A broken collarbone (fractured clavicle) is a common injury among two very different groups of people: children and athletes. Many babies are born with collarbones that broke during the passage down the birth canal. A child's collarbone can easily crack from a direct blow or fall because the collarbone doesn't completely harden until a person is about 20 years old. An athlete who falls may break the collarbone because the force of the fall is transmitted from the elbow and shoulder to the collarbone.

The collarbone is considered part of the shoulder and helps connect the arm to the body. It lies above several important nerves and blood vessels. However, these vital structures are rarely injured when the collarbone breaks. The collarbone is a long bone, and most breaks occur in the middle section.

Signs of a break:

• Sagging shoulder (down and forward).
• Inability to lift the arm because of pain.
• A grinding sensation if an attempt is made to raise the arm.
• A deformity or "bump" over the fracture site.
• Although a fragment of bone rarely breaks through the skin, it may push the skin into a "tent" formation.

Diagnosis

Although a broken collarbone is usually obvious, your orthopaedist will do a careful examination to make sure that no nerves or blood vessels were damaged. An X-ray is often recommended to pinpoint the location and severity of the break.

Treatment

Most broken collarbones heal well with conservative treatment and surgery is rarely necessary.

• A simple arm sling can usually be used to immobilize the arm. A child may have to wear the sling for 3 to 4 weeks; an adult may have to wear it for 6 to 8 weeks.
• Depending on the location of the break, your physician may apply a figure-of-eight strap to help maintain shoulder position.
• Analgesics such as acetaminophen or nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen will help reduce pain.
• A large bump will develop as part of the healing process. This usually disappears over time, but a small bump may remain.
• Range of motion and strengthening exercises can begin as soon as the pain subsides. However, you should not return to sports activities until full shoulder strength returns.
• In rare cases, depending on the location of the break and the involvement of shoulder ligaments, surgery is needed. Surgery usually gives good results.

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Triangular, mobile and protected by a complex of surrounding muscles, the shoulder blade (scapula) is rarely broken. Scapula fractures represent less than 1 percent of all broken bones. High-energy, blunt trauma such as a motorcycle or car crash or falling from significant height can fracture the scapula and cause other major injuries such as broken ribs or damage to the head, lungs or spinal cord. Symptoms include:

• Extreme pain when you move the arm.
• Swelling around the back of the shoulder.
• Skin abrasions.

Without treatment, a fractured scapula can result in chronic shoulder pain and disability.

Classification and evaluation

To give you appropriate treatment, your doctor will probably need to take X-rays of your shoulder and chest to describe and classify the location(s) of fracture to the scapula. In some cases, your doctor may also need to use other diagnostic imaging tools such as CT scan (computerized tomography).

One or more parts of the scapula may be fractured:

• Scapular body (50-60 percent of cases).
• Scapular neck (25 percent).
• Glenoid.
• Acromion.
• Coracoid.

Your doctor will evaluate the position and posture of the shoulder and treat any soft tissue damage (i.e., abrasions, open wounds, and muscular trauma). Your doctor may want a detailed neurovascular examination, which may not be possible if you have other severe injuries.

Treatment

Nonsurgical treatment with a simple sling works for most fractures of the scapula. The immobilization devices holds your shoulder in place while the bone heals. In many cases, your doctor may want you to start early range of motion exercises within the first week after the injury. Other fractures may need 2 to 4 weeks of immobilization. Your shoulder may feel stiff when the doctor removes the sling. Begin limited active use of your shoulder immediately. Continue passive stretching exercises until complete shoulder motion returns. This may take 6 months to a year.

If you have an isolated scapular body fracture, your doctor may want you to stay in the hospital. Certain types of scapular fractures may need further evaluation:

• Fractures of the glenoid articular surface (shoulder joint) in which bone has moved out of place (displaced) significantly.
• Fractures of the neck of the scapula with severe angular deformity.
• Fractures of the acromion process with impingement syndrome.

In these cases, you may need surgery in which the doctor uses plates and screws to hold together the bone.

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