The clavicle or collarbone is one of the most commonly broken bones in our body. It represents 4-5% of all fractures. Fractures of the clavicle are more common in children, cyclists, rugby players and football players. Many of you will be reading this because you were told that surgery was necessary to fix your clavicle. The research might not agree with early surgical intervention. You do have a choice. We are going to dive into what the research says about how we should manage a midshaft fracture of the clavicle.
The clavicle connects the arm to the rest of the skeleton. That means that all the pressure put on the arm from lifting or motion will go through the clavicle and around the ribs, into the spine and disburse through the ground. The clavicle will break or fracture if you fall onto the side of your shoulder. Another common cause of collarbone injuries is a direct hit from a helmet. Once struck you will notice pain, and you will usually notice a bump in the middle of your collarbone. Moving your arm will be very painful. A trip to a local Urgent Care center will reveal the diagnosis on a routine X-ray. Cat scans or an MRI of the clavicle is not necessary to make this diagnosis. We know from many publications that most clavicle fractures will heal well without surgery. Again, most collarbone fractures will heal well without surgery. Most athletes can return to sports after their clavicle has healed. Surgery might improve the time to return to sports.
[Updated with more recent scientific evidence October 2018. ]
You break your clavicle.. what’s your next step?
You or your child break their clavicle… you were seen in an urgent care center, then you met with an Orthopedic surgeon. Your surgeon recommends a sling or they recommend surgery. Perhaps you are a professional rock climber, or a fireman. Perhaps you are a desk worker, or a runner. We need a lot of information about you, your occupation and hobbies to give you the appropriate treatment recommendation.
You would think that there would be a simple consensus on how to manage a broken clavicle by now – but there isn’t. Competing interest exist. There is evidence, there is the fee for service model in medicine, and there is physician personal preference. Evidence should guide decision making about whether or not your injury or your child’s injury should be managed with surgery or with a sling. That’s why I am writing this. If there is a need for surgery, it should be based on science and sound judgement.
The recommended treatments for clavicle fractures have changed a lot over the last 20 years. For a long time, there was a significant amount of controversy about the best way to manage a clavicle fracture. 20 years ago many surgeons felt that all broken collarbones should be treated surgically. Yet prior to that we were taught that all clavicle fractures were treated without surgery. The research into this area has improved our understanding dramatically over the last decade. The most recent scientific paper was just published in prestigious journal in October, 2018.
Management of Clavicle Fractures: follow the evidence
What is our current thinking? What does the research show about the treatment of clavicle shaft fractures? In this post, we are going to try to teach you more about clavicle fractures and what the current research says your best options are.
As the research into this area has improved, the pendulum has clearly started to swing back towards a non-surgical approach. Even though the majority of recent literature shows that most clavicle or collarbone fractures can be managed without surgery, this still remains a very controversial area. Many of you might learn that your surgeon wants to operate on your clavicle. Hopefully, this post will help you in your decision making on how to manage your clavicle fracture or broken collarbone. It should also help you with questions that you should be asking when you are meeting with your surgeon.
1. Will my broken clavicle heal faster after surgery?
For the vast majority of clavicle fractures, this is simply not true. The clavicle does not always heal faster with surgery. Many collarbone fractures heal quickly when treated without surgery. The younger you are, the faster your fracture typically heals. For a fracture to heal, it requires a blood supply. That blood supply comes from the arteries and muscles attached to the clavicle. During the surgery, we must strip off a lot of the muscle so that we can see the bone. In addition, when we place a plate and screws on the bone, the bone will not heal in the same manner as a fracture left alone to heal on its own. That process could take longer to heal than a fracture that was not operated on. In a small number of collarbone fractures which are significantly “displaced” – eg. the distance between the fragments is large (2cm), then surgery might result in faster healing. A clavicle that has been operated on might feel better faster than a clavicle fracture treated without surgery. That is because the bones are no longer moving. But that feeling that the bones are moving goes away in a week or two when managed without surgery. That difference might be a few weeks. That doesn’t mean the clavicle is healing faster, that means that the screws are not allowing the pieces to move as much. Given that the surgery has a relatively high risk of potential complications, 10-15%, it is hard to recommend surgery to feel better 10-14 days sooner.
2. Will I play better if I have surgery on my broken clavicle?
Given the current evidence, you have a great chance of returning to sports after your clavicle fracture heals – with or without surgery. There are certain fractures where surgery to put the fractured clavicle back into its normal position might lead to a better chance of healing. This is usually the case if the fracture has resulted in significant “shortening” (2cm) – meaning that the two ends of the collarbone overlap by a significant distance (2cm). This is actually a rare finding and most fractures do not shorten that much. Thus when they heal it should not affect the function of your arm. Many athletes will return to their chosen sport with or without surgery for a collarbone fracture.
References from PubMed.gov:
- Results of conservative treatment of displaced mid-clavicular fractures in adults
- Mid-clavicle fractures in adults: end result study after conservative treatment.
- Operative versus nonoperative treatment of midshaft clavicle fractures in adolescents.
- Sports participation and radiographic findings of adolescents treated non-operatively for displaced clavicle fractures.
- Surgical versus conservative interventions for treating fractures of the middle third of the clavicle.
3. Will I return to sports faster after surgery to fix my broken clavicle?
Basically, the answer is maybe. But, this is a controversial area. A recent 2018 article shows that the return to sports was faster in the surgery group. High level athletes returned had a faster return of function after surgery on the clavicle. BUT, when all athletes were assessed at 6 month and one year following their injury there was no functional difference.
For research to be useful, we need to be sure that we are comparing apples to apples. If you want to compare one clavicle fracture treatment to another, then they need to look the same. That means that the separation between the two pieces is not significant in both, or the separation between the pieces is significant in both. In some studies, the return to sports and overall function was quite good with the non-surgical management of a clavicle shaft fracture. Other papers show that the return to sports after surgery on a clavicle fracture was also successful (reference 1). However, the later paper had no controls. In other words, they were just presenting the results of the fractures they operated on. They are not comparing them to a group of patients who did not have surgery. Thus the results of this paper lead to limited conclusions at best. A few papers do show that patients who have a clavicle fracture addressed surgically will be happier at 6 weeks after the injury. But after 6 months most all patients, whether they had surgery or not are doing the same with regards to function. In the long term – up to 5 years later, there is little or no difference between the surgically managed group and the non-surgically managed group (reference 2). Given the current scientific literature (current to 2018) on the treatment of clavicle shaft fractures it appears that the only potential upside is that there will be fewer cases of clavicle non-unions after surgery and perhaps a faster return of function. A non-union is a fracture that doesn’t heal. If it occurs, a non-union can be be operated on if it proves to be painful. So, do we operate on 100 out of 100 fractures if only 8 -10 will not heal completely? Also, surgery is not without risk. The incision is not pleasant looking. You have a high risk of nerve injury causing numbness of the upper chest. There is a risk of developing a painful nerve scar (neuroma). Surgery brought along a high risk of needing further surgery (reference 3) to remove the plates and screws, and other complications that the group treated without surgery did not have. After the screws and plates are removed there is a risk that a fall will cause another fracture through one of the screw holes.
References
- Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes.
- Plate fixation versus conservative treatment of displaced midshaft clavicle fractures: Functional outcome and patients’ satisfaction during a mean follow-up of 5 years.
- Plate Fixation Compared with Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Multicenter Randomized Controlled Trial.
4. Are complications more common after non-surgical management of a broken collarbone?
Complications are more common after surgery, as opposed to non-surgical treatment. Complications can occur with surgical or non-surgical treatment of any broken clavicle. Complications in the non-surgical group include the potential for pain and decreased function associated with a fracture that healed “short” – where the two broken pieces were overlapping more than 2 cm. This is a common teaching in Orthopedics, but more recent studies show that function might actually be unaffected by shortening. The group of patients most at risk for functional issues after a clavicle fracture are high-level, elite overhead athletes. Most recent papers do not show an improvement in function when surgery is performed routinely for clavicle fractures.
Most people with non-surgically managed broken collar bones will have a bump for life. That is not a complication, but it is a fact of life. Many prefer a bump to a scar. After clavicle surgery, that scar might be painful and fairly unsightly. After surgery for a clavicle fracture, many of you will have numbness along the clavicle and upper chest wall. This will be permanent. A few of you might develop painful neuromas or nerve scars after surgery too. In an effort to minimize the scar from clavicle surgery a screw that goes inside the bone was invented. They were popular for a while, but have fallen out of favor. If your clavicle doesn’t heal and the screw breaks it can be quite a challenge to get the broken piece out.
The risks of surgery on the clavicle include a risk of infection and nerve injury which will make your upper chest area numb. There is a also risk of non-union where the fracture will not heal, even after surgery. There is a risk that the plates and screws we place will bother you and require removal. Bottom line: the risks of surgery often outweigh the risks of non-surgical management for most all clavicle fractures.
5. Can my clavicle fracture break again?
Yes. Whether your fracture is treated with or without surgery there is a risk that the bone will break again. Both methods to manage a clavicle shaft fracture have a risk of re-fracture or breaking your clavicle again. Think of Tony Romo who found this out the hard way. If you have surgery to repair your clavicle and then require removal of the plate. Your risk of developing a another broken clavicle goes up significantly for a few months until the old screw holes heal.
Take Home Messages About Clavicle Fractures and Surgery:
- Most clavicle shaft fractures or broken collarbones do not require surgery.
- Fractures with “significant” displacement or shortening (think 2cm) might benefit from surgery.
- Most clavicle fractures heal without surgery
- Most athletes with a clavicle shaft fracture or a broken collarbone will return to sports within a few months – with or without surgery.
- Surgery will improve the early return of function… but within a few months there is no longer a difference compared to fractures managed without surgery.
- The long-term outlook for most patients with a broken collarbone is excellent.
- Research shows that a simple sling, as opposed to a figure of eight bandage is more comfortable and equally as effective.
- The risks of surgery for a clavicle shaft fracture might outweigh the potential benefits for you! Have a long discussion with your surgeon before signing a consent for surgery.
Clavicle shaft fractures are a very common injury. Most of these fractures can be managed without surgery. Many research papers show that return to sports and normal use is similar with surgery or non-surgical treatment. Surgery might decrease the risk that the clavicle will not heal. Clavicle fractures heal 88-100% of the time in many trials published about clavicle fractures – without surgery.
Surgical management of a clavicle fracture is appropriate to consider with significant shortening, and perhaps in an elite overhead athletes shoulder.
The risks of surgery on a clavicle include infection, numbness over the front of your chest, the need for a removal of the hardware and the possibility that the fracture will not heal.
Do you have a story about your clavicle fracture journey? Share it with our readers in the comments below.
DUSTIN
Hi,
I broke my clavicle in a motorcycle accident 6 months ago. Mildly overridden and minimally inferiorly displaced fracture of the mid left clavicle. It still causes me some pain at the point of injury and minimal pain in neck and shoulder when doing physical activities. It feels as if it’s not healing or slowly healing. My doctor’s impression was “Alignment and apposition of clavicle fracture fragments are unchanged. Ends of the fracture fragments are slightly less distinct. Minimal bridging callus is present between the fragments, slightly increased. The acromioclavicular and glenohumeral joints are unremarkable. The sternoclavicular joint is mostly obscured. IMPRESSION: Slowly healing left clavicle fracture”.
I have a background of heavy weight lifting and wonder what effects a non-union healing could have on that. Is surgery at this point possibly worth it? My main concern is if this is going to limit me for the rest of my life if I don’t have surgery? I’d consider myself very athletic and I just can’t find good information on how a non-union could affect my passion for lifting. Any thoughts on this would be greatly appreciated.
Hi Dustin…
Most non-unions are bothersome, but some aren’t. I would expect that it will bother you with heavy weight lifting. But you never know until you try it. Ask your Orthopedist if you can start lifting weights. At 6 months it’s unlikely to heal on its own now.
In my experience, the majority of people who presented with a non-union of a mid-shaft fracture eventually chose to have it fixed. It’s a quality of life decision.
If you ever do choose to have it fixed, make sure you find someone who does a number of these each year. It’s not as easy as fixing a freshly fractured clavicle.
Good luck.
Lylah
Hi,
I am curious to know your opinion on the outcomes of surgical intervention when there is a malunion that is both visible, and causing pain/malfunction in musculature. I broke my left collarbone in a car accident as a child about 20 years ago, and it healed in such a way that my left shoulder is visibly lower (~1-2″), and closer to the midline than the right. My scapula on the left side is also winged, and there are two ribs that tend to remain dislocated from my sternum on that side (a chiropractor once tried to put them back, which was painful, and they popped right back out). This shoulder also “freezes”/locks up when I use the left arm for tasks regularly, and it is extraordinarily painful. Have you observed improvements when fixing the malunion happens so far from the time of injury, or is it not worth my time to look into having this repaired? I know it would be extraordinarily painful (not to mention expensive – would insurance even cover this kind of thing?), but it is also pretty severely malformed where the fracture occurred, and I do notice impaired functioning.
Thank you!
-L
HI Lylah.. There are a few solid trauma surgeons or shoulder surgeons who could give you an opinion on this. It is possible to rebreak the clavicle, insert a bone graft to lengthen it, and fix it in its new position. What you don’t know is if all the other structures will return to their normal position or not. It depends on how flexible the deformity is. This is something that the trauma surgeon or shoulder surgeon would look at.
Bill
Thanks for the great article Dr Luks! I broke my clavicle 2 days ago. Xray report says acute fracture of the left distal clavicle. It looks like the break is about 1/3 from the shoulder-end of clavicle. I used the measuring tool and it looks to be about 2cm overlapping. A surgeon wants to do surgery with a plate, but I found out about cervcial straps and was wondering if I could use one to pull the bones back into position, then maybe use xray to make sure? Then wear for 2-3 weeks without removing at all? I’d like to avoid surgery. If it healed too short, I guess they could always go back and re-break it?
I have better insurance that will kick in Jan 1, 2020, and surgeon said I could wait 2-3 weeks without a problem, but wouldn’t it heal alot by then and might need to be re-broken if I decide to do surgery in early Jan.?
Thanks!
Bill
Alison
I have just broken my collarbone 3 days ago but I’m lucky as it’s not displaced and the X-ray shows it’s a clean break. What I’m worried about is the constant clicking in my bone when I move. It feels like the bone is actually moving at the break. It this possible and won’t this prevent it from healing? I can’t keep rigid any more than I am and I’m scared to move.
That happens in all cases where the two ends are close to one another. Usually, within 2-3 weeks the fracture gets “sticky” and no longer clicks or moves around.
