The clavicle, commonly known as the collarbone, is a long, slender bone connecting the shoulder blade (scapula) to the breastbone (sternum). It is part of the shoulder girdle, providing stability while allowing a wide range of arm movement. While a bone cannot be sprained, the term “sprained clavicle” is often used by patients to describe a painful injury near the collarbone. This sensation usually points to damage in the soft tissues, specifically the ligaments and joints, surrounding the clavicle.
Clarifying the Terminology: Sprains and Fractures
Understanding orthopedic language is key to accurately identifying injuries near the collarbone. A sprain is a soft tissue injury involving the stretching or tearing of a ligament, which connects one bone to another across a joint. Ligaments stabilize joints, and a sprain occurs when they are forced beyond their normal range of motion, ranging from a mild stretch (Grade I) to a complete tear (Grade III).
A fracture, in contrast, involves a break or a crack in the bone itself. Fractures can be simple cracks, partial breaks, or complete breaks. Symptoms of both sprains and fractures often overlap, including pain, swelling, and bruising, making self-diagnosis difficult without medical imaging. The primary difference is that a sprain affects joint stabilizers, while a fracture affects the structural integrity of the bone.
Common Injuries Affecting the Clavicle Area
Because the clavicle is part of two major joints, injuries in this region fall into three main categories: two types of joint sprains and the more common bone fracture.
Acromioclavicular (AC) Joint Separation
The most frequent sprain near the clavicle is an Acromioclavicular (AC) joint separation. This involves the ligaments connecting the clavicle to the acromion, a part of the shoulder blade. This injury often results from a direct blow or fall onto the point of the shoulder, tearing the acromioclavicular and coracoclavicular ligaments. Severity is classified by grades, where Grade I is a mild sprain and Grade III involves complete ligament tears, causing visible upward displacement of the collarbone.
Sternoclavicular (SC) Joint Sprain
The second type of joint injury is a Sternoclavicular (SC) joint sprain or dislocation, which is relatively rare. The SC joint connects the medial end of the clavicle to the sternum, stabilized by multiple ligaments. This injury typically requires high-energy trauma, such as a motor vehicle accident or significant impact during contact sports. Posterior dislocations, where the clavicle is pushed behind the sternum, are serious due to the proximity of the trachea, esophagus, and major blood vessels.
Clavicle Fracture
The third and most common injury is a Clavicle Fracture, or a broken collarbone. Approximately 75 to 80 percent of these breaks occur in the middle third of the bone, as this section is the thinnest and lacks reinforcement. A fracture usually occurs from a fall directly onto the shoulder or onto an outstretched hand. When the bone breaks, the arm’s weight pulls the outer fragment down, while the sternocleidomastoid muscle pulls the inner fragment up, often resulting in a noticeable deformity.
Recognizing Symptoms and Causes
The mechanism of injury and the specific location of the pain offer initial clues about the nature of the damage.
A fall directly onto the shoulder tip is the most common cause for an AC joint separation, leading to pain localized at the top of the shoulder. An AC separation may result in a characteristic bump visible at the shoulder tip, caused by the collarbone protruding upward due to torn ligaments. Pain often worsens when attempting overhead movements or trying to sleep on the affected side.
In contrast, a clavicle fracture, particularly in the mid-shaft, causes severe, immediate pain directly over the bone. This type of injury is often accompanied by a grinding or crackling sensation, known as crepitus, when attempting to move the arm. The shoulder may visibly droop, and the skin over the fracture site may appear “tented” by the underlying bone fragments.
SC joint injuries are much rarer and typically cause pain and swelling at the base of the neck, near the front of the chest. If a posterior SC dislocation occurs, patients might report symptoms beyond pain, such as difficulty breathing or swallowing, which signals a medical emergency.
Diagnosis and Initial Care
If an injury near the clavicle causes significant pain, swelling, or deformity, seeking medical attention is important for an accurate diagnosis. Initial care should focus on immobilization, often using a simple arm sling to prevent movement. Applying ice to the injured area for 20 to 30 minutes at a time helps manage immediate pain and swelling in the immediate aftermath. Over-the-counter pain relievers can also provide comfort until a medical professional assesses the injury.
Diagnosis begins with a physical examination to check for tenderness, swelling, and visible misalignment. Imaging is then used to confirm the diagnosis and determine the extent of the damage. X-rays are the standard tool to visualize the bone and determine if a fracture is present. They can also show widening in the AC or SC joints, indicating a ligament sprain or dislocation. In more complex cases, such as an SC joint injury or a highly displaced fracture, a CT scan may be necessary to provide more detailed images of the bone and surrounding structures.