|Physical Therapy for Physical Lives|
The clavicle is commonly known as the collarbone. On one end, the collarbone attaches to the top of the sternum (the "breastbone"). The other end attaches to a bone of the shoulder blade. The clavicle provides considerable support for the shoulder complex. In fact, the clavicle is the only direct bony attachment that the shoulder has to the rest of the skeleton. The clavicle attaches to the sternum and shoulder blade primarily by ligaments (strong fibrous bands of tissue) and has very few muscles to help contribute to the support.
Injuries to the clavicle usually happen because of a trauma such as a car accident or by falling on the shoulder or the outstretched arm. The result is either a fracture (broken bone) of the clavicle or a ligament tear of one or more of the ligaments that attach at the sternum or shoulder blade.
When a clavicle injury occurs, pain will be felt either at the shoulder blade attachments or at the sternum. The shoulder may also have what is known as a "drop off." This means the shoulder is lower than the other shoulder and has a noticeable step off rather than a rounded appearance. The pain may increase as the shoulder is lifted, especially in the upper ranges over the head.
In either case, the first treatment is to brace and support the shoulder for a period of time to allow the fracture or the ligament injury to heal. In severe or complete fractures, the fracture will need to be set by a physician. The amount of time of immobilization depends on your physician's opinion and the degree of the injury. In severe injuries, surgery may be needed.
After a period of immobilization, a more active rehabilitation program is started. Lifting objects with the injured-side arm must be avoided, as well as carrying items such as purses or backpacks. Initially, modalities such as ice, ultrasound or anti-inflammatory procedures may be used to help decrease the pain and reduce inflammation. Gentle range-of-motion exercises are begun, usually in the lower ranges, avoiding overhead activity. As range is improved and pain is reduced, the exercise program transitions to a strength program with range-of-motion overhead exercises.
Clavicle injuries may be difficult and painful to rehabilitate, depending on the severity of the injury and ligaments injured. Ligaments can be slow to heal, so rehabilitation may be slow and relatively long. It is important to have patience and not become frustrated during this time. In most cases the outcome is good.