If the pain persists beyond a few weeks many surgeons might consider fixing the clavicle fracture. I would talk with your surgeon and see what they suggest.
Vicki
Hello
I broke my collarbone on the 14th October. It’s been 3 weeks and 2 days since I broke it and the pain is still very intense at times. Is it normal to be so sore this long after the break? Even going for a walk, being a passenger in the car and generally doing not much, it starts to hurt and I have to lie down to stop it hurting. The bone broke in half and the top bit is directly above the other piece. I can feel it clunking around if I move my shoulder. I get stabby pains down my arm and up my neck too. Thanks.
Vicki
Gene
I broke my clavicle a few years ago and there’s a sharp bone protruding on the front top of chest and clavicle. Is there any way to shave the bone down some to smooth it out and not be so pointy and pronounced? I’m also very concerned with doing any physical activity that might result in bumping it because it will hurt. The doctors didn’t want to do surgery but now I’m regretting it didn’t go somewhere else to have it.
It might be.. I imagine you can find a surgeon who can discuss this with you.
Cindy V
I had surgery on my left clavicle 6 years ago. I healed just fine but as the years go on, the pain becomes increasingly worse. I did PT for a year afterwards and still do some of the exercises. I have tried nerve pain management, amongst other types to no avail. Should I consider removal surgery? Any advice is appreciated.
HI Cindy …
Persistent pain can be due to the hardware, the fracture not being completely healed or something we call a neuroma. Those are little nerve scars that occur when we cut some of the nerves in that region. Once you identify what the source of the pain is, then you can decide if surgery might be in your best interest.
Sandi Walton
I am a 55 year old female on Atenolol and Atorvostatin for nine years now. I am a unfortunately, a smoker. One week ago, I slipped and broke my right clavicle. It has a 2 cm nonunion. Surgery with plates and screws has been recommended. I am trying to make an informed decision as to whether or not surgery is best for me. I have osteopenia and have concerns about whether the plate will cause increased risk of future fracture. I have read that with or without surgery, there is risk. I have pain that is semi bearable, and have limited the use of right arm, using a sling as long as I can bear it (causes weak, dull ache in upper arm). I am considering going nonsurgical, due to recovery time and the fact that research does not indicate that surgery will increase healing. What things should I be asking the surgeon and what insight might assist me in making this decision? I realize that if I choose surgery, it is best to do soon. Please help!
You can’t have a non-union at 1 week :-) We give fractures many months to heal before we can declare it is a non-union and will not heal on its own.
Without examining you and your X-rays I cannot give you formal medical advice. Most clavicle fractures from falls heal very well without surgery. So you should ask your doctor specifically why they think that operating on your clavicle fracture is in your best interest. Also, as a smoker, you have a very high risk of developing a non-union. So you should very strongly consider quitting smoking.
Dipak Tamang
I have small fracture on left collar bone nd I jst wanna know after one month later can I lift 40 kg bagpack on my soldier bcoz I m a mountain guide so I have to go nd climb above 8000 m , nd there will chance to effect by temperature ???nd I m jst running 20 years old . And almost one week gone from fracture nd almost gone pain also so exactly I will start at beginning of september …
Should be fine… good luck
Jerome
Hi Dr. Luks!
I’m 22 y/o male. I recently got into a dirtbike accident where I broke my clavicle in four places. I had surgery to plate it with 8 or so screws. The doc said surgery was successful and everything was lined up perfectly.
During my follow up appt two weeks later, he said that the bone dropped slightly from the plate indicating that the screw may back out if I’m not careful. I have another appt tomorrow, and wonder what the possibilities are of me needing realignment surgery if the bone is slightly overlapping? Will I have full range of motion and strength like I did before the accident?
I’m also curious if vaping 50mg nicotine has the same effect on the bone healing as cigarettes do. I have been vaping for about 6 months prior to the accident, and am unsure if it is safe to do so during the healing process. I don’t drink or smoke cigarettes.
Thank you for the info!
Jerome… Vaping is definitely affecting your ability to heal. Unfortunately, if the fracture is starting to move it might continue to do so. If the bones are slightly displaced and the bone heals then it’s not a problem. if the hardware fails, and the fracture doesn’t heal then they might offer a second surgery. If that happens, you may want to see if you have an ORthopedic Trauma surgeon in your region, they are experts in managing these issues.
Terri
Dr. Luks, I am now 1 wk out from my clavicle fracture—unfortunately the rarest type so very little info on the internet, making this blog available is invaluable for info and support. I fell off a 3 ft wall in my back yard first hitting the right side of my head then my shoulder (heard the crack). The ER I went to took 2 anterior, posterior views. Results from my ER Narrative read “acute fracture of the proximal clavicle with inferior displacement of the distal fragment. Rest of visualized bones are intact. Right acromioclavicular and stereoclavicular joints are normal”. My follow up visit 2.5 days later to an ORS included these comments as part of his notes: Diagnosis-Closed anterior displaced fracture of sternal end of right clavicle; it is significantly displaced (the doc mentioned 1 cm so is that the amount of displacement?). Impression-because fracture is very medial there may be very little mobility in this area which will most likely heal with a bony union. If it did heal with a malunion in this area that may not have significant morbidity. It also is a very small medial piece & any type of operative approach in this area would have a high risk of complications, which he wouldn’t feel comfortable doing. He advises treating non-operatively but certainly supports my consulting a trauma specialist. Because I want to make a fully informed decision, I hope to get the opinion of 2 Orthopedic trauma specialists. I’m currently using my sling almost 24/7 and currently feel the most pain in my right shoulder blade only when I have the slightest cough or sneeze; not even attempting to move my arm yet.
With this being such a rare fracture location, is there enough scientifically based evidence to have a good idea of what my short and long term outcome would be for either surgical or non-surgical route? My sales job entails a fair amount of lifting, reaching, driving. This is my first fracture, I’m in my early 60s, non-smoker, no chronic illnesses. Thank you for your insights and your patients must love you!
Hi Terry ..
It seems like you have a thoughtful surgeon.
The closer a fracture of the clavicle is to either end- medial (in your case) or lateral, the harder they are to fix. In the best case scenario (if we choose to fix a fracture), we are able to achieve “stable” fixation on both sides of the fracture. Fractures at either end prevent us from doing that.
That being said, 1 cm (if accurate assessment) is not a very significant degree of displacement for a clavicle fracture. Most of these fractures (even medial clavicle fractures) will heal without surgery. Bumps will occur and will be permanent, but most do not mind that.
If you are so inclined speaking to a trauma surgeon is worth it, first to explore all options and second for peace of mind.
Good luck!
Terri
Thank you for your reply, Dr. Luks. One thing I forgot to ask—is there an optimal ‘time window’ to proceed with surgery after a clavicle fracture if that route is chosen? I will be trying to schedule any trauma surgeon appointment(s) ASAP but just want to be aware of when timing might work against me.
Alex
Hi I broke mine with medium overlap 4 days ago. My consultant said not to bother with the sling as of no use at all. It will be ways moving regardless. It feels better without it. Everywhere else says I should is a sling. Thoughts ?
The sling is mainly used for comfort. It is ok to use it if you want to.
Clarke
Hi Dr Luks,
I fractured my left clavicle 4 days ago. The bone is displaced and my the ortho surgeon is leaving it up to me to decide on surgery. He says the bones will never heal back together but the scar tissue that will develop will sufficiently support the bones in the future. Do you agree that a displaced bone might be better left alone without surgery?
Every case is different. If you have something we call a distal clavicle fracture then he is accurate. Many of those will not heal, but will not hurt. Surgery on distal clavicle fractures can be challenging (depending on your age, and the type of fracture) and the surgery can fail— that’s the reason why many will not operate on distal clavicle fractures. Midshaft clavicle fractures might not feel as good if they do not heal. So, since i have not examined you or seen your xrays you need to have another discussion with your doc or see a second opinion to understand your options and their reasoning.
Chris C.
Hi Doc-
It’s pretty amazing that you answer all of these questions! My 13 y/o son sustained a non dominant, midshaft, non displaced clavicle fx last week at lacrosse practice. We’ve been to a pediatric orthopod who has indicated that he will be out of lacrosse for more than 6 weeks. What would you need to see clinically before you’d clear a 13 y/o pt for contact sports? Thanks!
HI .. I have seen these take anywhere from 3-8 weeks to heal in this age group. It depends on how fast the new bone is laid down and how it feels. It needs to be strong enough wrt healing so that a new fracture doesn’t occur with contact. Have to assess each case individually.
Jacob
Hi Doc. I’m 21 years old and I had right clavicle surgery a little over 2 years ago. It was displaced by more than 2 inches and shattered in 4 places. I followed through with surgery and have a metal plate in front of it along with about 10 or so screws holding it in place. As of only a few days ago, I’ve noticed some swelling near the end of the collarbone towards my right shoulder. And when I move my arm in a throwing motion or extend it in or out putting shirts and jackets on, pain returns for that split second. When I sit still or lie down it feels fine. It doesn’t seem like it’s broken again, but I’m going to see the surgeon who performed the surgery 2 years ago in 2 weeks. I’m looking at a second opinion here because I’m worried about having another surgery to possibly remove what’s holding everything in place. What might be the cause of the swelling? Nerve damage maybe? I don’t have my X-rays but my description is hopefully good enough for an second opinion.
HI Jacob …
An exam and X-ray is a good idea. Assuming the fracture has healed, swelling can be due to irritation caused by the plate, or by a broken screw.
Once a fracture heals completely the plate and screws are no longer holding the bone together. The hardware is only needed long enough to allow the bones to heal. Many people do not require that the hardware be removed. The main reason we remove it after the fracture heals is because of pain and sensitivity.
Robert
Dear Dr. Luks
Thank you for doing this. My collarbone was set with a plate and screws 4 years ago. I’m very active and have no mechanical or strength issues but recently I experience an ache over the length of my clavicle the day after repetitive movements like hack-sawing, washing windows or torquing wheel nuts. Lifting weights, push-ups, chin-ups and cross country skiing do not seem to bother it.
Could the screws be lose in the holes? Could I be irritating some new nerve growth?
Thanks again,
Bob
HI Bob…
It could be irritation from the hardware. If possible an exam and X-ray is worthwhile.
Good luck
juliaGH
Hi Dr. Luks,
Thanks for the article and your feedback to so many. My husband had surgery after a skiing accident March 20. He has a plate and 9 screws. (He had a comminuted fracture and significant displacement.) Can he go on a multiple day wilderness hike May 17? This would be 8 weeks post surgery but does involve carrying a pack for a few days.
Thanks,
Julia
I’m sorry Julia … I cannot answer that for you. If the surgeon says it is healed then I imagine he will say it is ok to go. But no one can predict whether or not all fractures will heal.
Darren Spina
Hi Dr Luks,
Thank you for your very informative website on fractures collarbones. I broke mine 17 days ago in the lateral third region. The ER Specialist Dr said it didn’t need surgery.
The pain has settled and it seems to be healing ok? My question is I can feel the clavicle bone ends moving only very minimally. Like a creak? Could you pls let me know if this is normal and when I could expect them to stop doing this.
Thank you.
Kind regards
Darren Spina
Australia
Bill Paul
Hello Dr Luks
Last week I fell of my bike and broke my collarbone. At the hospital they told me I had a distal displacement of my clavicle.
The orthopaedic surgeon is recommending I have surgery but I’m not so sure.
What are your thoughts?
Thank you
Bill
Gill
I broke my R collarbone in a bike accident 6 years ago. Due to the bones angle being far apart I had it pinned with surgery, and recovered well, just some numbness at first, and six months later was actively playing tennis etc. with it. The plates have been visible under skin but no discomfort unless carrying a heavy backpack.
Two weeks ago I was in car accident and put my wrist out and I think took some impact into my shoulder. I’ve since been able to do yoga and can lift the arm, but had have increasing discomfort pain in that R clavicle, and am wondering if it’s damaged underneath / possible re-broken and just the plate is holding it together (?). Can this happen following surgery, when further impact is sustained?
Wondering the best way to check, and if to go to A&E / Doctors, ask a physio, or just leave it longer to see if pain goes away.
Thanks,
HI Gill…
It is possible to re-injure the clavicle, despite the plates and screws in place. Perhaps a good examination and a good set of X-rays will help shed some light on this.
Leo
This is by far the best information I have read in reference to collar bone injuries. I have learned so much and my mind has been placed at ease after reading the information you’ve provided. Please continue helping others and “THANK YOU”. Now I can stop spazing out about my sons injury. 😊
I’m glad it was helpful :-)
Michelle
I have fractured my clavicle 4 weeks ago, 1.5cm displacement but no shortening. 0-4 weeks but there has been little to no healing noted on the X-ray’s. If at 6 weeks there is minimal signs of healing, do you think healing non surgically is even possible…obviously this is just your opinion but I am curious what you think. I don’t want surgery and don’t mind if it takes a little longer but if it won’t heal, then I guess I’ll need surgery. Can I wait as long as 10-12 weeks to decide if I want surgery or is it normally decided upon before that time? I am just after an opinion. Thanks in advance.
Certainly little or no harm in waiting. Some people might try a “bone stimulator” too, but insurers may or may not cover the expense. You can check with your doctor to see what they think.
DJ
I am a 43 year old triathlete female and had a serious bike crash that resulted in 3 breaks in my left clavicle. I had my break 26 days ago and my surgery 14 days ago. Non surgical Route was not an option for me. I had a plate and 12 screws installed and my plate does protrude a bit to where you can see and feel it. I’m lean (5’6” @ 117 pounds) and I’m very thin in my collarbone area, and they said if it becomes bothersome, they may need to remove it in 9 months.
I was in extreme pain for the first 4 days post surgery and on pain meds and pretty much immobile sitting upright with pillows on couch. Constant pain in collarbone area, shoulder, shoulder blade upper chest muscle and side of neck. I came off my pain meds last week and the pain is decreasing each day. My skin is still very sensitive to the touch, upper shoulder muscle pain/ache and many sleepless nights.
These are the things I have done that has helped me along my recovery thus far:
1.Drink lots of water!
2.Ice, Ice and Ice!
3.Eat healthy as possible. Lots of fruits, veggies, and lean meat. Stay away from caffeine, sugar, alcohol and junk food.
4.Stay away from shoulder movement. (For me, after my surgery, I was instructed no shoulder movement of any kind for 4 weeks) Like, little to none. This has been hard for me because I trained everyday and cycling running and swimming is what I love, but I want to make sure this baby heals so I can come back stronger!
