Overview
The clavicle is the strut that holds the shoulder out from the chest wall and the only bony link between the arm and the trunk. It is one of the most commonly fractured bones in the body, and about four in five breaks occur in the middle third, where it is thinnest. The rest are at the outer end near the AC joint or, rarely, at the inner end near the sternum.
Most clavicle fractures heal in a sling, and for decades nearly all were treated that way. What changed is the recognition that fractures which heal shortened or angled leave a measurable loss of shoulder strength and endurance, and that a fair number of badly displaced fractures never heal at all. Treatment now turns on how far apart the fragments are, how much the bone has shortened, and how much the patient will ask of the shoulder afterward.
Common Symptoms
- Immediate, sharp pain over the collarbone after a fall, with the patient supporting the arm against the body
- A visible bump or step in the bone, sometimes with the skin tented over a sharp fragment
- Swelling and bruising that tracks down the front of the chest over the following days
- The shoulder sitting lower and further forward than the other side, because the strut that held it out has shortened
Deformity along the shaft of the bone is a fracture. Tenderness confined to the very end of the collarbone with the bone itself intact is an AC joint injury, which follows the same fall. Pain lower on the arm with bruising down to the elbow suggests a proximal humerus fracture, and weakness lifting the arm once the acute pain settles raises the possibility of a rotator cuff tear.
Causes & Risk Factors
The usual mechanism is a fall directly onto the point of the shoulder, less often onto the outstretched hand. Cycling crashes over the handlebars are the single most common cause in adults, followed by skiing and snowboarding falls, contact-sport collisions, and motorcycle and car accidents. In children the bone heals quickly with almost any treatment; in young and middle-aged adults it is the high-energy, displaced fracture that raises the question of surgery; in older adults a simple fall can break osteoporotic bone, and those fractures are more often managed in a sling.
How It Is Diagnosed
The diagnosis is usually obvious on inspection. Dr. O'Donnell examines the skin over the fracture for tenting or an open wound, both of which change the plan, checks sensation and pulses in the hand because the brachial plexus and subclavian vessels run directly beneath the bone, and examines the shoulder blade and AC joint for associated injury.
X-rays confirm the fracture and measure what matters: an AP view and a second view angled upward show the pattern, the number of fragments, and how much the bone has shortened or overlapped, and a film of both clavicles lets shortening be measured against the normal side. CT is ordered for fractures at the inner end, complex distal fractures, and when surgical planning needs a three-dimensional picture; MRI is rarely needed. Visiting patients can upload existing images through mymedicalimages.com so the plan can be made before travel.
Treatment Options
Non-operative care
Fractures that are not displaced, or in which the fragments still touch, are treated in a sling. The sling is for comfort and comes off for elbow, wrist and hand motion from the first day; pendulum exercises begin within one to two weeks, and shoulder motion is restored as pain allows over the first six weeks. Lifting waits until X-rays show healing, usually at six to eight weeks, and strengthening follows. Most heal in eight to twelve weeks, leaving a bump that fades but does not disappear. Figure-of-eight braces do not improve alignment over a simple sling.
Clavicle fracture fixation (ORIF)
Dr. O'Donnell recommends plate and screw fixation when the fragments have lost contact entirely, when the bone has shortened by 2 cm or more, when the fracture is in several pieces or has a fragment turned on end, when the skin is tented or broken, and when the shoulder blade is also fractured. Those are the fractures most likely to fail to heal or to heal in a position that weakens the shoulder. He also offers fixation to athletes and manual workers with displaced fractures who want a predictable timeline, because a plated clavicle moves from the first week and returns to contact sport at three to four months rather than four to six. Surgery is performed as an outpatient at Bayside Surgery Center, and the plate stays in unless it is prominent enough to bother the patient a year or more later.
Recovery & What to Expect
After fixation the plate carries the load while the bone heals, which allows gentle motion early. Strengthening waits for X-ray evidence of healing regardless of how good the shoulder feels.
| Phase | Timing | What happens |
|---|---|---|
| Protected motion | Weeks 0–2 | Sling except for exercise. Pendulums; passive and assisted elevation limited to 90°. Elbow, wrist and hand kept moving. No lifting, no overhead reaching. |
| Motion | Weeks 2–6 | Sling weaned. Active motion progressed to full in all planes; gentle scapular and cuff isometrics late. No resisted strengthening or weight through the arm until union is confirmed at about 6 weeks. |
| Strengthening | Weeks 6–12 | Begins once X-rays confirm healing. Progressive rotator cuff, deltoid and periscapular strengthening; overhead loading as tolerated. Advance at 80% strength of the other side. |
| Return to activity | Months 3–6 | Plyometrics and sport- or job-specific progression. Contact and collision sport typically at 3 to 4 months with confirmed union. |
Desk work is possible within a few days, driving once the sling is off and the arm controls the wheel comfortably at 2 to 4 weeks, road cycling and skiing at about 3 months, and contact sport at 3 to 4 months once the bone has united. Non-operative fractures follow a similar sequence about four weeks later. The full protocol is available as a PDF: Clavicle Fracture ORIF rehabilitation protocol.
Frequently Asked Questions
Can a broken collarbone heal on its own?
Most do. Fractures in which the fragments still touch heal in a sling over 8 to 12 weeks with no lasting weakness. Fractures that are fully displaced or shortened by 2 cm or more heal less reliably and, when they do, often heal short, which costs shoulder strength and endurance. Those are the ones Dr. O'Donnell recommends fixing.
How long does a clavicle fracture take to heal?
Six to eight weeks for the bone to show healing on X-ray in an adult, and 8 to 12 weeks for full healing. Children heal in about half that time. With plate fixation the bone heals on the same schedule, but motion starts in the first week and strength work begins as soon as the X-ray confirms union.
When can I cycle or ski again after a broken collarbone?
Indoor trainer riding, seated and upright, is usually fine within 2 to 3 weeks of fixation or once the sling is off. Road cycling, mountain biking and skiing, where a fall would land on the same shoulder, wait until the bone has united and strength is back, typically 3 months after surgery and 3 to 4 months after non-operative treatment.
Will the plate need to come out?
Usually not. The plate stays in permanently unless it is prominent under the skin and irritates you, which happens in a minority of thin patients, particularly with backpack straps or seatbelts. If so, it is removed after the bone has been solidly healed for at least a year, as a short outpatient procedure.
How quickly can I be seen after a fall?
Same-week appointments are kept for acute injuries; call (305) 393-8810. If you were seen in an emergency department, bring the X-ray disc or upload it through mymedicalimages.com. A fracture that needs fixation is best operated within the first two weeks, so early review matters.
This page is for general education and is not a substitute for a medical evaluation. Treatment recommendations depend on your individual diagnosis and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.