For individuals with a broken collarbone, can conservative treatment help in the rehabilitation process?

Broken Collarbone

Broken collarbones are very common orthopedic injuries that can occur in any age group. Also known as the clavicle, it is the bone over the top of the chest, between the breastbone/sternum and the shoulder blade/scapula. The clavicle can be easily seen because only skin covers a large part of the bone. Clavicle fractures are extremely common, and account for 2% – 5% of all fractures. (Radiopaedia. 2023) Broken collarbones occur in:

• Babies – usually during birth.
• Children and adolescents – because the clavicle does not fully develop until the late teens.
• Athletes – because of the risks of being hit or falling.
• Through various types of accidents and falls.
• The majority of broken collarbones can be treated with nonsurgical treatments, usually, with a sling to let the bone heal and physical therapy and rehabilitation.
• Sometimes, when clavicle fractures are significantly shifted out of alignment, surgical treatment may be recommended.
• There are treatment options that should be discussed with an orthopedic surgeon, physical therapist, and/or a chiropractor.
• A broken collarbone is not more serious than other broken bones.
• Once the broken bone heals, most individuals have a full range of motion and can return to the activities before the fracture. (Johns Hopkins Medicine. 2023)

Types

Broken clavicle injuries are separated into three types depending on the location of the fracture. (Radiopaedia. 2023)

Mid-Shaft Clavicle Fractures

• These occur in the central area which can be a simple crack, separation, and/or fractured into many pieces.
• Multiple breaks – segmental fractures.
• Significant displacement – separation.
• Shortened length of the bone.

Distal Clavicle Fractures

• These happen close to the end of the collarbone at the shoulder joint.
• This part of the shoulder is called the acromioclavicular/AC joint.
• Distal clavicle fractures can have similar treatment options as an AC joint injury.

Medial Clavicle Fractures

• These are less common and often related to injury to the sternoclavicular joint.
• The sternoclavicular joint supports the shoulder and is the only joint that connects the arm to the body.
• Growth plate fractures of the clavicle can be seen into the late teens and early 20s.

Symptoms

Common symptoms of a broken collarbone include: (National Library of Medicine: MedlinePlus. 2022)

• Pain over the collarbone.
• Shoulder pain.
• Difficulty moving the arm.
• Difficulty raising the arm from the side.
• Swelling and bruising around the shoulder.
• The bruising can extend down to the chest and armpit.
• Numbness and tingling down the arm.
• Deformity of the collarbone.

1. In addition to swelling, some individuals may have a bump in the place where the fracture occurred.
2. It can take several months for this bump to fully heal, but this is normal.
3. If the bump appears inflamed or irritated, inform a healthcare provider.

Clavicular Swelling

• When the sternoclavicular joint swells up or gets bigger, it is referred to as clavicular swelling.
• It is commonly caused by trauma, disease, or an infection that affects the fluid found in the joints. (John Edwin, et al., 2018)

Diagnosis

• At the healthcare clinic or emergency room, an X-ray will be obtained to assess for the specific type of fracture.
• They will perform an examination to ensure the nerves and blood vessels surrounding the broken collarbone are unsevered.
• The nerves and vessels are rarely injured, but in severe cases, these injuries can occur.

Treatment

Treatment is accomplished either by allowing the bone to heal or by surgical procedures to restore the proper alignment. Some common treatments for broken bones are not used for clavicle fractures.

• For example, casting a broken collarbone is not done.
• In addition, resetting the bone or a closed reduction is not done because there is no way to hold the broken bone in proper alignment without surgery.

If surgery is an option the healthcare provider looks at the following factors: (UpToDate. 2023)

Location of Fracture and Degree of Displacement

• Nondisplaced or minimally displaced fractures are usually managed without surgery.

Age

• Younger individuals have an increased ability to recover from fractures without surgery.

Shortening of the Fracture Fragment

• Displaced fractures can heal, but when there is a pronounced shortening of the collarbone, surgery is probably necessary.

Other Injuries

• Individuals with head injuries or multiple fractures can be treated without surgery.

Patient Expectations

• When the injury involves an athlete, heavy job occupation, or the arm is the dominant extremity, there can be more reason for surgery.

Dominant Arm

• When fractures occur in the dominant arm, the effects are more likely to be noticeable.

The majority of these fractures can be managed without surgery, but there are situations where surgery can produce better results.

Supports for Non-surgical Treatment

• A sling or figure-8 clavicle brace.
• The figure-8 brace has not been shown to affect fracture alignment, and many individuals generally find a sling more comfortable. (UpToDate. 2023)

1. Broken collarbones should heal within 6–12 weeks in adults
2. 3–6 weeks in children
3. Younger patients are usually back to full activities before 12 weeks.
4. The pain usually subsides within a few weeks. (UpToDate. 2023)
5. Immobilization is rarely needed beyond a few weeks, and with a doctor’s clearance light activity and gentle motion rehabilitation usually begins.

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Long-Lasting Injuries

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References

Radiopaedia. Clavicular fracture.

Johns Hopkins Medicine. Clavicle fractures.

National Library of Medicine: MedlinePlus. Broken collarbone – aftercare.

UpToDate. Clavicle fractures.

Edwin, J., Ahmed, S., Verma, S., Tytherleigh-Strong, G., Karuppaiah, K., & Sinha, J. (2018). Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT open reviews, 3(8), 471–484. doi.org/10.1302/2058-5241.3.170078