5. Did I mention Ice? Ice as much as you can. Ice is your friend!
6. Keep active with things you ARE permitted to do. I can do resistance walking in the pool at waist level, eliiptical machine without holding onto bar, I can even ride my indoor bike trainer sitting upright with arm in sling, I can strength train my legs and core. You just have to think outside the box, but for me, being active has helped me stay positive and avoid depression.
7. I rub Vaseline and coconut oil on my scar and it has helped so much with the appearance and smoothing it out.
8. And one important reminder that is often not mentioned enough, is figure out a way to ween off your pain meds. These are so extremely addictive and even good honest people can easily get hooked. I made a chart of when and how many I took and I would start decreasing little by little each day and tried to get completely off of them as quick as I could. I have a pretty low tolerance to pain, and thought for sure I would be on them for a while, but the side effects wasn’t worth it. Bloated, constipated, fatigued but with insomnia, just out of it and loopy. There are healthcare centers that can help you ween off them if you have trouble.
My next visit is in 2 weeks and I will begin PT. I am very hopeful to be back to running, full stroke swimming and riding outside by November 1, which is in 7 more weeks. I have signed up for my next half Ironman which is next April and this will be my motivation over the winter.
Loved reading everyone’s input and good luck with everyone’s recovery!
~DJ
Mamta
Thanks for this article which was indeed very helpful and different from what we get on the internet.
Our 18 year old son fell from the bicycle in Mar 17 and had a clavicle fracture which was surgically fixed. In Jun 18 we got the plate removed since the bone had healed. 2 months after removal, he again broke his clavicle yesterday albeit very uneventful this time (he just swung the baseball bat in air and that was it). The X Ray report reads “there is a fracture of left clavicle shaft with marked inferior displacement of the lateral fragment, which maintains normal alignment with the Acromion. The Acromioclavicular joint appears slightly widened however this appearance is unchanged since previous post operative x rays. The bony elements, bony relationships, articular relationships, articular surfaces and joint space of the left shoulder appear otherwise normal.”
We are yet to see the doctor but are very inclined to go for conservative treatment. Our son is not in pain right now except has a stiffness around the area. Do you concur with following a conservative approach with close follow ups. Also if there is a risk of Malunion or non union, are we not better off considering a Surgery should this occur and needs a correction vs now.
Karina Jane
Two weeks in sling after displaced clavicle fracture, after being pushed over, landing side on to my shoulder, fracture clinic appointment in another ten days to check alignment and healing. Should I be wearing sling with arm against side or across front with arm bent, apart from showering, I’m sleeping in reclining chair, as too uncomfortable getting in/out of bed! Prescribed dihydrocodine 30mg 4/6 hourly, which am cutting down to 3/4 a day, is it ok to use voltarol gel for swelling in collarbone area? I’m 57year old female non smoker, occasional red wine, drink lots of tea, does this affect bone healing? Thank you!
Thanks for stopping by. We hope the article on clavicle fractures was useful! But, I am sorry … I can not offer specific treatment advice in this format.
Melissa
A week ago i lost control of my car on the ice and crashed into a tree, my left clavicle is broken in 3 places, surgery was not recommended as the bones were well aligned, thank goodness. I also fractured six ribs along my left side starting with number 1 and going down, im highly uncomfortable. Im in a sling with basically no motion in my shoulder, though xrays show there is nothing wrong with my arm/shoulder. When will I have movement, is there anything i can do to be proactive in my healing process? Don’t get me wrong, i am grateful for my life, which i very well could have lost, i just hurt.
Hi …
Pain can still fairly considerable only a week out from a high energy injury like this.
There is always the risk that something else in the shoulder or arm is injured…. but often we need to wait until the fracture pain settles down before we can properly evaluate the arm with a physical exam. Speak with your doctor…Follow-up with your doctor often. It is not unusual to still have severe pain. But follow up exams are very important to be sure that they do not miss anything in these cases.
Suzan Strads
I was in an accident over a year ago and had multiple fractures. Due to the odd combination of injuries my once broken clavical now looks deformed as it healed overlapping. I’m considering for them to do surgery which means they would have to break it again for it to not be overlapping. What do you think?
Very rare that needs to be done… but it all depends on your complaints and your examination. It’s a big procedure with many risks, so there needs to be a very good reason for doing it.
Good luck
KB
My daughter just broke her clavicle playing soccer, she’s 14. no surgery just a sling was issued at the ER. How long until she can start to move her shoulder? Does it only depend on if it hurts or not before she can start moving it?
We usually allow them to move after they are comfortable and early signs of healing show on the x-ray. At her age that is generally within 2-3 weeks.
Bill R
Thanks for your time. 8 weeks from 2cm overlap collarbone fracture. Xray shows the cloud of callus forming but there was little change/ improvement from 4-8 week mark. Physical examination indicates non-union. not entirely but definitely some “independant movement”. 48 yo non smoker, active cyclist… very anxious to put this behind me and get back on the bike. I’m in the gray area, Doc leaning toward surgery as he believes there should be more healing by now. Not pushy at all. I don’t want to “live with a non-union” since I’m too active. Are there diminishing returns by waiting longer to have surgery? Is the recovery worse because of all the bone callus? How long should one wait before determining a full union may not happen? Thanks!!
It pays to wait another month or so to see how the healing will progress. After that it depends on how your clavicle feels when you are active. Many fractures which look like a non-union on xray might actually be united on a Cat Scan.
Good luck
Lyn Hope
Hi Dr Luks,
I forgot to mention that my Dr said he would be using a bone graft, along with the plate and screws. Would this help in the bone healing?
Thanks again,
Lyn H.
It might work … it might not. In this case you usually need a very skilled trauma surgeon who has dealt with many of these. It is not easy to get these chronic non-unions to heal. It is also not easy to correct the lost length and deformity after so many years. Most of us would try to use more than one plate… depends on where the fracture is, the size of it, etc….
Lyn Hope
Hi Dr Luks,
Thank you so much for taking time to read and comment on so many people’s questions. It is greatly appreciated!
I am a 69yr old female, in very good health, and never a smoker. I broke my right collarbone about 17 yrs ago skiing. At the time, the Dr did not suggest surgery. It turned out to be a non-union fracture and I did try using a bone stimulator with no luck. I was able to get on with life with only a big bump and occasionally feeling some grinding. Fast forward to this year when I had to have a reverse shoulder replacement (arthritis and a shredded rotator cuff) on my right shoulder done in August. After going through PT, I have limited use of my right arm. When I lift my arm up, the broken bone in my clavicle moves over (I can feel the movement with my hand laid on the bone) and seems to pinch muscles, or nerves, so I have lots of pain in that area and going up my neck. My doctor has said that fixing the clavicle could possibly help. I am concerned that the bone won’t heal, since I had that problem before. The shoulder replacement is healing fine but I would like to be able to use my arm without the pinching pain.
I would appreciate any thought you might have about fixing my clavicle surgically.
Thank you, Lyn H
ash aerie
Hi doctor,
I have undergo a surgery to put a plate and screws to my broken collarbone but its already 6 weeks and there is still no sign of the bone to union. I saw a gap between the bone in the x-ray film . Is this called non union? The doctor suggest another surgery to put bone graft to my collarbone. Can my collarbone heal without have to put the bone graft because i dont wanna do another surgery? Thanks in advance and sorry for my poor english
Sometimes we can inject bone marrow if it’s only been 6 weeks. Sometimes we need to graft it. It is a little early to tell… There are far too many variables involved. I would need to see the plate, how it was placed, how many screws, etc… IF the plate and screws are failing, sometimes we need to revise the entire operation- new plates and screws. Or add a second smaller plate.
Most important, if you are a smoker, stop smoking immediately.
Mike G.
Dear Dr. Luks – thank you for all of this insight. It is greatly appreciated. I broke and had clavicle surgery on my left shoulder over 3 years ago. A regretful choice to say the least. Over the past three months, I have started to get numbness in my left hand fingers and what feels like nerve pain ratiating down the left arm. Additionally, I have also encountered intense itchiness on both forearms – with no signs of any skin dryness, sores or a abrasions. Should I assume this is all nerve damage emanating from the surgered shoulder? And, if so, is there any treatment? I never had the plate removed. Now I am wondering if I should…
Tough to say what the issue is Mike. Your doc can send you for metal sensitivity testing… http://www.orthopedicanalysis.com . But I’m not sure that you can blame all of this on the fracture and surgery. Only a good exam and perhaps some follow up tests will tell you. Good luck !
Mike G.
Thanks Dr Luks: I will begin the process of getting it checked out. Truly appreciate your quick response! Much thanks… Best, Mike
Melissa Auchenberg
Hello,
My 11 year old son just fractured his right clavicle for the third time. Would surgery help to strengthen and stabilize his clavicle? I don’t want him to break it again but I also don’t want to have unnecessary surgery
That’s a difficult question … Without knowing the entire story and seeing the images it is hard to say. It would be very unusual for an 11 yo to need clavicle surgery.
Denny
I am a 63-year-old male and broke my left clavicle bone 2-years ago in a bicycle accident in Japan. I had a titanium plate with 13-screws installed to put back together. The smaller bone chips were removed and one large chip tied in place. I was warned about numbness from the nerve cord being cut and pain that may follow. I had the plate removed 1-year later here in Japan. I still have some pain from the nerve ends at time severe, other times I feel tightness I assume this is normal and will never go away. It’s been almost two years and the screw holes can still be felt, I assume over time they will fill in and go away, I hope. Still weaker on the broken left side. My question is will the same strength ever come back and the pain ever go away?
Hi Denny…
Sometimes there are injuries to other structures other than the clavicle which is an obvious area of injury. Have they looked at your rotator cuff and the rest of your shoulder?
With regards to the holes, and nerve pain… that can happen after clavicle surgery. Often times the nerve pain quiets down over time.
Cam
Hi Howard,
I broke my collarbone 1 week ago in a biking accident. The bone is cracked in half, but still seemingly contained together (no fragments), but is bent upward in the middle at the break location. I am an athlete and need to ensure my best performance once I have healed. The surgeon I spoke to left it up to me to decided, what would you recommend to get the best outcome, surgery or no surgery? It seems time may be of the essence in choosing.
Thanks in advance!
HI Cam…
Surgery on clavicle fractures carries the risks of surgery… infections, nerve damage, perhaps the need to have the plate removed. Approximately 10-12% of people need a second operation or have a “complication”. Non-surgical treatment in a fracture without significant shortening should result in a well functioning arm without the risks of surgery.
A non-union is a fracture that doesn’t heal. The non-union risk is higher in the non-surgical group. Again, around 12% will not heal. Many choose to wait and see if it heals. If after 2-3 months the fracture doesn’t heal then surgery is necessary if a non-union exists.
I can not say what the best option for you is…. that decision is up to you. Perhaps another talk with your doc will help you decide.
Good Luck
Phil Young
15 months ago I broke my left collarbone in a cycling accident. There was a considerable overlap (3cm) but eventually it healed naturally and it doesn’t bother me now, I can even take a backpack when hiking. I always felt something else was wrong and 6 months after the accident an MRI scan showed a rotator cuff tear . 10 months after the accident my surgeon agreed to put me a waiting list ( national health service UK ) to repair the rotator cuff injury stating that it would not fully recover without surgery. It’s now 15 months after and I’m told that the operation may not be any time this year. Is this sort of injury time critical, is it more difficult to operate on the longer it’s left? I would greatly appreciate your opinion.
Phil from UK.
HI Phil ..
It depends on the size, type and location of the tear. Certain tear patterns might become larger and compromise the results… and certain tears will not become larger.
Laura
Hi,
My 13 year old son has what was described as a hairline fracture of the clavicle (in fact, the radiologist didn’t see it so diagnosis was based on physical symptoms). Things have improved rapidly (no need for sling after about 10 days and he has good range of motion and he has been able to participate in many activities without any pain. We can feel the hard callous at the fracture site. It has been about 4 weeks and we are going back to the fracture clinic for an assessment. I’m wondering if a seemingly minor fracture such as this requires as much time away from sports (hockey, in particular) as a complete fracture normally does? He’s very anxious to be back but we don’t want to rush it. Thank you,in advance, for your feedback.
These fractures usually heal quite rapidly and allow for a rapid return to sports. Hope your convo with your doc goes well. Good Luck.
william
Dear Doc
Fantastic website, thankyou.
I broke my left clavicle 10 days ago and the registrar said the two broken ends were ‘reasonably close together’ and on his advice have opted not to have surgery. He also advised against wearing a sling where as the physio suggested i keep it on most of the time. The physio has told me to start doing small pendulum movements with my arm hanging down. This does not feel good with the broken end moving. My question is should i be doing exercises already and should i be wearing a sling?
Many thanks
You can wait until the fracture starts to heal before commencing exercises. Most fractures (in non-smokers) start to heal enough within 2-3 weeks to allow for early motion. Be sure to check with your surgeon if you have any questions.
Good Luck
Gabor Lorincz-Veger
Dear Doc,
A week ago I broke my right clavicle in a bike accident. The doctor says it has to be operated because of 2 cm distance. I don’t have any pain and can move my arm up and down. I rather would give the natural healing a chance.
Elmari Jankowitz
I broke my clavicle in a motorcycle accident on the 23rd of Aug 2017. Another vehicle crashed right into me as I was on my way to gymnastics (I’m a coach). An ambulance picked me up abundance took me to the emergency room. The scans revealed that my clavicle snapped in half. The one side of my clavicle was going over the top of the other half and it was shortened by 6cm. So I had the surgery. How long does it take to heal and for the pain to go away? Because the owner of the gymnastics club it’s annoyed that it’s have been away from the club for 3 days and want me to come back imediatly. What recommendations do you have for exactly how long I should be resting before I can safely go back.
ahmed
I am 13 years old and broke my collarbone 22 days ago. My holiday is on Friday so I am wondering if i can go to valley fair it is an amusement park and I think my arm has healed what do you think I should do?
I’m sorry, I can not answer that for you. You would need to contact your doctor.
André Pieterse
I broke my collerbone 11 days ago and went for surgery on the second day after the injury. A plate was inserted and after the operation i have minimum pain. I can move my shoulder/arm with ease. Very good surgeon and a great success. Before the operation i had severe pain. I will rather sit with a scar than a hump that will bother when carrying a rack sack.
Shani
I’m 22 years old girl. I broke my left clavicle 6 weeks ago and 2 pieces are overlapping. I wore sling for 6 weeks. There’s a bump on my shoulder and I can’t wear a back pack because if something heavy placed on my shoulder doctor said that bumped bone(it’s a sharp end) will come out tearing my skin. So my doctor intially said that he will let to my clavicle heal without surgery and 6 weeks after the fracture he’ll do a surgery to remove that part. I want to know that is this solution is good? Will the shortness of bone will effect to arm to do normal things. It seems that I can’t lift my arm properly yet and lack of strength. And I’m scared because I’m a girl. Thankyu in advance.
