Clavicle Fracture

Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board

Clavicle Fracture: Causes, Symptoms, Diagnosis & Treatment

A clavicle fracture, aka broken collar bone, is a common injury usually caused a fall, direct blow or car accident. 

Broken collarbones are most common in children in young adults. The collar bone is the most commonly fractured bone in the body. 

Whilst they may be very painful, clavicle injuries are rarely serious and in most cases are managed conservatively with a sling rather than requiring surgery. Clavicle fractures are the most common cause of collar bone pain and clavicle lumps.

Here we will look at the common causes and symptoms of clavicle fractures, how they are diagnosed and treated, how to make the best recovery and common problem associated with a broken collarbone.

Clavicle Anatomy

The clavicle, aka collarbone, sits at the front of the shoulder joint.  It is a long, thin bone that sits in-front of the top of the ribcage. 

Shoulder girdle anatomy showing the clavicle and scapula

It connects the sternum (breastbone) to the acromion (front part of the scapula) forming two joints, the sternoclavicular and acromioclavicular joints.

It is slightly curved in shape, like a stretched-out “S” and is help in place by various ligaments and muscles.  It helps to hold the shoulder blade in place, like a strut, so that the arm can hang freely, as well as protecting underlying nerves and blood vessels.

Interestingly, the clavicle is the first bone to start growing during embryonic development (5-6 weeks gestation) and one of the last bones to finish growing, around the age of 21-25 years.

You can find out more about the collar bone in the shoulder bones sections.

Common Causes of Clavicle Fractures

Clavicle fractures are commonly caused by: 

  • Sideways Fall: where you land on the outer side of the shoulder e.g. falling out of bed. This is the most common cause
  • Fall: onto an outstretched arm
  • Direct Blow: to the clavicle
  • During Birth: particularly with breech babies
  • Motor Vehicle Accident
  • Contact Sports: e.g. football, wrestling, ice hockey and rugby
  • Winter Sports: skiing and snowboarding
  • Cycling: particularly mountain biking
  • Bone Pathology: e.g. osteoporosis or cancer weakens the bone

A broken collarbone is one of the most common acute shoulder injuries and the most common fracture seen in children. Clavicle fractures are less common over the age of 20, but still account for 2-5% of adult fractures.

Symptoms Of A Broken Collar Bone

The most common symptoms of a clavicle fracture include:

X-ray showing a clavicle fracture aka broken collar bone
  • Shoulder Pain: there may be immediate sharp pain at the time of injury which should settle to a dull ache.  The pain usually increases with any movement of the arm or upper chest or with any pressure over the fracture site

  • Strange Noises: Clavicle fractures are often accompanied by a “snapping” or “grinding” noise when you move the arm

  • Deformity: swelling and bruising may develop around the fracture site. The arm will often hang forwards and down compared to normal.  There may be a small bulge or lump on collarbone over the fracture site. In severe cases the bone may be so displaced that it punctures the skin and there may be associated bleeding but this is rare

  • Numbness and/or Tingling: if there is damage to the surrounding nerves, but this is uncommon

  • Decreased Shoulder Movement: it may be difficult and/or painful to lift the arm. The first sign of a broken collarbone in children may be them not using their arm normally if at all

Diagnosing Clavicle Fractures

Anyone with a suspected clavicle fracture should see their doctor immediately. The doctor will ask questions about how you injured yourself. They will then examine your arm looking at the position and your arm movements as well as gently palpating along the length of the bone. 

You will usually be sent for an x-ray to determine the type of fracture and to check for any associated damage. Diagnosis in children may be done with an ultrasound rather than x-ray.

Classifying Collarbone Fractures

Clavicle fractures can be classified into three groups using the Allman Classification, depending on the location and severity of the fracture:

Group 1 Clavicle Fractures

Locations of Clavicle Fracture
  • Location of Fracture: middle third of the clavicle
  • Incidence: The most common type, accounting for 80-85% of clavicle fractures in both children and adults as this is the weakest part of the bone
  • Presentation: If the fracture is displaced the outer (lateral) side of the clavicle is usually pulled down due to the weight of the arm and the inner (medial) side is usually pulled up by one of the surrounding muscles (sternocleidomastoid).

