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    Move Forward Guide

    Physical Therapist's Guide to Clavicle Fracture

    The clavicle, or collarbone, connects the arm to the body, helping to stabilize the shoulder and arm as they move. Clavicle fracture is a common shoulder injury, making up 4% of all fracture types and 35% of all shoulder injuries. The injury is most often caused by trauma, such as a direct blow to the shoulder or a fall, and is most often diagnosed in people under the age of 20. It is seen most often in young men, as a result of sports injuries. As people age, it is more likely to occur with a fall. It also becomes more common for women to fracture their collarbones with age, and less likely for men.

    Most clavicle fractures are treated without surgery, but more complex fractures may require surgery. In either case, a physical therapist can help promote healing and a safe return to normal activity by providing pain management, guided exercise, and functional training.


     

    What is Clavical Fracture?

    The clavicle (collarbone) is found on the front of the shoulder and connects the arm to the body by a joint at the sternum, or breast bone (the sterno-clavicular joint), and by a joint at the scapula, or shoulder blade (the acromio-clavicular joint). The clavicle helps stabilize the shoulder during movement, and helps to protect nerves and blood vessels underneath the shoulder.

    Clavicle fractures are classified according to the place where the bone is broken. The 3 classifications are:

    Midshaft (middle of the bone)

    • 75% to 80% of all clavicle fractures
    • Usually occurs in younger persons

    Lateral-end (near the acromio-clavicular joint)

    • 15% to 25% of all clavicle fractures

    Medial-end (near the sterno-clavicular joint)

    • Rare; 5% of all clavicle fractures

    Fractures are classified as:

    • Nondisplaced. The pieces of the fractured bone remain lined up.
    • Displaced. The 2 parts of the fractured bone do not line up.
    • Comminuted. Splinters or multiple small pieces of bone are found at the fracture site. Sometimes the fracture fragments can pierce the skin, causing a compound fracture.
     

    How Does it Feel?

    If you break your clavicle (collarbone), you will experience pain in the area of the break. You may see purple bruising in the area that may spread to the shoulder and arm. Swelling will occur at the injury site, and in the arm. You may see a bump in the area of the break from the bone lifting the skin, like a tent. It is common to feel movement of the bone as it shifts. It will feel tender to touch, and most people with this injury will not be able to lift their arm. They will hold their arm close in to the body, and support the arm with the other hand.

     

    Signs and Symptoms

    • Pain is usually felt in the area of the clavicle. Arm pain or changes in sensation may occur in more severe cases.
    • Bruising.
    • Swelling.
    • Inability to lift the arm.
    • Grinding sensation with movement.
    • A bump at the injured area.
     

    How Can a Physical Therapist Help?

    Most clavicle fractures are treated without surgery. The involved arm will be placed in a sling or a figure-8 brace to secure it and support its weight for comfort. Physical therapy usually begins early to help reduce pain and swelling. When you can tolerate movement of the arm, your physical therapist will prescribe gentle exercises of the involved shoulder and elbow to prevent stiffness, and to help you begin to recover full movement.

    As healing progresses, pain and swelling gradually resolve. When your physician sees adequate healing your physician will ask your physical therapist to help guide you towards reducing the use of your brace. Also under the guidance of your physical therapist, your exercises will be gradually progressed to a more active level to prevent weakness and stiffness, and regain full movement.

    After 6 to 8 weeks, or when the bone shows adequate healing, more strenuous strengthening exercises will begin. Your physical therapist will design a return-to-activity training program for you, specific to your activities of daily living, work, and sport.

    Healing times vary among individuals due to differences in age, health, and the complexity of the injury. Most patients return to nonstrenuous daily activity after about 6 weeks, and strenuous job duties after 9 to 12 weeks.

    Following Surgery

    Physical therapy rehabilitation after surgery is similar to that provided for nonsurgical cases, but progression of the program will follow a strict schedule set by the surgeon. Physical therapy typically begins immediately following the operation, and continues for 8 to 12 weeks.