Peggy
I fell and hurt my shoulder 6 months ago, went to the dr but she didn’t order an exray. Never got better went back and finally got the exray. It was broken and did not heal because it was never treated. Having sharp pain with some movement . Can it still b fixed?
Even 12-15% of properly treated clavicle fractures do not heal. An experienced shoulder fracture surgeon or Orthopedic Trauma surgeon should be able to tell you whether or not your fracture can be fixed.
Cara S.
Hi there:
You cite this link as research that shows that figure-of-8 bandages are no better or worse than slings, but the link is to an ongoing trial, started November, 2015, unless I’m misreading. Are the results of the trial described in the link published anywhere yet? =)
https://www.ncbi.nlm.nih.gov/pubmed/27142768
Whether or not a figure of 8 is worn vs a sling remains controversial. Most patients appear to prefer the sling, and find the figure of 8 more uncomfortable. The final paper for the trial mentioned has not, to my knowledge been published. It has been referenced at meetings.
This paper reveals no difference in terms of healing or shoulder function scores.
Ron
Hi Dr Luks,
I broke my right collarbone on June 12th after a bike accident. The XRay shows an overlap of 3.5 cm and my shoulder and arm are clearly shorten by the same size. I followed up with the ER Dr on the 21st of June and I was put under observation. On the 7th of July, the Dr did mention that I might need surgery and put me under another 4 weeks of observation before I can see an Ortho. On August 3rd, I saw the Ortho and he says that there is nothing to do since the wound is 2 months old. The Ortho did mention that the newest X-Ray didn’t show any build up of callus or sign of the bone being healed.
Is there anything that I can do after two months with such injury and overlapping (over 1 inch; 35mm).
thank you
These fractures are more difficult to fix a few weeks to months later… but it is certainly not impossible. You need to find a shoulder doc or a orthopedic surgeon who specializes in trauma who is comfortable with these fractures and delayed management.
Crystal
My 13yr old daughter fractured her collar bone twice in the same spot 3 months apart. She is a high ranking wrestler who competes nationally. At the time of the 1st fracture it was mid shaft and was displaced 3 cm and the Ortho MD decided not to do surgery. The bone was in the process of healing unaligned when it fractured again 4 days ago. Our Ortho appointment is scheduled for tomorrow. I’m scared that the ortho MD is just going to say let it heal naturally and avoid surgery based on our initial visit from the 1st fracture. The Ortho MD stated that the need for surgery is rare and that only old school surgeons do surgery. She stated even if the bones were displaced 7 cm they still wouldn’t do surgery. Is that accurate information? I’ve been trying to research myself and I feel the collarbone pin procedure would be the best due to less scarring and make sure the bone aligns. I feel as if the only way for her to complete in the future without complications would be surgery. Any thoughts?
Your surgeon is correct that the science is supporting non-surgical care for most clavicle fractures. It is possible that it broke simply because she landed in such a way that a normal clavicle would have broken too ??? Or perhaps there is another reason, i obviously do not know. The benefit of surgery is to decrease the risk of not healing… or non-union. Surgery has not been proven to reliably improve function or to diminish the re-fracture rate after a clavicle shaft fracture.
Deborah
First of all, thank you for your time and expertise.
I broke my collar bone about six years ago and wore a figure eight brace at the time. It seemed to heal fine at the time. Recently I have extreme pain every morning when I wake up, cannot sleep on that side and have extreme pain when my arm is in certain positions. I went to a family physician had an X-ray done and it shows there is a nonunited fracture of the distal clavicle. No dislocation identified. Do you think physical therapy would be helpful in my case? I am 63 years old and I do not understand why after so many years I am experiencing this pain. Thank you very much for your time, this is a wonderful thing you do.
Thanks Deborah… I’m glad that you find this information useful.
A non-union can become painful over time. It’s not common, but it can occur. Perhaps the pain is due to something else? 63 is a common age for degenerative rotator cuff problems too. Look up Rotator cuff tendinosis on my site. Sometimes the most obvious issue or problem on X-ray or MRI is not the cause of the pain. Only a good exam by a good shoulder doc will be able to determine what your “pain generator” is.
Good luck
Art
Dr. Howard,
Thank you for your initial answer on July 9th. 2 days ago I had another set of XRays (XRays are at day 17 after injury) – (https://photos.app.goo.gl/Oz4UkksmKUCdw3FG3) would appreciate to get your opinion on this as well, does this look still straightforward fracture (no worsening) and still the non operative treatment is the best option with the good chance of healing naturally? I am mostly pain free, in sling since the day of injury and doing elbow exercises and slight assisted limited moved on shoulder only. Thank you again !
Regards,
Art
Sorry Art … I can not offer specific treatment advice. I am only here to educate and hopefully improve your conversation with your physician.
Liliana
I fell from my mountain bike seven weeks ago and fractured my right collarbone. Fortunately, the bone didn’t get displaced and the separation was milimetric. It was really just a full crack. I got authorization to ride my bike again at week 6. I had full mobility, I could feel a good callus, and it would very slightly bother me at all. Today I took another fall and landed right on that side of my body. After the initial shock of falling on my recently fractured collarbone, I checked and realized I didn’t loose any mobility, it is not more painful, and only certain movements that didn’t bother me before, now slightly do. Of course, you’re soar after any fall, but I think I’m more concerned about the idea of having fallen on my bad collarbone. I can still feel the big callus there, the area didn’t get swollen, and I’m not in pain at all; just those slight discomforts that weren’t there; very few. If I manipulate the bone, I can feel a slight crepitation, but I can’t tell if it’s right at the fracture point, or at the joint, and it doesn’t hurt. So my question is: is the callus at this point flexible or already hard as a bone? Would an impact have a risk of breaking the callus, or would it more likely “stretch” or “bend”? Is there a risk that my fracture got worse, or, does feeling nothing but a slight discomfort mean I didn’t send myself weeks back in the healing process?
By the way, only a really dedicated professional would take the time and effort to answer all of these questions. Thanks so much. There’s not a lot of information out there, and it’s really frustrating not being able to find answers.
Callus is not very flexible… It is possible that the area is simply bruised by the impact. It is also possible to re-fracture at the same location with a high energy traumatic injury.If the pain persists more than a few days it might be worth getting a new xray before you get back on your bike
Sarah
I echo the praise of the time you give to this issue. Thank you!
I took a nasty fall mountain biking resulting in a mid-shaft angulated fracture of my left clavicle. The very tip of the bottom bone is touching the bottom of the top bone. I can feel the ledge of the top bone poking up. Zero signs of healing at 4 weeks. Used a sling most of the time through about 6 weeks. Doc started me on passive ROM with PT at 7 weeks which felt really good. Loosened up stiffness and decreased some pain. PT feels strongly my shoulder is impinged due to the clavicle break, and that there are rotator cuff issues and recommended an MRI. Doc wants two more weeks of PT, before ordering an MRI. Still no signs of healing on the xrays now at 10 weeks. He is absolutely convinced this break will heal on its own. Calcium and Vit D blood levels are normal. I have read that my thyroid issue (too low, take replacement) as well as being overweight (BMI 29) could be inhibiting the healing. Pain in my upper arm and shoulder are keeping me from sleep, and inability to do some tasks are keeping me from work and normal life. There is some discomfort in the break area with some movements but not really sharp pain like in my joint and arm with some movements. I am getting a formal second opinion this week, but was curious as to your experience…could this still go on to heal showing no signs at 10 weeks, and, if the break isn’t healing, should I be doing PT? If I did have rotator cuff issues, wouldn’t that be critical to know before moving forward? Are there other underlying medical issues I should have checked, or other things I should chat with the doc about at this point? We are all committed to avoiding surgery, and, this is getting really frustrating. If I have to do it, I want to just get it over with and get on the trail again. Thanks in advance for your thoughts.
Some fractures can take longer to heal… but the non-union rate is higher with non-operative management. Especially with high energy fractures.
Usually by 12-16 weeks if we do not think it is healing we might recommend fixing it.
Michael Kenny
Wow I can’t believe you have taken the time and care to get back to so many comments on here so first thank you. About my issue my son is 21 months old and took a nasty fall today resulting in a fractured clavicle. They tell me no sling or cast and it will heal on it’s own because of his age but it’s almost impossible to keep a toddler from playing resulting in further wincing pain. How great a chance is there of the bone not healing correctly if he’s constantly causing discomfort to the area even with the limited mobility we allow him? This is our first kid so of course we are super paranoid at the moment and any information is much appreciated.
It really is hard to immobilize a 21 mos old. Kids that age heal very quickly. And they have a remarkable ability to “remodel” a broken bone… such that in a few months you won’t even notice a bump and the bone will look normal on X-ray. He will start to use the arm more and more as his comfort levels improve.
A.T
I broke my Collar bone yesterday during a bike ride.x-ray shows 3cm displacement. Should I choose the Surgery or non surgical option? I am a cycling athlete, non smoker. I dont deal with a lot of overhead type of work.
That’s very very rare…. If it truly is 3 cm… and I would repeat a series of xrays to check, then surgery can be considered as a viable treatment option. You need to discuss this with your doctor so they can go over the risks, and potential benefits of non-surgical vs surgical treatment.
A.T
Thanks you very much for you fast reply
Art
Dr. Howard – thank you for article and website with active blog. I broke my left clavicle at the midpoint 2 days ago in a bicycle accident.i am 38 years old male, non smoker. Would love to get you opinion on my xray is here- (https://goo.gl/photos/wUsGsPAA11GUBSmx6) whether i would need surgery or no and how soon i can get into cycling again ?
HI Art …
Appears to be a straightforward clavicle fracture. But without seeing additional views and examining you I can be sure of that. As mentioned in the post, and as many of the references point out, surgery doesn’t allow faster return to sports. It does appear to lower the rate of non-unions… but no other significant improvement in function. Time to return to cycling depends on the healing time. That will vary by individual. Some will heal rather quickly. Some collar bone fractures can take longer to heal. It’s the next X-ray in a few weeks which will give you a clue as to how fast you are healing.
Stephen Rockower
As a fellow Orthopaedist, I respectfully disagree with you on your contention that clavicle fractures are just as comfortable in a sling as in a figure of eight brace. In my 30 years of experience, I can’t tell you how many times I have replaced a sling and have the patient exclaim how much better it felt. The article you cite is not a report, but a call for patient participation.
THanks Stephen … Some patients seem to like the figure of 8… some don’t. Both are an option to offer our patients. I often let them choose which to wear whichever feels more comfortable to them. Seems like more mid-shaft patients choose figure of 8, which distal fractures prefer the sling.
Thanks for stopping by!
Evan
Hi Dr. Luks, I broke both collar bones over the years and was only treated with a sling. I’m an athlete and surfer and I have a lot of shoulder problems and believe it’s due to shortening of the collar bone because of how it was set. Have you ever heard of having surgery at this point to rebreak the bones and set them at the right lengths?
I have… and I have had a few similar patients of my own with similar issues. It’s not common, and it’s a tricky procedure. You need to also keep in mind that the shoulder itself could have been injured at the time of the clavicle fracture. Therefore it pays to have the shoulder carefully looked at before considering an “osteotomy” and clavicle realignment.
Jon
Dr. Howard – thank you for the website and active blog. I broke my clavicle at the midpoint last Saturday in a high-speed bicycle accident. The Separation is clean, with 216 cm distance between the two pieces with little overlap, I am going back and forth between surgical and nonsurgical healing. Nonsurgical looks great when you see the amount of hardware installed to hold the fracture. However surgical is sounding better when I think about the prospect of the amount of time and associated pain it will take for the fracture to heal naturally. I am very physically active, and busy with work, so accelerating the process to stability is gaining appeal. I appreciate what sounds like a preference for natural healing, but I wonder if the 216cm distance and my need for certainty of outcome pushes me to a surgical treatment path. We are going to take X-rays in 6 days and if the distance is not resolving I think I will take the surgical path. Your thoughts are appreciated.
Hi Jon …
Sounds like your numbers a little off. So I’ll go with 216 mm. At over 2 cm and with a high energy injury healing can be delayed. On the other hand it could heal just fine or not heal at all. The higher the separation and the higher the energy of the injury the longer it takes to heal and the higher the chance that it might not heal.
Now, that being said… many if not most experienced trauma surgeons might double plate a high energy clavicle fracture if they chose to operate on it. It controls the fracture better and decreases the risk of the surgery failing. A high energy injury is also harder to get to heal after surgery too. Make sure you consult with an accomplished surgeon.
Good luck
Shemaiah
Broke my collar bone 1 week ago and it doesnt hurt does that i mean i can go back to sports in 2 weeks?
Typically not… that is too early. The risk would be making the fracture much worse if it isn’t given enough time to heal.
Marla
Thank you so much for all of this information. I fell 2 weeks and broke my right clavicle. After being in a sling for 2 weeks my ortho put me in a figure 8 brace. He asked me to wear it 3 weeks. I have a lot of movement back already. I mainly can’t raise my arm overhead and of course strength has been diminished . What are your thoughts on the figure 8 brace? Thank you again
The figure of 8 is not very commonly used… but if you’re comfortable in it then you can wear it until your doc says you’re healed enough to stop.
Andy
Hi Doc Howard,
I appreciated that we have these kind of forum discussion to share our story. Thank you. I broke my collarbone about 4 months ago( mid February ) in a car accident. Looking at the positive and grateful to be alive. Mine was broken in pieces with displacement in the middle section. I don’t really experience any major pain, just minor pain the first 2 weeks. Has been to 4 doc visits around 1 month apart, X-ray was taken at each time. Each X-ray seems to have progress with healing but the it still has not fully healed. Last one was taken on 6/2/17, the two bones still has not bridge but the small fragments seem to start attaching and sign of new bones growing. Doc said no heavy lifting or any kind of rigorous activities( push-up, garden work, ect ). I have most of the mobility back on that shoulder with no pain, I say 80% but still need a little more therapy with the muscle.
I’m only hoping that surgery is not needed, but Doc mentioned a small chance I will need it.
I’m just curious of how long it usually take to healed, I figure 4 months should be long enough. I’m 35 and fairly healthy. This is my 1st broken bone and hopefully last. Any input would gratefully appreciated Doc. Thank you.