Group 2 Clavicle Fractures

  • Location of Fracture: Outer (lateral) third of the collarbone – the side nearest the arm
  • Incidence:  Accounts for 10-15% of clavicle fractures
  • Presentation: These fall in to three sub categories
    Type 1: non-displaced or with minimal displacement (i.e. the broken parts of the collarbone are lined up normally) as the ligaments remain intact
    Type 2: displaced - the inner (medial) part of the clavicle raises upwards due to damage to the surrounding ligaments
    Type 3: articular surface fractures - associated damage to the acromioclavicular joint where the collarbone meets the acromion (part of the scapula)

Group 3 Clavicle Fractures

  • Location of Fracture: Inner (medial) third of the collarbone – the side nearest the breastbone
  • Incidence: Rare – accounts for approximately 5% of clavicle fractures
  • Presentation: If displaced there may be associated injuries to the surrounding tissues

Fractured Clavicle Treatment

In most cases, broken collar bones are treated conservatively i.e. non-operatively. With more severe, unstable fractures, surgery may be indicated, but this is only needed in around 5-10% of clavicle fractures.

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Treatment for clavicle fractures usually involves:

1. Sling

A figure of 8 sling may be used after a clavicle fracture to hold the clavicle in the correct position and ensure correct posture

With a clavicle fracture, the arm will be immobilized in a sling to hold the arm in place. This gives the broken collarbone time to heal by laying down new bone (ossification) to re-join the broken sections.

Either a simple arm sling or a figure of eight sling (that wraps around both shoulders and the neck to hold the shoulders back) will be used. There is little evidence that one is better than the other. 

You should keep using the sling until there is no pain when you move your arm. Initially you will need to wear it all the time (including at night), except when you are doing your exercises, but as it heals you will be able to wear it less – be guided by pain. 

Children can usually stop using their sling after around 2-4 weeks, adults will need it for longer, usually around 3-8 weeks, depending on the level of displacement of the clavicle fracture.  

2. Medication

Pain relieving analgesia e.g. paracetamol/Tylenol and anti-inflammatories e.g. ibuprofen/Advil can really help following a clavicle fracture. Always talk to your doctor before taking any medication.

3. Regular Ice

Ice should be applied to the collarbone area as soon as possible after injury and used regularly for the first couple of weeks to help reduce pain and swelling. An ice pack wrapped in a towel can be placed over the area for 10-15 minutes. 

You should wait at least 2 hours before reapplying the ice. For more information on using ice packs safely and effectively after a clavicle fracture visit the Ice Therapy section on our sister site.

4. Physical Therapy

Physical Therapy is necessary after a clavicle fracture to ensure you regain full range of movement and strength

Following a clavicle fracture you will be encouraged to start gentle range of movement exercises almost immediately in order to minimize stiffness.  These will start with gentle pendulum exercises for the shoulder and exercises for the elbow and hand, progressing on to range of movement exercises as the pain allows. 

As the bone heals you will gradually progress on to rotator cuff strengthening exercises to regain full strength in the arm.  Scapular stabilization exercises are also really important to regain the stability and control around your shoulder blade.

You will need to continue with exercises until you have regained full range of movement and strength – this usually takes up to three months.

5. Treatment In Newborns

If a baby has suffered a broken collarbone during delivery, treatment will usually consist of pain relief and careful handling of the baby. 

6. Surgical Treatment

Surgical treatment of broken collarbones is only necessary in 5-10% of cases. Surgery for a clavicle fracture is only indicated if there is:

  • Skin Penetration: the broken collarbone has broken through the skin, known as an open fracture
  • Severe Displacement: the two parts don’t line up
  • Multiple Fractures: when the collarbone is broken in more than one place
  • Clavicle Shortening: more than 2cm, caused by either overlapping of the bone fragments, or if the bone has shattered
  • Associated Damage: to surrounding nerves and/or blood vessels
  • Non-Union: the fracture has failed to heal after around 3 months

If surgery is required, the surgeon will realign the collarbone fragments and fix them together with either:

Plating of a clavicle fracture

Metal Plate: A specially shaped metal plate, made of titanium or steel is placed over the top of the collarbone or occasionally around the front to hold the bones in the correct alignment.  It is fastened in place with screws.

Intramedullary Fixation: A nail or rod may be used to fix the bone together.  This goes through the middle of the bone (known as the canal) to hold the pieces together.

