Collar Bone Pain

Collar bone pain is a common problem and can be due to a number of different issues.  The bone itself (known as the clavicle) may be broken or suffering from wear and tear, the surrounding ligaments injured or occasionally there may be something more sinister going on.

Here we will look at the most common causes of clavicle pain, what causes them, how they differ and the best treatment options.

Anatomy Overview

At the proximal end of the collar bone is the Sternoclavicular Joint, at the distal end is the Acromioclavicular Joint

The clavicle or collarbone is roughly 15 cm long and connects the arm to the body through two joints, the sternoclavicular joint at the proximal end with the breastbone (sternum) and the acromioclavicular at the distal end with part of the shoulder blade (acromion).  Both joints are surrounded by strong ligaments to hold them in place and a number of the neck and shoulder muscles attach to the clavicle.

Any damage to the collar bone or surrounding soft tissues can lead to clavicle pain. Here we will look at the most common causes.

Clavicle fractures are by far the most common cause of collar bone pain, and the most common bone to break.  Luckily though they are usually simple to treat and in most cases will have healed within three months.

Clavicle fractures are the most common cause of collar bone pain

Causes: Most commonly a fall onto the shoulder or on an outstretched arm or less often a direct blow to the collar bone or an RTA

Symptoms: Collar bone pain especially if you place gentle pressure on the bone which may spread to the shoulder, deformity (a lump over the fracture, in severe cases breaking the skin) and limited shoulder movement which may be accompanied by a clicking/grinding noise

Treatment: In most cases clavicle fractures are treated non-surgically with a sling and physical therapy, but in some cases surgery may be required to fix the broken pieces back together

Recovery: the bone usually heals in 3-6 weeks in children, 6-12 weeks in adults.  People usually make a full recovery by around 3 months

You can find out more about this common cause of collar bone pain in the Clavicle Fractures section

ACJ Ligament injury

The acromioclavicular joint (ACJ) is held in place by four strong ligaments.  Damage to any of these ligaments can cause instability and clavicle pain.  The ligaments may be overstretched, partial torn or completely ruptured depending on the severity of the injury.

Acromioclavicular Joint injuries are a common cause of collar bone pain near the shoulder

Causes: A fall onto the shoulder when the arm is by your side, fall onto an outstretched hand, repetitive heavy lifting

Symptoms: Collar bone pain that is worse with arm movements, particularly reaching up, pulling, pushing or heavy lifting.  Arm range of movement may be restricted

Treatment: Minor injuries will be treated with a sling for 2-3 weeks and physical therapy.  If the ligaments have completely ruptured causing dislocation of the clavicle then surgery will be advised

Recovery: ligaments usually take longer to heal the bone as they have a poor blood supply.  It can take months to recover fully from acromioclavicular ligament injuries

Acromioclavicular Joint Arthritis

Inflammation and degeneration (arthritis) of the cartilage and bones of the ACJ is another cause of collar bone pain.  With arthritis, the space between the two bones, the clavicle and the acromion, reduces and the surfaces of the bone may become bumpy instead of smooth.  This leads to friction and pain.  This may be due to the normal aging process or may be accelerated by certain activities.  In children and young adults, the joint space (space between the two bones) is usually around 1-3mm.  By the age of 60, this has usually reduced to around 0.5mm or less.

Causes: Aging, repetitive or prolonged over-head activities such as weightlifting or construction work and contact sports

Symptoms: Mild to moderate collar bone pain over the distal end of the clavicle (nearest the shoulder) which may spread to the shoulder and chest.  Pain gets worse if you reach across your chest, known as horizontal adduction as it compresses the joint

Treatment: Physical therapy, activity modification, anti-inflammatory medication and injections.  In severe cases (which is rare) surgery may be done to remove a small part of the collarbone so there is more space between the clavicle and acromion – this is known as a resection arthroplasty or ACJ Excision. After surgery you will need to wear a sling for a few days and have physical therapy

Recovery: Degenerative changes to the cartilage and bone cannot be undone but by strengthening the muscles and ensuring good posture you can take the pressure of the AC joint and reduce pain and inflammation either altogether or to a manageable level. After surgery, you can usually return to work after a week or so but you should avoid any overhead activities for 3 months.  It can take a year to make a full recovery

Distal Clavicular Osteolysis
aka Weightlifters Shoulder

Distal Clavicular Osteolysis is a condition where tiny fractures (breaks) develop in the distal end (nearest the shoulder) of the clavicle.  Repetitive forces through the bone, e.g. from frequent training, mean it doesn’t get a chance to heal and the bone gradually breaks down and is reabsorbed, known as Osteolysis, faster than it can be repaired.

Distal Clavicular Osteolysis aka Weightlifters Shoulder can cause collar bone pain due to damage of the AC Joint

Causes: Repetitive trauma from heavy overhead activities such as weightlifting and plastering and excessive traction on the AC joint in activities where the elbows end up behind the body such as bench presses

Symptoms: Collar bone pain usually directly over the acromioclavicular joint, usually a dull ache.  Shoulder movement is not usually affected but it will be painful to cross the arm across the chest.  Pain gets worse with overhead activities, heavy lifting and throwing

Treatment: Weightlifters Shoulder usually resolves completely within a couple of years essentially by avoiding aggravating activities.  Medication, injections and physiotherapy can help reduce the symptoms of clavicle pain.  If symptoms fail to settle, surgery may be performed to remove a small portion of the distal clavicle followed by physical therapy to restore range of movement and strength

Recovery: It can take up to two years to recover from Weightlifters Shoulder, and even then, collar bone pain often returns if you start doing any aggravating activities regularly again

Acute Osteomyelitis of the Clavicle

Osteomyelitis is an infection that develops in the bone and is a very rare cause of collar bone pain. 

Causes: Infection may develop after an injury to the bone or may pass into the bone through the bloodstream after an infection (usually bacterial) somewhere else in the body.  It is also a rare side effect of head and neck surgery

Symptoms: Severe collar bone pain, fever, swelling and the area may appear red and hot

Treatment: Intravenous antibiotics, usually for around 4-8 weeks.  Early treatment is vital to stop the progression of the disease.  In severe cases surgery may be required to remove any infected or dead tissue

Recovery: Collar bone pain from Osteomyelitis will usually settle after a month or two of antibiotics, but can return, usually if the patient has an underlying medical condition such as poor circulation or a weakened immune system

Sternoclavicular Joint Injury

Injuries to the proximal end of the clavicle where it joins the sternum is another rare cause of collar bone pain.  Ligaments hold the joint together and occasionally one or more of these ligaments may get over stretch or rupture completely which can lead to dislocation, usually anteriorly (forwards), of the sternoclavicular joint

Causes: A significant blow to the shoulder (front or back) or to the top of the collarbone e.g. from an awkward sporting tackle or car accident

Symptoms: Proximal clavicle pain (near the breastbone), visible lump over the joint

Treatment: Usually a combination of rest from aggravating activities and physical therapy.  Very rarely surgery may be required

Recovery:  It usually takes a few weeks for the collar bone pain to settle but it may take a few months to make a full recovery

Other Causes of Collar Bone Pain

Other possible causes of collar bone pain include:

1)  Bone tumour: which may be benign or malignant
2)  Thoracic Outlet Syndrome: where there is compression of the vein, arteries or nerves in the space between the collar bone and first rib

What Next?

By far the most common cause of collar bone pain is a fracture.  You can find out more in the clavicle fractures section.

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