Note: I have all X-rays to post or email if permitted
Many fractures, especially high energy fractures (car accident vs. a slip and fall) can take much longer to heal. As long as there are signs of progressive healing then that’s all that matters. If the xrays show that the clavicle fracture has stopped healing on two subsequent xrays then further study such as a cat scan might help determine if the fracture is healed.
Andy
Thank you Dr Howard for the quick response. Do you have an estimate of how long I should give it to heal before consider other options( such as surgery )? Sorry, I’m just losing a little patience. Also, I sometime experience mild pain( like a pinch ) and is that normal? Around a 2 out of 10 on the pain scale. Thank you.
Eric
Hello,
Just like to say, Thank You for answering the questions.I dont think Ive ever seen someone spend such a large amount of time actually caring for people that were not their paying patients.
I broke my collarbone in a carwreck 15 days ago.Surgery that night, and again 5 days later to put a plate and some screws in.I have a black/yellow bruise that starts at outside of shoulder(broken collarbone side) and goes down,skips my elbow and then continues straight down the middle of my forearm.Its by far the worst pain Ive experienced with this entire process.Im guessing my subclavius muscle? My question is…Is this type of paain normal?
Thank You,
Eric
Hard to say Eric … it’s not unusual for the discoloration to spread– however, a very important part of treating accident victims is the concept of secondary surveys and so on. That means that we keep examining you to be sure that something else isn’t wrong.
Perhaps talk to your surgeon about assessing your arm/forearm to be sure everything is ok.
Good luck… thanks for the kind words.
ballavandale
hi, im 29 years old active in police operations. i broke my left clavicle into 3 fragments after a motor vehicle. 3 days ago i had a clavicle plating using recon steel. will i be able to return my heavy activities as before? in how many weeks should i return to work after my operation? how long can i do push ups and pulls ups again?
IT all depends on how well your clavicle heals. Certain fractures will heal in 6-10 weeks after surgery. Others might take longer. A few may not fully heal.
Eat a balanced diet… and keep talking to your doc about how well the clavicle fracture is healing and when you can start your various exercises. Do not start them until they tell you to do so….
kashif
i broke my collar bone in fall during riding about 20 days back. i am 28 years old. Doctors after checkup not advised surgery and recommend arm sling only. i think both ends are away from each other and over lapping in x-ray. i am confused still. please give me some solution.
Many clavicle fractures will overlap after the injury. This is a very common scenario. Most of these fractures will heal very well over time.
Morghan
I’m 16 years old and my growth plates are closed, I broke my collarbone about 3 weeks ago, and the first X Ray showed the bones still touching but a clean break. It is not 3 weeks later and I got another X Ray yesterday and it has displaced itself and is overlapping by 1.7cm. It’s my left shoulder. I do gymnastics and pole vaulting and pole vaulting is 80% my left shoulder doing all the work and gymnastics is using a lot of arms as you can imagine as well. Because my overlap was by 1.7cm and considering my sports, my doctor said I should do the surgery if I want to have a better outcome when I go back to sports. The next day, he told me nevermind and that I don’t need surgery and the bone will heal on its own. I’m torn on whether I should do the surgery because of what he said the first time. Because he said I would lose 10-15 degree of range in my shoulder if I don’t do surgery. He said its borderline surgery and could go either way. I don’t want to not take the opportunity of surgery when I could have had a more effective outcome WITH surgery. What do you suggest?
I can’t comment on your particular situation- sorry. Perhaps the xrays were taken differently. It would be unusual for one xray to show no overlap and the next to show overlap of 1.7 cm. Many athletes do fine even if there is overlap of 1-1.5 cm. Others might complain of issues with their shoulder, but this is not very common. I would get another opinion if you are concerned Good Luck
R. Johnson
thank you for your professional fore thought….
You’re welcome
Mia
I broke my collarbone while skiing. Exray showed a 2 cm gap between broken parts. So i went through a surgery having a plate now. Yesterday i fell accidentaly on my butt not on my shoulder, the fall wasnt very hard. But my shoulder where the plate is hurts and a huge bump is there now. Going to my doctor in 2 days only. What could that be? Another fracture?
It is possible… especially if the original fracture did not heal.
alan hoyle
Hi I broke my collarbone 12 weeks ago and am still having sharp stabbing pains and generally a dull ache round my shoulder I also get sharp pains when I put my arm around my back as in scaratching my back is this normal or shoul I be well on the way to recovery by now I am 57 it just doesn’t seem to be getting any easier I went for a walk and on my return had some severe pains which resulted in me visiting my local ER
Have you had xrays recently? Did the fracture heal? If the fracture is healed and the shoulder region still hurts then a good shoulder exam, and perhaps further imaging is necessary.
Desiree Burnum
My 2 year old grandson fell out of bed and I suspected a broken clavicle. This was confirmed at the er. I have a question on his treatment though because they did an x-ray and we waited 9 and a half hours to see some bone doctor that never appeared. The emergency room visit ended with Jim being put in a sling and the nurse advising myself and my daughter to follow up with his primary care doctor to get a referral to a bone doc but in the meantime to keep him ad immobile as possible because the way the bone is broke there is a definite possibility of puncturing a lung if it is jarred the wrong way. All of this being done yesterday (Friday) evening, so there’s no hope at all of follow up until Monday morning, in a perfect world. How concerned should I be or is this treatment pretty standard?
Seems very standard…. clavicle fractures are not a common cause of puncturing a lung.
Merv
I broke my collarbone in a snowmobile accident and I had an X-ray doe. And the doctor said it was a 2cm brake is surgery rocommended ? I was about to go for surgery but the other doctor I seen said I should let it heal on its own was that a good idea?
Many if not most fractures can be treated without surgery. I can not speak to the specific management of your fracture. I hope our video helped a little. Hope you feel better soon
Jerry
Hi Dr. Luks,
Firstly, thank you so much for taking the time to answer the various queries people have on this topic. I have read through all the cases and responses. It is very reassuring to hear from an expert.
Just looking for a little advice regarding general exercise and activities following my clavicle break.
Brief history;
I am 49 and male. On Nov 26th 2016, I fractured my right clavicle towards the outer third, near the shoulder ball joint. An inch from it perhaps. I did not use a sling after the accident and foolishly assumed it was only heavy bruising and didn’t go to my GP for 2 weeks. He immediately referred me for an MRI as he assumed it might be muscle or tendon damage. Had the MRI approx. 3 weeks after the incident. The MRI indicated a break so he sent me for an x-ray, which I had at 4 weeks. I then got referred to an ortho surgeon and had more x-rays at approx. 6 or 7 weeks. Scans still showed non-union but pretty clean with good alignment, no overlap etc. The break/gap looked around 1cm (give or take). He said to come back in 3 months for another x-ray and to review at that point. This is scheduled for April 12th.
Things still don’t feel right and my instinct is telling me it is still a non-union break. No real pain, just some stiffness and diminished mobility when overreaching in some directions.
Assuming it continues to be non-union on April 12th I’d be happy to take surgery to fix it up as it just feels strange carrying on with a broken bone.
My questions;
1. Is playing golf now out of the question?
2. I’ve not lifted a weight since the incident (I’ve lost former muscle tone), now that I am 4 months after it, is it ok to do basic weights like bicep curls?
3. My preferred sleeping position was always on my right side but I have avoided that since the incident. Sleeping on my other side feels a bit strange but not too bad. Can I go back to sleeping on my right side at this stage? I tried it momentarily last night and it felt a little uncomfortable but this might have only been psychological.
4. In your experience if the break was non-union after 6-7 weeks, is it unlikely to fuse after that?
5. Is my preference for surgery to make me ‘complete’ again foolish?
Your opinion on the above would be most appreciated.
HI Jerry..
At this point you can sleep anyway you want. It isn’t going to move the fracture. These distal clavicle fractures are known to go on to a non-union more often than other fractures. But many non-unions are not symptomatic. That means that they do not bother the person. If the fracture isn’t healed there is no harm in trying physical therapy to improve your shoulder function. If the PT restores your function and confidence in the shoulder then you may not need the surgery. These distal clavicle fractures can be difficult to fix… keep that in mind when considering whether or not to have surgery on it.
Jerry
Great thanks for the advice. I expect there will be some PT scheduled after the next X-ray. Can you please just let me know your final thoughts on playing golf or doing weights/bicep curls at this stage……or ever?!
Also is there any advantage (or disadvantage) in vigorous deep tissue massage around that area to help address the stiffness or maybe even encourage healing?
Masiur
can a bio-degradable plate be used for clavicle fracture?
not really….
Stephanie
Hello again! You were kind enough to reply to my question about a “delayed” union and efficacy of a bone stimulator. I have a follow up question, if you don’t mind. I was reading about different types of nonunion. I appear to have an atrophic nonunion. I am concerned that the bone stimulator may cause me to build up some callus, but not enough to knit the bone back together. Is it possible for the bone stimulator to cause build up of callus so that an atrophic nonunion changes to a hypertrophic nonunion? My concern is that a hypertrophic nonunion is supposedly more painful and I can’t have surgery, so I’m stuck with whatever result i end up with long term. I don’t want to use the bone stimulator and end up worse off that I already am…!
Thank you!
Definitely a lesser chance of healing with an atrophic non-union.
Malgorzata
Dear Dr Luks,
I am a dentist. I broke my right clavicle on 03/01/17 (broken by seat belt in car accident).
The broken pieces are dislocated, but I haven’t got an operation. I had a control xray taken 6 weeks after accident and the doctor was happy with the result. I’ve got some exercises to do. I am still not able to do all movements. Could you please give me any advice when it would be safe for me to come back to work?
It is “safe” to use the arm once the fracture has demonstrated signs of healing.
-less pain with motion
– less pain on palpation
– new bone formation seen on serial X-rays.
Montine
Hi Dr Luks-
Thank you so much for this reassuring info!
I broke left clavicle due to a car accident – hit by a drunk driver. This was October 2016.
First ortho pushed surgery- where as ER md said I probably would not need it. Saw second opionio ortho suggested by my lawyer- and he kept telling me that he doubts I will need surgery. I’m 20 weeks from accident today and had lots of X-rays and more recently (Monday) had a CT. Shows the clavicle is not healing. Bone end just sitting almost right on top of one another.
Ortho does not want to surgery due to all the risks and the fact I have no pain. I started a bone stimulator on January 18. Did PT since getting out of sling at three weeks- taking vitamins- had frozen shoulder- better now!
I’m supposed to see ortho end of April.
Do you the clavicle will ever heal? Is it odd or dangerous to be living life with a non-union?
Thoughts? Thank you!
Montine
Generally speaking … Some people can live with a non-union… As long as they have reasonable function, little pain, and do not perform heavy overhead work. A smoker has little chance of healing a non-union. Bone stimulators might work. Time will tell.
Dave
Hi Dr. Luks, thank you for taking time to respond to everyone’s questions. Your insights are reassuring. It’s rare to find someone willing to help and take the time to listen, where doctor visits feel rushed, and you are left wondering if you got the best advice. I’m 53 and broke my left clavicle skiing two weeks ago, with some displacement (9mm) and one small spike-looking piece next to break. X-rays from the hospital near ski area were taken with my left arm bent at the elbow (90 degrees) across my stomach. Is that the proper position for a clavicle x-ray? Orthopedic surgeon back home said I needed surgery after looking at the bump, but before looking at the x-rays…really. Then after looking at the x-rays, said probably not, necessary. He did say spike fragment could hinder healing…is that true? He measured distance from the arrow shaped pointed end of the break (from the bone coming from shoulder) to the open end of the other bone (from sternum) where it matched…displacement was 9mm. Is that the correct way to measure displacement? He said I could let my arm hang down occasionally, is that OK? When I went back one week later, they took new x-rays, but with my arm hanging down completely, not bent like original, which I didn’t realize. The ortho. said I need surgery as the new x-ray showed much greater displacement…with my arm hanging down. After I left in despair I realized the difference in arm position vs. original and called and made new appt. with same ortho to take new x-ray like original and then compare this coming week. What is proper arm position for x-ray to determine actual displacement? Would one week be enough to tell if anything is better or worse, assuming x-ray is taken in proper position? When should I expect to see signs of healing and how can I tell its healing from an x-ray? I’m in great shape, exercised 5x week with weights, plyo, etc., non-smoker. Pain and swelling are gone except for some rib or muscle pain in back, left side. What is proper position for immobilization to allow proper healing? I am not using my left arm and have it in a sling only, arm constantly across stomach, except occasionally I sleep with it at my side. Can or should I avoid removing sling, have only removed it to shower and sleep? Should I avoid traveling, need to for work 1x or 2x per month? Was going to check my vitamin D levels and I’ve started supplementing already, any thoughts on efficacy? I’ve heard vitamin D levels in pop. are generally low. Sorry for all the questions, but trying optimize healing and on guard with current ortho, going to get 2nd opinion…most orthos are surgeons which is ok, but this one seems to be in a rush to operate and not offering detailed protocal for non-surgical healing which is making me leary of others…except you. I’m too far away, Denver, or I’d make an appt. with you. Ironically, I travel to Mt. Kisco, NY near you several times a year on business. Thanks in advance for your reply. Dave
HI Dave …
There is no optimal way to image the clavicle. Subtle changes in the angle of the tube pointed at you or your arm will change the appearance of the X-rays. Fracture separation with regards to the clavicle really doesn’t change significantly after the injury.
9 mm is really a small number. Without seeing you I can not comment on how your fracture should be managed. Most fractures can be managed without surgery. The literature is pretty clear in this area. Unless you are a competitive overhead athlete, unless the fracture is shortened nearly 2 cm or more, etc (as I discuss in the post) then most fractures will heal fine without surgery. The bump stays, but it’s often better to have a bump than a scar. The research shows that the complication rate of clavicle surgery is high enough that it shouldn’t be the standard of care for all fractures… only those that would clearly benefit from it.
Vitamin D levels are important. Check with your PMD about your last level and then talk with them about supplementation. I start my clavilce fractures moving once I see healing on the X-ray and once you are more comfortable. That can be between weeks 3-6 after the fracture. It’s OK to remove the sling from time to time. Especially since our elbows tend to get sore sitting still in a sling for a while.
