Collarbone injuries

As part of the shoulder, the collarbone is one of those bones in the body that can be injured while doing almost any activity -- from body surfing to bicycling to basketball.

Because it lies close to the surface of the skin, the collarbone is very susceptible to fractures. But it is also involved in shoulder separations, which are almost as common and often as painful. In this week's Sports Injury feature, Dr. Dana Seltzer, a member of the Association of Professional Team Physicians (PTP), talks about collarbone injuries -- what they are, how they happen and what can be done to help an athlete get back to competition as soon as possible.

What is a collarbone?

Dr. Seltzer: The collarbone, or clavicle, is the connection between your axial skeleton, or your trunk, and your body. It runs from the middle of your chest to your shoulder and connects your shoulder blade and your shoulder to the anterior chest wall.

What are the most common collarbone injuries?

Shoulder separations are very common in sports like football and hockey. If you look around an NHL locker room, every other player will have had a shoulder separation

How is the collarbone most commonly injured?

Dr. Seltzer: The two mechanisms for injury are direct and indirect injuries. Direct injuries, as their name suggests, are caused by direct blows to the shoulder, particularly from the top of the shoulder. A common example would be going over the handlebars of your bike and landing on your shoulder. Indirect injuries are caused by falling on an outstretched hand or a blow to the outside of the shoulder, which pushes the shoulder into the chest and compresses the clavicle, causing it to be injured.

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Q: I felt a "pop" in my calf today while jumping and assume it is a pulled or strained calf muscle. What is the best mode of treatment for this? -- Jim Gould, Omaha, Neb. A: Dr. Robert Hunter, team physician for the U.S. Ski team: " It is important to know whether this is a strain, a stretch or a complete tear. Complete tears in active populations need to be surgically repaired. However, assuming it is just a strain or a partial pull of the muscle, this can be treated acutely with ice and oral non-steroidal anti-inflammatories, and rest using crutches as necessary to resolve the initial sharp pain. Quickly thereafter, one should embark on a stretching program, done in the sitting position initially and in the standing position as the calf muscle becomes less tender. As range of motion is restored and as the aching in the back of the calf lessens, a gentle strengthening can be initiated using non-ballistic, non-impact exercises such as two-legged toe-up exercises, advancing to toe-up exercises against resistance. "As soon as strengthening exercises in this low-impact environment are tolerated effectively, then one can resume more aggressive push-off using running on a treadmill initially, followed by more aggressive stop-start-run-cut-pivot-twist-jump, such as would be seen with racquet sports or basketball. Recovery from such an injury can vary between a week to 10 days to six to eight weeks depending on the severity of the tear, the amount of bleeding, and the amount of cramping." Do you have a question for a team physician? Click here to ask. And check out more "Ask the Pro Doc" answers to users' questions.

What are the common symptoms?

Dr. Seltzer: With fractures or separations, significant pain and swelling will be present, often with an initial inability to lift the arm over the head. A deformity is often present, since the bone is immediately under the skin. There is also a general feeling of "looseness," that things are moving around in the shoulder, and the shoulder or arm can feel heavy. The clavicle and its joints support the arm, and the loss of integrity of the collarbone, makes it more difficult to use the arm.

Additionally, in the sternoclavicular joint, there can be a popping or clicking where the patient can actually feel the shoulder popping out of place. In the acromioclavicular joint, the patient frequently reports some fatigue with repetitive exertion, especially overhead.

What about treatments?

Dr. Seltzer: Most clavicle fractures can be treated without surgery. Most physicians utilize a sling or a figure-eight splint, which pulls the shoulder back and pulls the clavicle out to length. Widely displaced fractures that have muscle or soft tissue interposed between the fragments may require surgery, which usually involves a plating technique, with or without a bone graft.

Anterior dislocations of the sternoclavicular joint are usually left alone, but posterior dislocations are more problematic and may require a reduction. Posterior dislocations are more serious and can cause vascular injuries, or difficulty swallowing or breathing.

Shoulder separations are also generally treated non-operatively, usually with a sling and range-of-motion exercises, ice, anti-inflammatories and occasionally a single cortisone injection.

How can these injuries be prevented?

Dr. Seltzer: The injuries caused by direct blows can partially be offset by wearing good, well-fitted pads that provide more cushioning (i.e., shoulder pads). The indirect injuries, such as falling on your hand to break a fall, are obviously more difficult to prevent.

What about prognosis?

Dr. Seltzer: The prognosis is generally very good for all of these injuries. Most clavicle fractures heal up quite well on their own. Even if surgery or grafting is required, the vast majority heal uneventfully. Most dislocations are asymptomatic and don't prevent people from playing sports. Those that are symptomatic can generally be improved through surgery.

Dr. Dana Seltzer, a member of the Association of Professional Team Physicians (PTP), is a team physician for the Phoenix Coyotes. He received his undergraduate degree from Pomona College in Claremont, Calif. and his medical degree from the University of Southern California in Los Angeles, and he completed a sports medicine fellowship at the Kerlan-Jobe Clinic in Inglewood, Calif. In addition to his work with the Coyotes, Dr. Seltzer is also an assistant professor of clinical surgery, division of orthopaedics, at the University of Arizona School of Medicine.

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