Injuries to the clavicle (collarbone) and the acromioclavicular (AC) joint are among the most common sports injuries of the upper extremities. The clavicle attaches to the chest at a joint high on the sternum (breastbone), and to the shoulder blade and arm at the AC joint. Clavicle fractures occur when people fall onto their shoulder or clavicle, as frequently occurs in mountain biking, skiing, snowboarding and contact sports. Older patients with osteoporosis are also at risk for clavicle fractures. Most fractures occur around the middle of the bone shaft.
Our approach to clavicle fractures
Clavicle fractures in which the bone's alignment is still normal (not "displaced," or separated) can be treated with a simple sling to immobilize the bone while it heals. Displaced fractures require surgery to align the pieces, so they can then knit together properly.
Our orthopedic surgeons are experts in using state-of-the-art technologies and advanced techniques to repair clavicle fractures, providing each patient with the most appropriate and effective care. Our goals are to relieve pain and restore mobility, so patients can return to their normal lives and favorite activities.
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Signs & symptoms
Patients with clavicle fractures may experience the following:
- Pain, tenderness and swelling at the fracture site, particularly when trying to use the arm on that side
- A bump at the fracture site, followed by bruising within about 48 hours
- Rarely, numbness and tingling in the arm (if the fracture compresses blood vessels and nerves in the area)
X-rays will usually show whether the clavicle is fractured. Other imaging tests, such as a CT scan or an MRI, are rarely needed.
Bone fractures generally take six to eight weeks to heal, though the pain from a clavicle fracture subsides after two to three weeks. Patients need to use a brace or sling for several weeks, even after the pain lessens, until a doctor says it's safe to discontinue its use. People who don't need surgery typically take between three and four months to make a safe return to full activity, including contact sports.
As part of the healing process, new bone will form around the fracture site, which often leaves a bump under the skin. This bump will remodel over the course of the following year and will decrease in size, but rarely disappears.
Surgery is the best option if the clavicle's broken ends are pushing on the skin, if the ends are significantly overlapping, or if the ends are widely displaced. Surgery consists of repositioning the fragments and securing them in place with a plate and screws. This procedure, usually performed at the UCSF Orthopaedic Institute, takes about an hour and a half, with most patients able to return home the same day. Patients are under general anesthesia (completely asleep) and given a nerve block (an injection that interrupts pain signals in the area), which lessens post-op pain. While surgery does decrease the deformity created by a healed fracture, it will leave a scar on the skin.
After surgery, patients must wear a sling at all times for approximately four weeks and while standing up and moving around for two more weeks after that. Driving isn't allowed until patients no longer need a sling.
During weeks one to six, patients do a light physical therapy regimen to maintain range of motion in the shoulder, either in person with a physical therapist or by following a prescribed home exercise program. At six weeks, new X-rays are taken, and if the healing is acceptable, the sling is removed and more active range-of-motion and strengthening exercises are begun. X-rays are taken again at 12 weeks, and in a majority of cases, patients are allowed to return to sports and other physical activities.
Most patients live comfortably with the plate that was placed during surgery, but for about 15 percent of patients, especially those who are very thin, the plate is bothersome. In those cases, the plate can be removed after the fracture is completely healed, which ranges from six to nine months post-op.
Frequently asked questions
- When can I shower after surgery?
You'll need to keep the incision clean and dry until your first post-op visit, one to two weeks after surgery. At that time, you'll likely be cleared to shower, but don't submerge the surgical site in a bathtub or swimming pool until three to four weeks have passed since your surgery.
- When can I drive after clavicle surgery?
You'll be using a sling and unable to drive for six weeks, but you can resume driving after that, so long as you have appropriate control to do so safely.
- When can I return to school or work?
Most patients are ready to return to school or desk work five to seven days after surgery. If you're able to work from home, your initial recovery period will be easier. If you have a physically demanding job that requires overhead lifting or strenuous arm work, you'll need more time for a safe recovery and medical clearance before returning.
- When can I return to recreational activities?
People are able to return to most sports and other physical activities anywhere from three to six months after clavicle surgery, depending on the severity of the initial injury. Your doctor will advise you on this.
- Do the plate and screws need to be removed?
The plate and screws are designed to be left in place, and that's fine for most people. But about 15 percent of patients find the plate bothersome. If that's the case for you, these devices can be removed after your clavicle is completely healed.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.