Good luck
Dave
Hi Dr. Luks,
It’s been 15 weeks since I broke my clavicle as I noted in my post above. The bones are overlapping and the distance between the bones seems 10mm-20mm. Originally the doctor measured 10mm, but it seems like more when I look at the x-rays. The last visit to my orthopedist, two days ago, is showing no real signs of healing from the last visit, which was very minimal then (30 days ago). It’s hard to tell from the x-rays if there is any callous formation. He suggested getting a CT scan to have better visibility. I’m not in any pain and haven’t been for 8 weeks or longer, but I’ve been in a sling for most of that time and only recently started to not wear it. My doctor said I can begin to use my arm more. In the last two days I started to do more and have felt some pressure at the area with more use, and occasionally clicking, but no real pain. I haven’t tried to raise my arm much or lift anything over a few pounds, so I’m not stressing it. I believe I’ve been diligent in immobilizing it and have maintained a healthy diet. I have had two glasses of wine a day, about 4-5 days a week, for the last 5-6 weeks, and that seems to be the only questionable concern, so I’ve stopped completely. Prior to that maybe one glass a week if that. I regularly take vitamins, multi, and additional calcium with other vitamins, glucosomine/chon. religiously. My Vitamin D level was well above normal. Also, I’ve been supplementing with Ashwaganda for the last 4-6 weeks as I read it can improve osteoblast activity. I’ve also been applying Comfrey a night before bed. I’m a non-smoker and was working out 5 days per week prior to the fracture, so health was very good. Hardly use NSAIDs also. I was diagnosed with Scheurmanns disease 5 years ago as I lost 2 inches in height, but that doctor thought it was something that occurred many years ago when I was younger and I never noticed or had reason to look at it…I’m 53. Should I consider having any blood work related to bone health and formation? Is the CT scan a good idea at this point? Can healing occur gradually like this? I’m concerned that I’m coming up on 6 months without normal signs of healing? Could it be healing, but not showing up on the x-rays. Thanks, Dave.
Stephanie
Hello Dr. Luks,
I have a “delayed” union of broken displaced clavicle with little to no signs of healing on X-ray at 12 weeks. I’ve been doing physical therapy for a few weeks and have been getting my range of motion back and doing pretty well, though still have some mild pain sometimes. My ortho now wants me to try a bone stimulator. I am very averse to surgery as I have young children and a blood clotting disorder. What are my chances of healing at this point? Can I live with a non-union?
Thank you so much for your time and for this helpful site!
HI Stephanie… glad the site has helped you.
A bone stimulator might help. People do live with non-unions… although they might bother you from time to time.
Dawn
Hi Stephanie,
how are you now?
I’m at 12 weeks and being advised to use electromagnet therapy (PEMF), soft callous formed.
any advice would be appreciated
thanks Dawn
M. Mosler
Hi Dr. Luks, my 13-yr old son broke his right clavicle skiing on February 19th. It is a clean break and the doctor in the ski clinic said it would heal well. Today we met with a pediatric orthopedic surgeon who recommended surgery because there is a 1.5 cm. overlap. We were very surprised (we were not looking for a second opinion but wanted our son to see a specialist who would monitor the progress). The doctor was not pushy at all but it is his recommendation to do the surgery but in the end our call. Surgery can be done as soon as this Friday. The second option is to take another X-ray on Monday and then decide to do surgery on Wednesday. Not ideal to wait of course. Thank you for your advise.
HI … tough decision. A 13 year old still has a fair amount of growth left. A broken bone in a child will typically over-grow due to the increase in blood flow after the fracture. That might lessen the overlap over time. This is not a clear reason to operate. It is gray at best.
In a situation where someone is a top flight, elite overhead athlete then we might consider fixing a clavicle fracture in this situation. Otherwise most would likely watch it heal. I would consider another (in person) opinion. I can not comment specifically on how your child’s fracture should be treated.
Paul
Hi Dr Luks, thank you so much for this very helpful page. I broke my right clavicle and had surgery 3 weeks ago. it was fixed with a plate, 7 screws and a bone graft. After surgery they gave me a sling but said I didn’t really need it, it was just for comfort. they told me not to lift anything heavier than a cup of tea with my right arm (touch weight bearing?) I’ve been back to work at my job which is semi physical for 2 weeks now. I’m not putting any weight on my right arm at all but mostly not using the sling. I have no real pain and almost full movement of my arm (though I’m trying not to move it from my chest). when I went back to the hospital for my follow up at the clinic, the doctor I saw was surprised that I wasn’t wearing a sling. he didn’t really give me a straight answer about the sling / going back to work. he just said if there’s too much movement it might not heal.. I’m wearing my sling more often now but not wearing it at work. Am I taking a big risk by going back to work. should I be wearing the sling all the time? is it worthwhile asking my GP for a referral for an x-ray to check the progress.? thank you for any advice.
Follow up X-rays are important to make sure everything is healing well. Becoming too active too soon can cause problems.
Jonny Hammond
Separated my AC joint snowboarding! I race Arctic Man ! Surgeon is saying to go with the non surgical route!
It works for many .. good luck!
Kate
Thank you for this page Dr Luks, very informative. I also broke my clavicle at the lateral end in October 2016. As it was close to being an open fracture they performed surgery and fitted a plate and screws. I was in immense pain for weeks after with very limited movement. today, 15 weeks later I’m still in pain every day and although movement has returned, I only have about 20% and certainly with no strength. When x-rays were taken at 3 weeks and 9 weeks post op, it showed the bones had not joined. At 14 weeks the bones have just started to connect in the centre. My doctor says this is perfectly normal and to be expected. He says when he removes the fixing plate 1 year post, he will shave the bone and possibly carry out a decompression. This all seems very intense to me and that the initial surgery could have been done satisfactory in the first instance and had the bones join, even possibly with a graft. I feel my whole life is on hold as I can’t play my sports or musical instruments. My question is- is this really ‘normal’ or should I seek further opinions and examinations? Many thanks.
Thomas Murphy
I broke my left clavicle in October, it is misplaced and broken at the shoulder end, I have been back for x-rays every 6 week since then with little improvement, I have to go back on 15th march for another x-ray and then surgery might be an option. I have full movement back in shoulder but am still getting pain and cannot lift anything heavy without discomfort. I’m a bit frustrated as if I had had surgery straight away I feel I would have been fully healed by now but It was never discussed as an option until now.
Would you expect a full recovery after surgery of a break over 6month old?
Those are tricky fractures at that end. The complication rate of surgery is high and the results from non-surgical management in most is very good. That’s likely the reason why your doc chose non-surgical management. Since I have not examined you and have not confirmed that it is the fracture that is still bothering you I can’t comment on how you might or might not do after surgery.
Sorry
Arlie
I have a friend had a right clavicle fracture and took surgery using pins almost 5 years ago. He resume on playing basketball a year after the operation. And now he is experiencing pain on the back part of his shoulder and it feels sharp when he flex. There is small bump on it. What is the possible cause of that small bump because when it pains, it becomes bigger? Does he need to undergo another surgery? Thank you, this is a great help.
You friend needs an X-ray to see where the pins are (they can move) and to make sure that everything healed well.
Tim
Great article, wish I found your page 9 months ago. I’d made a rapid bicycle dismount flipping over the handlebars at speed on to my head courtesy of a passing motorist resulting in a 3 Part lateral clavicle fracture. I could not lift my own arm. Filled me with dread but I opted for surgery as the benefit from surgery for this fracture appeared to outweigh the risks. It was impressed upon me that if surgery was the best option, better to have it soon after the injury as it is potentially less complicated/increased chance of a successful outcome than needing surgery later. Had plate inserted with 6 lateral locking screws and 5 medial screws & inferior fragment held to medial fragment.
6 weeks in a sling, tiny pendular movements only, followed by passive then active phsyio but took 12 weeks before fracture healed sufficiently to allow holding anything heavier than a shirt. 5 months to regain most of my dexterity and the strength to do press-ups. I underestimated how quickly muscle wastes and how important physio was. I honestly don’t know how procyclists get back on their bikes only a few weeks after fracturing their clavicles and having surgery. 9 months on, I have a well healed 7 inch surgical scar, no sign of infection and although I’m constantly aware of the plate, it does not currently bother me. Sensation eventually even returned to the numb patches post surgery. I’d be interested to know if there are any circumstances in which removing the plate and screws could be recommended and if the metalwork presents any additonal risks, say if I was unfortunate enough to meet the same motorist again?! Thank you!
There is a risk of re-fracture if an unfortunate event (fall) were to happen if the plate was removed. That risk can extend out 3-4 months after plate removal.
Gid D
16 y.o. broke my collarbone skiing 2 weeks ago. got surgery a week ago today. i feel like i have super good motion and no pain at all. doctor had me out of the sling 3 days after surgery so i feel super normal. i’m hoping to catch the tail end of the ski season. optimistically, do you think i could get back on some easy runs in about a month?
Nope … you wouldn’t want to have the surgery again.
penny
Hi I had a bike acciendent July 10th 2016. 3 ribs , punctured lung. elbow, wrist and collarbone. Collarbone never united for 14 weeks . I had surgery Oct. 12 still waiting to move on with life. How careful do I have to be? Finally back at work very active. 61!! Thanks this has been very helpful
Janice
My 58 old father broke this collar bone like three days ago. Do u know how long would it take for it to heal?
Average is 5-6 weeks… some longer, some may not heal.
Roger
I broke my collarbone 5weeks ago. Pain was all but gone till about 3 days ago. Now I have med pain by my neck. The break was about the middle of the bone. Their is an overlap and according to the X-ray things are healing well. Is the new pain normal?
Thanks a ton for your article and replies.
HI Roger…
Hard to say. Neck pain may not be associated with the fracture… perhaps it might be an injury which occurred when you broke the clavicle though?? I would follow up with your doc if the pain persists.
John Goss
Dear Dr Luke
A couple of days back I discovered a cyclist on your brilliant site, I think a few years back, who had broken his collar-bone, similarly to me and had eventually ended up with, I think, a non-painful non-union or something.
I am seventy two in March. A week ago today I broke my clavicle at the distal end and thankfully the fracture is aligned. I came off my bike after having been to a Pub Quiz. This is my second clavicle break. The first, perhaps twenty years ago or more, also in a biking accident though not my fault then, was painful. I remember how long it took to be able to reach my arm above my head.
This time I was only about two hundred yards from home when I came off. The initial pain was bad, I realised the bone was fractured, and I had difficulty managing my bike one-handed. As it was a downhill slope to home I painfully remounted my bike, checked that I could use the brake with my injured arm, and cycled down the slope the rest of the way home. It was much easier than trying to walk with the bike. Feeling an idiot for coming off, I really wanted to get home.
Getting undressed was almost unbearable. The next morning, although painful, I discovered it was not as painful as my previous fracture. Nevertheless I cried out a few times. Without showering I took myself to A&E. The physiotherapist, a nice man in a bow tie, was very understanding, examined me and the X-rays revealed the fracture. I was told I could exercise my lower arm and a triangular sling was given me with an appointment to return the next day to get a cuff fitted. He advised that the bone might not knit completely.
When I saw the consultant the next day my main concern was when I could get back to playing golf. For putting almost straight away, and your very short game about the same I was informed. Yesterday I took an eight iron to my course and struggled with six holes rather unsuccessfully, but learning from the experience. I have had difficulty in getting my left arm, the fractured arm above my head without pain. What I have been doing to stretch it is force it up to say the top of a door and pull down using the door to stretch it. I have also used the sink and side of the door. This gives relief and at the moment I am very optimistic of a speedy recovery.
To treat the pain, especially early in the morning I have been using a Devil’s Claw (harpagophytum procumbens) gel which is cool and soothing. I have taken no other analgesics except wine to get me off to sleep at night. While I should be jumping for joy I am concerned about other reports regarding keeping my arm in a sling for three weeks. I’ve worked on the principle that if what I do is not hurting too much I should continue doing it. Am I right? Or is there going to be payback?
Well… you should significantly limit your motion until your fracture has had some time to try and heal. Once the area becomes “sticky” it will enable you to move more freely and without such significant pain (getting dressed). Distal clavicle fractures have a much higher non-union rate– but many of those non-unions are painless and do not require operative treatment. I would give the fracture a few weeks to try to heal… and see how things progress from there. Shoulder stiffness after treatment for a clavicle fracture is uncommon.
John Goss
Thank you very much for your advice. Today, nearly a fortnight after the accident, I am virtually pain-free, though not quite. I do realise that each individual circumstance is different and some patients experience multiple fractures and crushed bones, non-aligned bone fragments, which must be altogether more painful than my straightforward fracture. I decided to log my progress based on my initial request to you for advice (edited).
[I meant to include this here].
My appointment at the QE Hospital Birmingham UK, is 03/02/17 a month away.
I have heard since first writing to you that some collarbone fracture victims are back in the gym in three weeks. I don’t know, but for certain collarbone fractures there may be a case to get mobility back as soon as possible. Not sure on this.
We allow people who are comfortable to head back to the gym for lower body work and aerobic training. We would not allow resistance training on the arm until the fracture is healed a bit more… usually 5-6 weeks.
John Goss
Thanks again Dr Luks. I am taking your advice to slow down a bit and not overdo working towards getting back into the swing of things.
I am impressed by your website which must be unique.
John Goss
My progress appears to be extraordinary if not unique.
https://wordpress.com/post/johnplatinumgoss.wordpress.com/10
Ashley Hinton
I broke my left collarbone 2 days ago when i fell off my bike. Very active triathlete. 39 years old non smoker. First broken bone of my life. Ortho said he would let me chose about surgery that it could go either way. He agreed to wait and see the 2 week follow up X-rays but probably no surgery. Having to be out of the gym for more than 2 days is a huge struggle for me. Would you agree with no surgery? When can I at least begin lower half exercises and right arm weights?
Thanks!
Hi Ashley … The pendulum is swinging back towards non-operative management of most clavicle fractures. Research shows that the healing rate of these fractures might be higher if treated surgically, but the complication rate in very high (infections, non-unions, numbness, neuroma, and so on). Being a very active runner, cyclist and gym goer I get it… I will let my patients back in the gym for non-impact cardio when they are comfortable…. lower extremity weights when I see some early signs of healing (2-3 weeks after fracture). Without seeing you or your X-rays I cannot comment on your specific case. But you should have an in depth discussion with your doc about what activities you can pursue at what time frame.
jon sabes
ashley – did u go non-surgical route? i was going non surgical route, but i am changing my mind – i want this fixed sooner – given i am accepting some additional risks – it just feels that a non union is possible as there is 216mm separation with muscle in between
Alex Black
Hello Dr. Luke. Broke my collar bone skiing about a week ago. It is a distal end fracture with small (1cm) displacement. From what I heard distal fractures tend to have a higher rate of non-union. Do you know if people with non-unions can return to sports activities such as skiing, bicycling or surgery is a must?
You are correct … distal clavicle fractures do have a higher rate of non-union. Long ago, because of that we started to fix most distal clavicle fractures. The pendulum has swung back to managing many without surgery. This is because most of these non-unions are asymptomatic. That means that even though you may have a persistent non-union you may not have any pain.
