Clavicle (Collarbone) Fracture

Presentation

A patient presents with anterior shoulder pain after falling onto the lateral shoulder or, less commonly, an outstretched arm, or has received a direct blow to the clavicle. With distal clavicle fractures, patients may complain of pain on the top of the shoulder. There may be deformity of the bone with swelling, abrasion, and/or ecchymosis. This is usually seen in the midclavicle and is exquisitely tender if palpated. The deformity may appear similar to an acromioclavicular (AC) joint separation with distal clavicle fractures, but the tenderness is usually more medial along the clavicle than with AC injuries (see Chapter 95 ). The affected shoulder may appear slumped inward and downward compared with the contralateral shoulder, and the patient is usually supporting the injured side by holding the arm adducted. Paresthesias in the distribution of the supraclavicular nerves can occur.

An infant or small child might present not moving the arm after a fall, but examination of the arm will be normal, and only further examination of the clavicle will reveal the actual site of the injury.