Clavicle Fracture (Shaft)

with Rehab

ExitCare ImageA mid-shaft clavicle fracture is a break (fracture) in the collarbone (clavicle) that occurs in the middle third of the bone. Mid-shaft clavicle fractures are the most common type of clavicle fracture.

SYMPTOMS

  • Pain, tenderness, and swelling over the fracture site.

  • 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, when attempting to use 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

Mid-shaft 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 sprain or dislocation.

  • Inadequate protective equipment.

  • History of bone or joint disease (osteoporosis).

PREVENTION

  • Maintain appropriate conditioning, especially neck, shoulder, and arm muscle strength, endurance, and flexibility.

  • Ensure proper fit of protective equipment (shoulder pads).

  • Use proper technique and have a coach correct improper technique (including falling and landing).

PROGNOSIS

If treated properly, mid-shaft clavicle fractures can be expected to heal. It is important to allow for the needed healing period, before returning to activities.

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 compression bandages, to reduce pain and inflammation. The shoulder should be restrained immediately. You should rest from activities for at least 6 weeks, to allow the bone to heal. Pain usually subsides within 2 to 4 weeks and goes away in 6 to 8 weeks.

Surgery is not often advised for mid-shaft clavicle fractures. Surgery is able to reduce any bump (deformity) that was caused by injury, but surgery will also leave a scar in the area. Often, surgery is reserved for only very serious cases, where the bone protrudes through the skin (open fracture). 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 a period of rest and healing, it is important to perform stretching and strengthening exercises, in order to regain strength and a full range of motion. These exercises may be performed at home or with a therapist. You may return to sports once you have regained your strength and range of motion, which usually takes 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 or hand.

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

  • You develop a fever of greater than 100.5° F (38.1° C).

  • You develop shortness of breath.

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

EXERCISES

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

These exercises may help you restore your elbow mobility once your physician has discontinued your restraint period. Beginning these 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.

ExitCare Image 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 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 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.

ExitCare Image 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 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 ExitCare Image

  • 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 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.

ExitCare Image 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.

ExitCare Image 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.

ExitCare Image 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.

ExitCare Image STRETCH – External Rotation

  • Tuck a folded towel or small ball under your right / left upper arm. Grasp a broomstick or cane with an underhand grasp, a little more than shoulder width apart. Bend your elbows to 90 degrees.

  • Stand with good posture or sit in a firm chair without arms.

  • Use your strong arm to push the stick across your body. Do not allow the towel or ball to fall. This will rotate your right / left arm away from your stomach. Using the stick, turn/rotate your hand and forearm away from your body. Hold for __________ seconds.

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

STRENGTHENING EXERCISES - Clavicle Fracture (Shaft)

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.

ExitCare Image 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.

ExitCare Image STRENGTH - Shoulder Flexion, Isometric

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

  • 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.

ExitCare Image 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 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 only from 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.

ExitCare Image 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 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 only from 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.