Msid2
I broke both my collar bones, smoking other bones in a car accident 10 years ago.
Only yesterday I discovered that one of my collar bones never fused and there is still a significant break gap,
It’s never caused me any problems and I have full range of movement in my arm (as far as I’m aware!)
I’m guessing/hoping that they’ll be no need for surgery?
We don’t need to operate on all clavicle non-unions… usually just the ones that bother patients enough to want to have the surgery.
Rubiah Haq
Hello Dr. Luks. My 12 year old daughter broke her collar bone in one spot 9 weeks ago, it looks like a triangle. It is still not healing. Is that unusual? For females, if they are already on their period for 2 years effect the healing time? Thank you.
howard2
Why do you say it’s not healing? Is she more comfortable? sometimes healing on the X-rays lags clinical healing (less pain with use and touching the fracture).
Paul Kings
I broke my clavicle back in 2007 , til this day I still have a 2 inch break . I feel no pain , movements are normal , I do avoid certain movements when it becomes uncomfortable. I live an active lifestyle , gym , work . Etc . I am starting to feel back and neck pains more often and even recently numbness in arms and hands when I sleep . Should I look into surgery at this point ?or is it too late since it seems bone ends have calcified .
howard2
It might be worthwhile talking to someone who has treated many clavicle non-unions before.
Jeffrey Love
Hello Dr Luks
My 12 year old son broke his clavicle in 2 places, clean breaks. One at the end and one in the middle of the clavicle.
The break at the end where it attaches to the shoulder has a minor gap and the other break has a significant gap of about 1.5″ ~ 2″, I have keep him out of school for 8 days after spending those days imobelized and now he is moving around and back at school.
Will it help now he is moving to realign his shoulder?
Do the mussles around the clavicle help to realign the break.
The clavicle has moved very little to realign so it can begin healing. To what extent should he be moving his shoulder if at any this early in the healing process?
Is there a reasonalble amount of time that should be given to allow for alignment before considering surgery?
He is wearing a shoulder brace that allows movement of the arm.
Thank you for taking the time to comment. I am hoping we can avoid surgery.and that he is young enough to heal well.
Hi Jeffrey… I am sorry to hear about your little guy. I really can’t comment without seeing him and the xrays. Segmental fractures like this are unique… and require an individualized approach.
Good Luck
Dave Scott
Hey Mr. Howard. I had a fracture collarbone on October 22 I’m moving around pretty good now with a lil pain my team have or in the semi and we have a huge chance on making it to the final on Dec 4. You think there is a good chance I can play in that final game or I shouldn’t? And how long would it take for me to get back in the gym again?
Nope… that would be a mistake. It depends on your xrays… but usually 2-3 months minimum… especially with contact sports.
Bless
Thanks. Wish i lived closer so you could be my ortho doc, but i am clear across the country.
Bless
Thanks for all this info, Dr. Howard. I fractured my clavicle last Wed, while on a cycling trip in Cuba after my chain came off & flew into my back wheel (always bring your own bike to 3rd world countries–lesson learned!). In Cuba, they put me in a cast but after returning home, I was able to have that removed today & a sling put on. Ortho doc can’t see me til Wed. Any special position of arm in sling (hand height relative to shoulder?). I am a very athletic 69 year old distance runner, cyclist, tennis player–non-smoker. Fracture is on right side & good news is I am a lefty. How soon til I can start jogging?
I hate when I fly off my bike! No special position needed. The position of the fracture rarely changes from what it looked like initially. Jogging starts after some healing has taken place… that will change person to person. Usually 4-8 weeks.
Alex Avgerinos
Thank you for the reply Dr.Howard. I will try and stop smoking (have quit before for over a year) as per your recommendation.
If I could ask you one more question. If I have a choice to have surgery or simply pop bone back in place which would be a quicker healing period?
Concerned that popping bone in place will result to once again waiting a long time to heal only to find out it hasn’t. My job requires me to be able to handle “contact” and I really need to get back to it.
Alex Avgerinos
Great site. Very nice of Mr. Howard to do this.
So I broke my collarbone playing football 7 weeks ago. It was a minor displacement so was told to wear a sling and no surgery needed. Wore the sling off and on for 4 weeks. After 4 weeks I felt much better with little pain and almost full range of motion. Got another x-ray to see if I can be cleared to go back to work ( peace officer) but results said that no callous has been formed, still minor displacement.Another 3 weeks and now x-ray says that it has transformed to significant displacement. Just got referred to a surgeon. This is a nightmare. I am 41 and smoke socially but more since injury…
Doctor says that surgeon will do surgery or pop bone back in.place. What do I do? I don’t think I can handle being off work for another 2 months. ( Career in jeopardy if it takes more then another month or so.
Alex…
Smoking is the number one cause of bones not healing well. Some people have a relatively pain free non-union- that means that the fracture didn’t heal, but it doesn’t bother them. I allow those folks to return to most jobs (no overhead heavy lifting), but do not allow them to return to contact sports. Bone stimulators and bone marrow injections have had some success in getting these fractures to heal … Now, without examining you or your X-rays I can not make formal recommendations… but perhaps you can use this to stimulate a discussion with your doctor. This is a great time to stop smoking — which could cause the surgery to fix the fracture to fail too.
Chad
My son had some soreness after a big collision in his last football game. He’s never injured his collarbone before. It’s been a few days and there isn’t much if any pain unless you really press on the area. He is 11. We were going to wait through the weekend and see a DR for an x-ray if it was still bothering him. But since it’s not I’m inclined to just not worry about. What do you think? Is it possible that it was just bruised? He did fall onto his side with a player on top of him. Thanks!
Without examining him I can’t tell you what to do. If the area is tender more than a few days after trauma then it might be worth seeing his Pediatrician.
L. Barr
Hi
I had surgery 11 days ago to plate my clavicle which was described as a 3 step break . I am in no pain and have already taken off my sling as my movement was good . I’m not lifting anything heavy but can do most things around the house etc . Just wondered if taking off the sling is ok after reading other comments on this informative site. Thank you
It’s up to your surgeon. That decision depends on how many plates were used, how many screws were used on either side of the fracture and how strong your bone is. If you use it too much, too early the repair can fail in certain situations.
James
Hi howard is there an email i can send yoy my xray for my clavicle?
sorry.. no. I can not offer treatment recommendations.
David
Dr.Luks, thank you for getting back to me. I wanted to ask one more question if you don’t mind. I should add i am 61 year’s old ,to be 62 in Nov. active male. I did some research on this and read that a bone graff has to be performed so the old bone ,remember a year old fracture will heal. Does the bone have to come from me? I read where someone said the bone graff from there hip was very painful. After the year i have had i am not ready for more pain.The rotator cuff recovery was tough and painful. I should also add that when i was given the option for surgery to repair the collar bone i did not do it because i had never had surgery and did not want the hardware in me. Thank’s again………………………
Gert
Broke my left collarbone 5 years ago (Sep-2014). At that time i was hitting the gym 4-5 times a week, dedicated to bodybuilding. Daytime job working in construction and road maintainence.
Got it “fixed” (with a piece of barbwire) at least i wanted it to be close to the shape, length as it was before. Anatomical correct like the body intended it to be.
The collarbone / clavicle / (in Dutch : sleutelbeen) is an important part of the shoulder and it biomechanics. Shortening, malrotation, angulation AFFECTS the entire shoulder. I know because my clavicle has a great number of defects. A symptomatic malunion with a vary of symptoms.
Shortened by +/- 18 mm
Angle instead of curvature. The natural curve is oblitirated.(S shape)
Malrotated at the fracture that causes the shoulder to be rotated forward (ptotic) and stuck in that position.
Pins and Needles when lifting something heavy (5kg)
Muscle Weakness and spasms. Sore muscles and tired arm in no-time. No full rom in left shoulder. Sore AC & SC joint.
Scapula winging. The blade sticking out all the time. Discomfort when lying down and sitting with your back against a suface.
Thoriac outlet syndrome. Heartbeat goes away when lifting arm above shoulder hight.
A-Symetrical drooping forward stuck shortened shoulder.
And always diThrought and pain. In rest and in activity.
I was a very active person. Not any more. No more gym, no more bodybuilding. Had to find another job. Goodby old-job.
The doctors here in my country decided this was good enough for me. Because other people had the same or worse to their clavicle / shoulder and they had no discomfort. (Yeah right) Through the years ive been to multiple doctors (at least 8) and all laughed at me and just said, “learn to live with it”.
I gave up after 2 years to find a doctor here in my country who was seeing the problem and willing and able to help me and correct this malunion. (Combination of Brains and Balls)
..
On the ” bright” side at least i got morphine capsules after endless complaining and begging.
So i can “live life” with a little bit less pain.
Dont mind my English. It’s not my native tongue.
David
I broke my collar bone a year ago. The first xray showed one part leaning on the other. I did not have surgery. Well after the sling for some amount of time . I did the rehab p/t. I got my rom. back but still could feel some pain if i moved it a certain way. After about 6 weeks my doctor took a xray to see how it looked. Well it did not heal. The two ends did not connect. The slip and fall that broke my collar bone also tore my rotator cuff on my left shoulder. I did have the surgery to fix it. I am still rehabbing the left shoulder but it feels pretty good. Now back to my collar bone on the right side. It still give’s my pain when moved in different ways. It’s been close to a year. My doctor said if i want ,he will fix it. My question is what is the chance of a successful repair after a year has passed?Is it worth going though the rehab again? I have been out of work for almost a year as it happened in Nov.2015. I hope you can give me some advise that will help make a decision. Thanks
Surgery on clavicle fracture non-unions (fracture didn’t heal) is usually successful… but it should be done by a surgeon who is well versed in dealing with these fractures. We do things a little differently in the setting of surgery on a non-union.
Bob
I broke my caller bone and the bone over laps the other one they say I should put plates in my arm but I play football what would be better for my football carrier
JGiles
11 y/o female. Original break 2 wks ago, non-displaced, arm in immobilizing sling. Subsequent fall 4 days later, did not impact arm or shoulder however she was in a lot of pain from body jolt. Following visit/xray with Ortho MD showed noticeable movement and separation at break site in comparison to original xray. Ortho stated 50/50 for surgery. What is your opinion?
howard2
unlikely
Louise
We have got so much information from this website today. We are just back from the hospital having found out my partner broke his clavicle after a biking accident. Thank you for being so kind to answer everybody’s queries!
ache
Hi there i broke my right clavicle on sunday i didn’t have pins and needles when i went to the hospital and i don’t have them when i sleep on my back with my arm out of the sling however with my arm in the sling close to my body my thumb feels tight and i get pins and needles in it when i remove my arm from the sling and move my fingers about the pins and needles go away should i contact my doctor about this or wait until next week as the doctor advised me to wait a week then have another x ray to see if it requires surgery. I can attach pictures to instagram if you can access them I’m not sure how to attach them. Your site has been very helpful thank you.
Galen Schlag
My wife fell out of bed last night. Emergency visit x-rays showed fractured clavicle. The fracture was in the middle and still looked to be lined up. However, there was piece of bone that had chipped off. Any concerns, or should it heal without surgery?
Nope … shouldn’t be any concerns
Mrs A Wilson
Hi my 17 year old son has broken his clavicle, when first seen by A&E the doctor said he will more than likely need surgery. I went out to call my husband to explain this, then my son was visited by the Paediatric who spent no more than 10 seconds with him, told him to take 2 paracetamol and go home. I was not happy as I think this should have been explained to myself as my son was in shock and his body was shaking I didn’t think he was in a fit state to take what she had to say in. When we arrived home we wasn’t happy with the state he was in and it looked like the bone was about to pierce through his skin. I took him to another hospital for a second opinion. The gave him a local anesthetic to numb him and hopefully his shoulder will drop a little and some serious pain killers. They also thought he would require surgery and said I have to visit the original hospital on the 4th October where they may well decide to op then. I have a copy of the x-ray would you be able to give me advice on whether you think he would require surgery. Here in the UK they don’t like to use NHS money, but I am willing to pay private for my boy if this is what is required
I’m sorry.. I can not offer advice from afar.
See Dr Funk … great shoulder doc in the UK for a quality opinion.
Cam
I just broke my left clavicle last week and it seems to be over lapping. It doesn’t hurt much but i can’t use my arm very well. Do you think it will heal on its own or will i need surgery? Thanks a lot!!
You need to wait until the clavicle starts to heal. That could take 5-6 weeks — longer in some people.
Lynda Trimble
Dear Dr. Luks, I am a 66 yr old widow. I have never smoked. 2 months ago I fell going downhill in my yard & fractured my left clavicle. When I saw on the X-ray that the bones were overlapped, I didn’t see how it could ever heal properly on its own. My late husband was an interest & rheumatologist so I never had to take another physician’s opinion without the feedback from my very intelligent hubby. I’ve been feeling really lost until I read your comments. I feel much better now & feel I can wait longer to see if it will either heal on its own or if I can tolerate the discomfort caused by moving around. Could you tell me why the doctor & nurse practioner stress NOT lifting my arm above my head ? Thank you so much for this labor of love & remember that for every person who takes the time to leave a comment or thank you, there are probably ten who don’t have the time or don’t feel well enough to type.
Respectfully,
Mrs. David Paul Trimble, Jr., M.D.
Kansas City, Ks.
I’m sorry for your loss ! Thank you for the kind praise.
Once the pain has diminished and the fracture has started to heal you are able to move your arm overhead for stretching purposes. Repetitive overhead lifting is possible and fine to do once the fracture has healed.
jeff
I broke my collarbone over 9 years ago, it never healed and has significant movement. It feels sharp and even has a grinding sound when I flex. It hasn’t bothered me too much, I can tell me shoulder is lower and farther down but never really hurt. Is there a chance that eventually I’ll need surgery? Would that require that the surgeon breaks it to reset? Does the nonunion wear down overtime?
A non-union that is this old will certainly not heal on its own. I would not expect it to “break down” either. Pain would be anticipated due to the motion that remains between the bones. These can be fixed.. usually— but it should be done by someone who has operated on many non-unions in their career. It is trickier than operating on a fresh fracture.
Auffman
My fifteen year old daughter broke hercollarbone in four places and got surgery back in August. Two months ago the doctor let her start playing volleyball again. One month ago we had her last appointment.
She plays a lot of volleyball, but all of the sudden she is experiencing pain in her collarbone and the muscles in her shoulder. Is this from her lack of use for three months (the first month she had a cast on the same side) or from her surgery? What exercises do you recomend? Should we go back to the surgeon or a physical therapist?
