The clavicle, or collarbone, is a long bone between the sternum (breastbone) and scapula (shoulder blade). A fracture can occur by a direct hit to the clavicle, a fall on the shoulder, or by a fall on an outstretched hand. Clavicle fractures commonly cause pain and swelling at the fracture site, as well as pain with movement of the affected arm. The fracture may cause “tenting” of the skin at the fracture site, which is the bone pushing against the inside of the skin. Sports Medicine evaluation work-up for a suspected clavicle fracture begins with an examination of the injured clavicle, shoulder, and arm, as well as the uninjured clavicle, shoulder, and arm. This includes an evaluation for tenderness, range of motion of the shoulder, strength testing, and sensation testing. X-rays are often necessary to confirm the diagnosis.
These fractures are common in contact sports like football, wrestling, rugby, lacrosse, and hockey. They also can happen in sports where there is a chance of falling hard, such as biking, skiing, snowboarding, and skateboarding. A cracked or broken collarbone will be very painful. There may also be swelling or tenderness around the injured area, bruising to the skin, bleeding if the bone has damaged the tissue and skin (this is rare) and numbness or pins and needles if nerves in the arm are injured. Your shoulder may be slumped downwards and forwards under the weight of the arm, as the broken collarbone is no longer providing support. There may have been a snapping or grinding noise when your collarbone broke. In severe cases, one end of the bone may poke through the skin.
Most broken collarbones are left to heal naturally using a simple triangular sling to support the arm and hold the bones together in their normal position. The sling is usually fitted in hospital after an X-ray has confirmed the collarbone is broken. You’ll be given painkillers to relieve the pain. Surgery under a general anaesthetic is only needed if the injury is severe – for example, where the bone has broken through the skin – or if the bones have failed to line up and are overlapping significantly.
Guidelines for Clavicle Fracture Rehab
You may be referred to physical therapy three to four weeks after your injury. Your physical therapist will take your history and do an assessment to see the specific ways she can help your rehabilitation. These can include:
Pain: You may continue to have pain for another two to four weeks. Your physical therapist can recommend using heat, ice, or transcutaneous electrical nerve stimulation (TENS).
Range of motion (ROM): Joint mobilization techniques can help restore joint mobility and your therapist will teach you how to do these at home. Several exercises are used to help restore range of motion. Your doctor may allow a therapist to perform passive ROM exercises for a stable fracture. If it’s not stable they may require complete immobilization for a period of time.
Strength: Strengthening exercises will help restore the muscle and bone strength lost during immobilization.3
Scar tissue mobility: If you had surgery for your fracture, your physical therapist may use scar mobilization and massage techniques and teach you how to do self-massage at home.
Standard daily exercise routine: You will perform isometric or static exercises daily. During isometric exercises, you contract your muscles without movement. Here are the exercises you can expect:
- Pendulum exercise: In this exercise, you bend forward at the waist and let your injured arm hang down toward the ground. Make small circles with your hand and let momentum move your arm around effortlessly. Try to make clockwise and counterclockwise circles.
- Grip-strength exercise: Squeeze a small ball (a racquetball works well) with gentle but even pressure several times per day.
- Isometric triceps exercises: The triceps brachii is the muscle on the back of the upper arm primarily responsible for extending the elbow. Rest your injured arm on a table with your elbow at 90 degrees. Make a fist and press onto the table with your entire forearm, from fist to elbow. Your arm will not move, but your triceps muscle will contract.
- Rotator cuff exercises: The muscles that make up the rotator cuff are often damaged or torn during shoulder injuries. Isometric internal and external rotation exercises are often prescribed to rebuild strength in the rotator cuff.4
- Isometric shoulder exercises: You may also be instructed to do isometric shoulder exercises that include abduction, adduction, extension, and flexion, with your arm at your side.
Weeks 2 to 4
Your physical therapist will continue treating your soft-tissue injuries and identify structural imbalances caused by our clavicle fracture. Here are some exercises they may suggest in addition to the standard daily plan:
- Begin passive wall crawl or easy pulley exercises twice a day to build shoulder range of motion.5 To do the wall crawl, simply walk your fingers up a wall as high as you can without too much discomfort in the shoulder. Each day, do a bit more.
- Start building elbow range of motion with easy pivots and bending and straightening the elbow and wrist.
Weeks 4 to 8
If you are healing well, you’ll start increasing your range-of-motion exercises and begin strengthening exercises. These can include: Rotator cuff range-of-motion exercises continue, but now you may add some light resistance with bands or weights. Let pain be your guide regarding how much exercise to do. You should, however, avoid shoulder elevation, rotation, or excessive movement. You may begin easy shoulder range-of-motion exercises that your physical therapist prescribes.
Weeks 8 to 12
During this phase of rehab, you will work toward a full range of motion in all directions. Your strengthening exercise program will continue to progress, but you should avoid heavy lifting. Focus on rebuilding muscle endurance using light weights and higher repetitions.
Weeks 12 to 16
If your physical therapist indicates you are ready, you’ll start a more aggressive strengthening program. Stop activity if you feel pain, instability, or “catches” in joint movements. You may include the following: Increase the intensity of strength-training exercises and begin sports-specific skill drills and exercises.
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