    The first week after surgery, your physical therapist will help you control pain and swelling, and may begin some gentle motion exercises. You will be wearing a sling or brace for support and comfort. Over the next few weeks, your physical therapist will help you gradually increase your exercise program.

    After 4 weeks, if x-rays show good position and stability, your physical therapist will guide you to achieve a full range of motion of your shoulder. At 6 to 8 weeks, if x-rays show adequate healing, treatment will progress to include strengthening and resistance exercises.

    These time frames will vary among individuals based on differences in age, health, the complexity of the injury, and the surgical procedure.

     

    How Can a Physical Therapist Help Before & After Surgery?

    Not all clavicle fractures can be prevented. However, you can reduce your risk of injury by wearing appropriate protective gear when participating in sports, such as shoulder pads for football. You can also reduce your risk by avoiding falls. To reduce your fall risk, it is important to maintain strength and fitness throughout your life
     

    Real Life Experiences

    David is a 16-year-old high-school football star. During a recent game, he was hit from the side and fell hard onto his left shoulder. He heard a crack, and felt sudden and severe pain at the top of his chest by his left shoulder. The team sports physical therapist noted a tent-like deformity in the clavicle area, with swelling. The area was very tender to touch. He suspected a clavicle fracture. He immobilized David’s arm with a sling and applied ice to the painful area.

    David was immediately sent to the local hospital's emergency department for further diagnosis. X-rays confirmed a nondisplaced, midshaft clavicle fracture. David was further assessed for possible nerve and vascular (blood vessel) injury. These tests were found to be negative. Fortunately, David's injury did not require surgery; his arm was placed in a sling, and he was sent home to rest.

    For the first 3 weeks after the injury, David was instructed to keep his arm in the sling and to not move his shoulder. He worked with his physical therapist to control any pain and swelling. The physical therapist taught him some active movements of the elbow, wrist, and hand to prevent stiffness, and isometric exercises (mild resistance of a muscle without movement of any joints) to preserve muscle tone in his shoulder.

    After 3 weeks, David’s pain levels were greatly improved and a new x-ray showed the bone was beginning to heal. His physical therapist could now progress his program by adding some mild passive movement (no active or resisted movements) of the injured left shoulder. The physical therapist helped David increase his range of movement of the shoulder, and was careful not to make the pain worse, or force movement too far. David was also allowed to remove his sling for short times throughout the day.

    At 6 weeks, another x-ray showed that David’s clavicle had healed enough that he no longer needed the sling. His physical therapist taught him active movement, progressing to resisted exercise, which did not increase his pain or swelling. He also designed an individual home-exercise program that David performed daily. The home-exercise program allowed David to achieve a full range of motion of his left shoulder.

    After 9 weeks, David’s fracture was completely healed. He continued to work with his physical therapist on strengthening and conditioning exercises, to prepare him for a return to his normal sports activities. After 11 weeks, he returned to the playing field, and scored a winning touchdown!

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat clavicle fractures. However, you may want to consider:

    • A physical therapist who is experienced in treating sports injury, pediatric, or orthopedic conditions. Some physical therapists have a practice with a focus on sports medicine and orthopedics.
    • A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedics and sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have fractured a clavicle/collarbone.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions, and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence related to physical therapy treatment for fractures of the clavicle (collarbone). The articles report recent research, and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Donnelly TD, Macfarlane RJ, Nagy MT, Ralte P, Waseem M. Fractures of the clavicle: an overview. Open Orthop J. 2013;7: 329–333. Free Article.

    Pecci M, Kreher JB. Clavicle fractures, Am FamPhysician. 2008;;77(1):65–70. Free Article.

    Faldini C, Nanni M, Leonetti D, et al. Nonoperative treatment of closed displaced midshaft clavicle fractures. J OrthopTraumatol. 2010;11(4): 229–236. Free Article.

    OrthoInfo: Clavicle fracture (broken collar bone). American Academy of Orthopedic Surgeons’ website.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Mary Kay Zane, PT, OCS.  Reviewed by the MoveForwardPT.com editorial board.