Hard to say what’s going on … possibilities include:
the fracture hasn’t completely healed
the shoulder isn’t full rehabilitated
the hardware is bothersome
and other possibilities that a physical exam and repeat X-rays would be needed for to make a determination about the cause of her recurrent pain.
First step is to follow up with her doctor.
Mark
My son (16) broke his left clavicle 12 days ago during a soccer goalkeeper clinic. ER doc on date of injury said a simple arm sling was sufficient, clavicle fractures generally heal on own, and to follow up with an Ortho. At first Ortho visit (4/5 days out due to holiday w/e), doc said there was no indication for surgery (<2 cm overlap, no open fracture, no fragments, etc.). Had follow up visit with Ortho today, again said surgery was not required, however, introduced the idea of surgery (along with the risks) if we were looking for the bones to be perfectly aligned and wanted to have more mobility with the arm in a shorter period of time. Looking for the most reliable approach for recovery and best long-term results for returning to athletics (weights, soccer, dive, golf, snowboarding). Realize no guarantees, any thoughts on best approach? If elects not to have surgery, and sees doc in 3 weeks, can any issues be corrected at that time with surgery? Thank you for the consult.
The return to play (RTP) isn’t very different between those treated with or without surgery. IF there is no significant shortening there is nothing wrong with continued non surgical treatment. Having surgery now will restart the healing clock back to zero since they will need to remove any healing bone that is present in order to repair the fracture.
SMullen
My 13-year-old son broke his clavicle 4 days ago at football practice. A family physician, after looking at the x-rays, ordered the usual treatment, a sling, and said he will should be healed in 6 weeks. I’ve noticed that his left shoulder area, the side of the break is significantly lower, by several inches, than his right (non fractured side). Is this normal? Just wondering if I should have a ortho look at it or if it was common.
Not uncommon as your child relaxes the arm so it hurts less. Also no harm in at least talking to an Ortho for peace of mind. He needs follow up X-rays anyway.
Angelica
My son broke his clavicle on Friday and is requiring surgery. Football is his life and is very depressed. The ortho surgeon said that it’s probably not a good idea to play his senior year because he will still have the plate in and it could possible break where the plate isn’t. Is this true? I mean it’s almost a year away and this is not helping his spirits. thanks for any advice
Re-fracture risk is generally higher after a plate is removed. Sure.. it is possible to break the clavicle again after it’s fixed, but that’s not a common reason to sideline someone. You might want to consider a second opinion… you have time.
Connaire M
I broke my left collar bone in a motorcycle accident just over three years ago and it fused with a relatively large overlap (my left side is about 1 inch shorter). I had asked for surgery as around 4-5 weeks in because the two pieces were still grinding/moving freely but when I did the Dr. told me that there was a 5% chance that I would lose all function of my arm which at the age of 18 seemed a bit too high for me to risk. Now I’m having back/neck problems from it and I am wondering if there is a way for them to re-break it and pin/plate it into place.
If the pieces are moving then it may not be healed. It can be fixed, but it is challenging for an inexperienced surgeon. Find someone who is comfortable with an old clavicle fracture.
Eddie M
My son broke his clavicle aka collarbone 4 weeks ago playing football an is expected to return to football in a couple of weeks. What’s your outlook on returning at 6 weeks?
Can be risky… the issue/risk is refracture if athletes return too quickly.
J Gomez
My son broke his collarbone and had surgery 6 weeks ago. He wants to return to play football in 4 weeks. Making it a total of 10 weeks after surgery. Is that to soon?
That depends on whether or not it is healed.
Phil (from UK)
What a great site. After my cycling accident 3 weeks ago that left me with broken left collar bone and 3 ribs I was getting conflicting advice about the position of my sling. Some people told me my left hand should be on my right shoulder but doctors and nurses told me that horizontal across the chest was fine. Horizontal was better for me as it was less painful. At my fracture clinic today the x ray showed the bones have not lined up and there is at least 2cm overlap. My doctor told me that it should heal even in that position without any significant problems. Do you think that if I had my arm on my opposite shoulder over the past 3 weeks it would have allowed the bones to line up better. Is there anything I can do at this stage to get better alignment or is it too late. My next fracture clinic appointment is in 6 weeks.Many thanks.
The position of your arm in the sling is not affecting the overlap. The injury led to the overlap… nothing could have been done other than surgery. These are rarely easy decisions to make.
Chad
I broke my right collar bone 6 weeks ago after a lost control of my motorcycle on some gravel. By the time I knew what happened it was too late and I took the weight of the bike square on my shoulder. The doctor suggested surgery, but I couldn’t afford it due to terrible insurance from my employer. I opted to try the sling and went back for Xrays a week ago. The bones did not end up lining up causing my right shoulder to be dropped a few inches. I inquired about going through with the surgery now, but was told it was too late as it was already starting to heal crooked (there is a small piece of bone connecting between the two larger sections almost making a Z pattern). I have now gone without the sling for the last 3 days but have a lot of back aches behind my right shoulder blade and at the top of my shoulder. The fracture site doesn’t really bother me at all, just feels tight, but the muscle aches are hard to deal with. Do you think I should get a second option on the surgery? Will doctors re-break this and plate it? If the back pain keeps up I’m not sure I will be able to deal with it. Any feedback is greatly appreciated.
No harm in trying therapy first for a bit… you can find a surgeon who can take it apart and fix it— but only if it’s necessary.
Carrie
My six year old broke her collarbone and is in a sling she is to go see bone dr again next Thursday. I know she is to wear this for six weeks or so…can I remove the sling for bathing and should I let her straighten her arm some…she is not moving it at all keeping it in the sling in a bent position?
Thanks in advance!
The Brownings
Children simply won’t move the arm because it hurts too much. No harm should come from removing the sling to allow for careful bathing. She will move the arm when she is ready to… don’t force the issue.
Rehana
my husband broke his clavicle bone from the middle into two pieces but in straight line four weeks ago his pain is much better now please tell us how much time need for recovery thank.
Sounds like he is recovering very well.
Another 3-4 weeks and most clavicle fractures will be well healed.
Pete
My son broke his collar bone at school yesterday falling on it. The ER doctor ordered a sling and a follow up visit with an Orthopedic doctor tomorrow. He is 10 years old and I heard kids heal faster after they break their collar bone? We are going on a cruise in 17 days and I was wondering if he will have any mobility or none? I really do not want him to have surgery unless it is the absolute last resort. I read most collar fractures heal perfectly fine on their own. Please take a look at his x-ray and tell me what you think, Thanks!
https://www.dropbox.com/s/aksabtuh7817ko7/X-RAY.jpg?dl=0
Surgery on a clavicle fracture in a 10 year old is very very rarely necessary.
When you meet with your ortho they will base their recovery plan on his exam and X-rays.
Pete
Thank you!
Harry
I broke my right collarbone (clavicle) about 3 months ago playing rugby. It was broke into 2 parts and over lapping 1.5cm. Surgery was briefly considered however the distance between the 2 bones had to over 2cm. I wore a sling for 5-6 weeks. I began doing gentle exercise 4 weeks ago(2 months after the injury) such as PE lessons and running, but still can’t pick up heavy(ish) things or carry a backpack for to long because I can feel the bone it self aching. Bearing in mind the first doctor I saw said in 3 months I could be back on the rugby pitch. I know now realistically this isn’t possible. Is it aching because the bone hasn’t properly healed? Should I stay away from sport for a longer period of time? Will I be able to lift weights in the future because I am planning on joining the army, and when would it be safe to be able to play rugby again? Any help or advise would be appreciated.
Ps: I’ve been looking on the Internet about other people with the same injury and many only had a sling for 2-4 weeks and after a month or 2 have gone back to normal. Is this because mine is a over lapping brake and haven’t had surgery?
Thanks
Some fractures heal slower than others. Over-lapping doesn’t usually affect healing…it more the 1.5-2cm it can cause weakness in some high level overhead sport athletes
Feliks Raap
Jo man I have the exact same situation, how are you now?
IanD
How com you did not publish / reply to my comment?
I don’t see it …
Drew DeMann
I fractured my clavicle earlier today while traveling on vacation. I fell while playing my young daughter. X-ray shows a comminuted fracture with a complex appearance. I am a 55 yo active pain management specialist but I dont have much experience with these and really need your advice. If I need surgery I need to start making plans to go home early. I have attached the ER X-ray. THANK YOU IN ADVANCE! Drew
https://dl.dropboxusercontent.com/u/6806376/Home%20Documents/Project%20-%20Personal/DeMann%2C%20Drew/Fracture/IMG_0155%202.JPG
Might look scary … but many of these will heal fine — larger surface area. The decision making about whether or not to have surgery on a clavicle fracture is based on many variables and it also depends upon you, your activity, etc. . . It can usually wait until you get home from vacation.
Shauna Carpenter
My orthopedic surgeon said I needed surgery on my left shoulder’s broken clavicle near where it connects to humerus. Three days go by and swelling and pain are reduced so I’m balking at surgery. Will it heal in several weeks without surgery to play golf satisfactorily? I am 50 in good shape and no smoker.
Most distal clavicle fractures do not need surgery. Many will actually not heal… but it develops something we call a painless non-union. Meaning, despite the fact that it might not heal — it often doesn’t hurt or bother people.
Tracey Nordmeyer
My 81 year old mother broke her collar bone and some ribs. The figure 8 sling she is wearing keeps slipping off of her shoulder. Will it heal properly without the sling?
Figure of 8 slings aren’t used much anymore. They do not really correct the displacement in the fracture and should not affect fracture healing if they are not worn. I standard sling or shoulder immobilizer should work just fine
George
Hi I’ve shattered the end of my collarbone. Xray shows two small fractures on top and a splinter pointing 90 degrees downward a few cm from the end. I use my right arm alot. Shouldnt the splinter be put back into place for better healing and less risk for chronic pain and stiffness in cases like this? Would seem most logical to me. Thanks for your time and a great blog post.
It certainly sounds logical… but, most of these sharp fragments will smooth out over time and not cause constant pain.
Good luck
Josef Hoffman
Thank you very much for posting this. I broke my clavicle on the distal end 11 weeks ago and I’m super glad it stayed aligned. I’ll find out if it’s healed after an X-ray two days from now. There’s a lot of poor info out there and it’s really easy to convince yourself you need surgery, especially while you’re brooding inside with a sore shoulder and nothing to do. Anyway, thanks for writing a clear, concise guide to current medical thought behind treating this.
Robert Marquette
My 15 year old son has a fractured collarbone, is it necessary to see an orthopedic surgeon for this?
I think so
Rick horenfeldt
I fractured my clavicle near to the ac joint and the displacement seems large. If I forward X-rays to you would you provide an opinion as to whether or not you would advise surgery? I am a 59 year old, active, non smoker, DDS and want to return to to work and life asap.
Sorry… I can’t Rick. Laws are laws.
Jay
Broke my left collarbone and chose surgery as a 63 year very active person. First post surgery follow shows one of 6 screws ( end) partway out. Dr. wants to go back in soon and do it over. Will new screws and longer plate increase danger to healing? Is this even realistic to try? Can that screw actually release out further?
Screws can back out … yes. Tough to say what next step should be without examining you and looking at your X-rays. There are more than one option available. Perhaps a second opinion?
Pankaj Kumar vidyarthi
Good to read.
Chris
Thank you for posting this article – it’s both helpful and reassuring. i broke my collarbone six weeks ago, overlap was under 2 cm and my doctor advised not having surgery.
My question is, aside from a x-ray, is there a way to know that the bone has reconnected? The pain has mostly subsided, but it still feels as if the bone hasn’t reconnected.
addie
I broke my collarbone 5 days ago and it is displaced. I will ask surgeon how much but x-ray shows a decent gap. Ortho is recommending surgery which makes me really nervous. He says it will heal quicker? Pain has already improved significantly and not sure I can handle pain from surgery. I’m 45 healthy athletic and don’t smoke. Thoughts?
Surgery is not proven to make a clavicle fracture heal faster. There are only a few reasons to consider surgery and healing time is not one of them.
I would consider a few more opinions.
Cathy
I broke my collar bone and after six weeks in a sling no progress. I have no choice but surgery now, correct? Can’t be out of work this long to see if bone stimulator will assist. Has this happened in many cases?
Very unusual … but if the fracture still hurts and moves after 6-8 weeks surgery becomes one of the suitable options. I hope you are a non-smoker. Surgery may not work if you smoke.
Chase
What does smoking have to do with the surgery?
Smoking diminishes the blood flow through the smaller vessels in our body… that limits the blood supply to the bone and can increase the chances of not healing a fracture.
Kyle
Bone is broken in 3 possibly 4 places. Surgery is being recommend. I am nervous about cost, and surgery in general. I would prefer no surgery, but if it’s a necessity I will do it. Bone is poking upward making visible bump/brushing on skin. Please see my Instagram photo and let me know your thoughts. I have to make a decision tomorrow. Your help is much MUCH appreciated.
I can’t comment on particular cases without seeing you and your X-rays. Sorry.
David Mic
I broken my clavicle 17 days ago.. when I feel it with my fingers I fell that the bone is overlaping on the other.. my orthopedic sergeant told me to go to physio therapy now.. but I feel it moving in a separate way.. is it healthy if I do physio when the bone is not started to join yet? Please help
Probably not the best idea if the bones haven’t started to heal together yet.
Zoe Baker
The exact thing happened to me 5 days ago. The advice was to keep it completely still but I still had to do physio? Maybe wait until most of the pain goes before you try to properly move it :)
Joaquin
I broke my collarbone 8 days ago, pain almost gone, arm in a sling. I have a fracture and have two fragments. Can it heal without surgery when its a multiple fracture? Do I need surgery?
Roberto Landeros
I broke my collar bone and got surgery will I ever be able to play soccer again and lift weights ?
IF the surgery is successful then most patients will be able to return to sports.
Stef White
Dr Luks,
I’m an active 51 year old woman, underwent surgery for clavicle fracture incurred while skiing last Feb. it partially healed, part non-union and the plate recently snapped.
I cycle, ski, yoga.. or did.
I hate the idea of more surgery. Can you direct me to possible alternatives/sources?
I’d like to be able to just leave it, even with broken plate, and let it all be well enough alone. Is there any possibility of healing with broken plate? Without broken plate but no further surgery?
Thank you.
Sorry to hear that….
IT is hard to get non-unions to heal without surgery. Some treatment options that could be considered by sadly not guaranteed include: bone stimulators and bone marrow injections.
Good luck