Broken Collarbone: Symptoms, Treatment & Recovery

What Is a Broken Collarbone?

A broken collarbone (clavicle fracture) is a crack or complete break in the long bone that connects the shoulder blade to the breastbone. It is one of the most common fractures, accounting for 2.6-4% of all adult fractures and up to 15% of all childhood fractures. The injury typically results from a direct blow or fall onto the shoulder.

The collarbone, also known as the clavicle, is an S-shaped bone located at the front of the chest between the shoulder and the center of the body. It serves several important functions: it acts as a strut to hold the shoulder away from the body, allows the arm to move freely, and protects important nerves and blood vessels that run beneath it. The collarbone is also the only bony connection between the arm and the rest of the skeleton.

Collarbone fractures are particularly common in certain situations. Falls from bicycles are one of the leading causes, especially among children and recreational cyclists. Contact sports such as football, rugby, hockey, and martial arts also contribute significantly to these injuries. In newborns, the collarbone can occasionally break during a difficult delivery when the baby's shoulders need to pass through the birth canal, though this is relatively uncommon.

The reason children are more susceptible to collarbone fractures relates to their developing skeletal system. Children's bones are softer and more pliable than adult bones, which makes them more likely to bend and break under pressure. However, this same characteristic also means that children's fractures typically heal faster and more completely than those in adults. The bone's natural healing process involves forming new bone tissue between the broken ends, a process that is remarkably efficient in young, growing individuals.

Anatomy of the Collarbone

The collarbone is approximately 15 centimeters (6 inches) long in adults and has a distinctive curved shape. The inner portion curves forward while the outer portion curves backward, creating an S-shape when viewed from above. This unique shape allows for complex shoulder movements while maintaining structural stability.

Several important structures lie directly beneath the collarbone, including the subclavian artery and vein (major blood vessels supplying the arm), the brachial plexus (a network of nerves controlling arm movement and sensation), and the apex of the lung. In severe fractures, there is a small risk that displaced bone fragments could injure these structures, which is why medical evaluation is always recommended.

What Are the Symptoms of a Broken Collarbone?

The main symptoms of a broken collarbone include visible swelling over the bone, intense pain when touching the area or moving the arm, a visible bump or deformity, bruising, and significant difficulty lifting or moving the arm. In children, the key signs are refusal to use the affected arm and crying when the shoulder is touched.

Recognizing a broken collarbone is usually straightforward because the symptoms are often quite dramatic and distinct. The pain typically begins immediately after the injury and is usually severe enough to prompt medical attention. Understanding the full range of symptoms can help you identify when to seek care and what to expect during the healing process.

The most characteristic symptom is swelling over the collarbone itself. This swelling typically develops within minutes of the injury and may be accompanied by visible bruising that can spread across the chest and shoulder area over the following days. In many cases, a visible deformity or bump can be seen where the bone has broken, particularly if the fragments have shifted out of alignment. Some people describe feeling or hearing a grinding sensation (called crepitus) when they try to move the arm, caused by the broken bone ends rubbing against each other.

Pain from a collarbone fracture is characteristically worse with certain movements. Trying to lift the arm, especially above shoulder level, typically causes severe pain. Even simple activities like reaching forward, carrying objects, or lying down can be extremely uncomfortable. Many people find that the only comfortable position is keeping the arm supported close to the body, which naturally limits movement and reduces stress on the broken bone.

Symptoms in Adults

• Swelling and tenderness: Noticeable swelling directly over the collarbone that is painful to touch
• Visible deformity: A bump, bulge, or step-off where the bone has broken
• Bruising: Discoloration that may spread across the chest, shoulder, and upper arm
• Pain with movement: Significant pain when trying to move the arm or shoulder
• Limited range of motion: Difficulty or inability to lift the arm above shoulder height
• Grinding sensation: A crunching or popping feeling when attempting movement
• Sagging shoulder: The affected shoulder may appear to droop forward and downward

Symptoms in Children and Infants

Children may not be able to articulate their symptoms as clearly as adults, so parents and caregivers should watch for specific behavioral signs. A child with a broken collarbone will typically refuse to use the affected arm and may cry or become distressed when picked up, particularly if lifted under the armpits. Older children often instinctively support the injured arm by holding it against their body with the opposite hand.

In newborns who have sustained a collarbone fracture during birth, the signs may be subtle at first. Parents may notice that the baby seems uncomfortable when being handled, shows reluctance to move one arm, or cries during diaper changes or bathing when the arm is moved. A visible bump over the collarbone may develop as the healing process begins and new bone forms at the fracture site.

When Should You See a Doctor for a Broken Collarbone?

Seek medical care promptly if you experience significant pain over the collarbone after an injury, visible swelling or deformity, or difficulty moving your arm. Go to the emergency room immediately if you have difficulty breathing, numbness or tingling in the arm or hand, skin broken over the fracture site, or if the injury appears severe.

While a broken collarbone is rarely a life-threatening emergency, prompt medical evaluation is important for several reasons. A healthcare provider can confirm the diagnosis, assess the severity and alignment of the fracture, check for any associated injuries, and develop an appropriate treatment plan. Getting proper care early can also help ensure the best possible outcome and prevent complications.

The vast majority of people with collarbone injuries can safely travel to a clinic or emergency department for evaluation. However, there are certain warning signs that indicate the need for more urgent medical attention. Difficulty breathing can occur if the fracture has affected the underlying lung or if pain is severe enough to limit chest expansion. Numbness, tingling, or weakness in the arm or hand may indicate nerve involvement. If the skin is broken over the fracture (an open fracture), this requires urgent treatment to prevent infection.