Whichever surgical method is used, you will normally be discharged home later that day or the following day. In most cases, the metal work will be left in place indefinitely, but if it starts to causes a problem, such as shoulder pain, stiffness or it shifts out of position, it can be removed once the collar bone has fully healed.

Following surgery, treatment will be similar to the non-surgical treatment above. You will need to wear a sling for at least 3-4 weeks and you will be given an exercise program to follow by a physical therapist to ensure you regain full movement and strength - visit the rotator cuff exercises section to find out more.

Clavicle Fracture Recovery

Recovering from a clavicle fracture usually takes 3-6 weeks in children and 6-12 weeks in adults for the bone to fully heal. It takes about twice as long to regain full function. 

Most people who suffer from a broken collarbone make a full recovery within three months, at which point it is safe to return to contact sports. Healing may take longer if you smoke or suffer from diabetes.

Here is some advice on how to make the best recovery following a broken collarbone:

After a clavicle fracture you will need to keep your arm supported in a sling for a few weeks, taking it out only to do your rehab exercises
  • Support: Keep your arm well supported in the sling the first few weeks except for when you are doing your exercises.  Gradually wean yourself off the sling as the pain reduces, starting with short periods, but as soon as your arm feels sore, pop it back in the sling

  • Medication: Use medication as directed by your doctor - this helps keeps pain and swelling under control and will enable you to get going with your exercises

  • Exercises: Follow the exercise plan given to you by your physical therapist and keep going with it until you have regained full strength and movement – don’t be tempted to stop too soon

  • Don't Forget Your Hands: Start moving your fingers, hand and elbow as soon as possible to prevent them from stiffening up in the sling.  Remove your arm from the sling to do this a few times a day

  • Nighttime: At night prop yourself up with pillows to get yourself into a comfortable position. You will need to wear your sling in bed initially

  • Restrict Range of Movement: Avoid lifting your arm above shoulder height for the first few weeks, until your doctor or physical therapist gives you the go-ahead

  • Lifting: Avoid any heavy lifting - anything over 5lbs for at least 6 weeks

  • Sports: Avoid contact sports at least 10-12 weeks - check with your doctor before returning to them

  • Posture: Think about your posture - avoid the temptation to let your shoulders drop forwards and your upper back to round. A posture correction brace can really help

Possible Complications

Long-term problems following a clavicle fracture are rare with most people making a full recovery. But complications can occur both with surgical and non-surgical treatment for a broken collar bone.

Non-Surgical Complications

This clavicle fracture has healed but the patient has been left with some deformity
  • Bony Prominence: you may be left with a small lump over the fracture site. This may settle down after a few months but may remain in some cases

  • Non-Union: in 1-5% of cases the bone does not reunite. If there are no symptoms associated with this, no further treatment is indicated but if there are ongoing symptoms such as pain or reduced movement, surgery may be required
  • Mal-Union: the bone may heal in a displaced position which may lead to ongoing shoulder problems

  • Decreased Shoulder Strength and/or Movement: The risk of this can be reduced by following your exercise program. It most commonly affects people where there was shortening of the collarbone

Surgical Complications

Any surgery is associated with risks such as infection, bleeding, blood clots and damage to the surrounding nerves and/or blood vessels.  Specific risks associated with surgery for a broken clavicle include:

  • Implant Problems: in around 30% of cases the metal work may need to be removed due to discomfort or if it has loosened and shifted position. Occasionally, the hardware fails (breaks)

  • Injury to the Surrounding Tissues: in around 3% of cases there may be some damage to the surrounding blood vessels or nerves during surgery

  • Non-Union: similar frequency to those treated non-surgically

  • Frozen Shoulder: approximately 4% of surgical patients develop a frozen shoulder aka adhesive capsulitis after surgery for a clavicle fracture

What Else Can Help?

Clavicle fractures are the most common cause of collar bone pain but there are a number of other things that can cause pain in this area. Visit the Collar Bone Pain section to find out more.

To find out about fractures of other parts of the shoulder region, visit the shoulder fractures section or if you think your pain might be caused by something out have a look at:

And if you have suffered from a clavicle fracture, don't worry - most people make a full recovery in just a few weeks.

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Page Last Updated: May 16th, 2024
Next Review Due: May 16th, 2026