with your right / left side facing the wall.

  • Bend your right / left elbow. Gently press your right / left elbow into the wall. Increase the pressure gradually until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Flexion, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall.

  • Keeping your right / left elbow straight, gently press the top of your fist into the wall. Increase the pressure gradually until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold for __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - External Rotators

  • Secure a rubber exercise band or tubing to a fixed object (table, pole), so that it is at the same height as your right / left elbow, when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is at your healthy side.

  • Bend your right / left elbow 90 degrees. Place a folded towel or small pillow under your right / left arm, so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it away from your body, as if pivoting on your elbow. Be sure to keep your body steady, so that the movement is coming from only your rotating shoulder.

  • Hold for __________ seconds. Release the tension in a controlled manner, as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Internal Rotators

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the same height as your right / left elbow, when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is at your right / left side.

  • Bend your right / left elbow 90 degrees. Place a folded towel or small pillow under your right / left arm, so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it across your body toward your stomach. Be sure to keep your body steady, so that the movement is coming from only your rotating shoulder.

  • Hold for __________ seconds. Release the tension in a controlled manner, as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.