Fractured Clavicle from Bike Crash

author : AMSSM

comments : 3

How long before I will notice major improvement? How long in the sling? Should I do any kind of exercise or rehab while in your sling?

Member Question

I fractured my clavicle one week ago in a bike crash. The doctor says it’s a small fracture near my shoulder (as opposed to the center or interior). He put me in a sling with 4-6 week time-frame of wearing this thing. One week later I can't tell a lot of improvement.

How long before I will notice major improvement? How long in the sling?  Should I do any kind of exercise or rehab while in the sling?

Answer from Sam Schimelpfenig, MD FAAP
Member AMSSM 

Fractures of the clavicle account for around 3% of all fractures, and are usually the result of trauma to the shoulder region.  Most clavicle fractures involve the middle third, with the rest tending to involve the distal third (the portion closest to the shoulder joint).  Fractures of the proximal third (near the breastbone) are uncommon.  As long as the fracture is not displaced, conservative care is usually all that is needed for treatment, but consultation with a physician is needed to ensure the proper course of treatment.

Treatment begins with immobilization of the area involved.  A sling or a figure-of-eight brace should be worn for comfort.  Patients often tell me that they prefer one method to the other, and they each come with advantages and disadvantages.  As the pain and shoulder motion improves, use of the sling or brace can be discontinued - usually after a few weeks.  Local application of ice helps with the discomfort, as does over-the-counter pain medications which should be taken as directed by your doctor.  Occasionally, I will use stronger, prescription-strength pain medications for short periods during the initial phase of recovery.

I routinely tell patients to anticipate 4-6 weeks before they will be fully healed to the point where daily activities are not painful, but sometimes that period of time is shorter or longer, depending on how quickly the person heals in general and the exact nature of the fracture itself.  When treating athletes who participate in contact sports I sometimes wait as long as three months, depending on the fracture, before they are fully cleared.

As the symptoms of pain improve, I have the patient begin gentle range-of-motion exercises beginning with pendulum swings.  To do this exercise, bend over so your arm is hanging toward the floor and make small circles with your arm (like you are drawing a small circle on the floor).  As the pain improves over time, you can make the circles larger.  This can be followed by some more routine shoulder range-of-motion exercises.  For highly motivated athletes, referral to a physical therapist can also be helpful in restoring motion as the fracture heals.

From the description of your fracture, it sounds like it is a non-displaced fracture of the distal third of the clavicle.  I agree that it should heal in around 4-6 weeks if all goes well.  Still having a significant amount of pain one week out from the injury is not unusual.  Remember, this is a broken bone which is still being subjected to motion and stress, even though it is in a sling (unlike other fractures that would be completely immobilized in a cast).  It is possible that there is additional trauma to that region other than the actual fracture of the bone that may be contributing to your discomfort.  Also, as fractures heal, it sometimes becomes apparent that the fracture was more extensive than it initially appeared on the x-rays.  If your pain is not improving in another week I would re-visit your doctor to see if any additional testing or referral needs to be done.  I hope it heals up well, though, and that you are back out there in no time! 

Sam Schimelpfenig, MD FAAP
CAQ Sports Medicine
Avera Medical Group, Sioux Falls SD

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date: October 18, 2012