When to Seek Routine Medical Care

• Pain and swelling over the collarbone after a fall or injury
• Difficulty moving the arm on the affected side
• Visible bump or deformity over the collarbone
• A child who refuses to use one arm after a fall
• Bruising across the shoulder and chest area

What Can You Do at Home for a Broken Collarbone?

First aid for a suspected broken collarbone includes supporting the arm in a sling to reduce pain, applying ice wrapped in cloth to reduce swelling, taking over-the-counter pain medication if needed, and avoiding any movements that cause pain. A homemade sling can be created from a triangular bandage or large scarf.

While medical evaluation is essential for any suspected broken collarbone, there are several things you can do at home to manage pain and support healing. The primary goal of home care is to keep the arm still and supported, which reduces pain and allows the bone to begin the healing process. These measures are also helpful during the recovery period after you have been evaluated by a healthcare provider.

Creating a sling is one of the most effective immediate interventions. A sling supports the weight of the arm, taking pressure off the broken collarbone and reducing pain. To make a simple sling, fold a large scarf, bandana, or piece of fabric into a triangle. Position the arm across the chest with the elbow bent at approximately 90 degrees, then place the triangle under the forearm with the point at the elbow. Bring the two ends up behind the neck and tie them together, ensuring the forearm rests comfortably above waist level.

Pain Management at Home

Over-the-counter pain medications can be very helpful in managing the discomfort associated with a collarbone fracture. Acetaminophen (paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are both effective options. NSAIDs can also help reduce inflammation and swelling. Always follow the recommended dosage instructions and consult a healthcare provider if you have any underlying health conditions or take other medications.

Ice application can help reduce swelling and provide some pain relief, particularly in the first few days after the injury. Wrap ice or a frozen gel pack in a thin towel and apply it to the injured area for 15-20 minutes at a time, several times a day. Never apply ice directly to the skin, as this can cause frostbite.

Practical Tips for Daily Activities

Living with a broken collarbone requires some adjustments to daily routines. Here are practical strategies that can help minimize pain and support healing:

• Sleeping: Many people find it more comfortable to sleep in a slightly reclined position, such as in a recliner or propped up with pillows. This reduces pressure on the shoulder. Placing a pillow under the affected arm for support can also help.
• Bathing: If showering is too painful due to the arm movements required, sponge baths may be more comfortable initially. Keep the sling dry or remove it carefully during bathing, supporting the arm with your other hand.
• Dressing: When putting on a shirt, put the injured arm through its sleeve first, then the head, then the uninjured arm. Reverse this process when undressing. Loose-fitting clothing with wide arm holes or button-front shirts are easiest to manage.
• Activities to avoid: Refrain from lifting, pushing, pulling, or reaching with the affected arm. Avoid contact sports, cycling, and any activity that risks further injury to the shoulder.

How Is a Broken Collarbone Diagnosed?

A broken collarbone is diagnosed through physical examination and X-ray imaging. The doctor will examine both collarbones for comparison, check for tenderness, deformity, and swelling, and assess nerve function and blood circulation in the arm. An X-ray confirms the fracture and shows its location, type, and alignment.

The diagnostic process for a suspected collarbone fracture is typically straightforward and involves a careful physical examination followed by imaging studies. During the examination, the healthcare provider will first take a detailed history of how the injury occurred, including the mechanism of injury, when symptoms began, and any other injuries that may have occurred at the same time.

The physical examination begins with visual inspection of both shoulders and the chest area. The doctor will look for swelling, bruising, deformity, or any visible differences between the two sides. They will then gently palpate (feel) along the length of both collarbones, comparing the injured side to the uninjured side. The fracture site is typically very tender to touch, and a gap or step-off in the bone may be palpable.

Neurovascular Assessment

Because important nerves and blood vessels pass close to the collarbone, the examination includes checking the function of these structures. The doctor will assess circulation by checking the pulse at the wrist, comparing skin color and temperature between the two arms, and asking about any tingling or numbness. Nerve function is evaluated by testing muscle strength and sensation in the arm and hand. This assessment is crucial because, although rare, displaced fractures can potentially injure these vital structures.

Imaging Studies

X-rays are the primary imaging tool for diagnosing collarbone fractures. The standard approach involves taking images from at least two different angles to provide a complete picture of the bone. The patient typically stands or sits in front of the X-ray machine, which is quick and painless. For children, a parent or caregiver can often stay in the room during the X-ray, wearing a protective lead apron.

X-rays reveal not only whether the bone is broken, but also important details about the fracture itself. These include the exact location of the break, whether it is a simple crack or a complete break through the bone, whether the bone fragments are aligned or displaced, and whether there are multiple fragments (a comminuted fracture). This information is essential for determining the appropriate treatment approach.

In some cases, additional imaging may be needed. CT (computed tomography) scans can provide more detailed images and are sometimes used for complex fractures or when surgery is being considered. MRI (magnetic resonance imaging) is rarely needed for straightforward collarbone fractures but may be used if there is concern about ligament damage or other soft tissue injuries.

How Is a Broken Collarbone Treated?

Most broken collarbones (85-90%) heal successfully with non-surgical treatment, which includes wearing a sling for 2-6 weeks, pain medication, and physical therapy to restore movement and strength. Surgery with plates and screws is recommended only for severely displaced fractures, open fractures, or fractures that are not healing properly.

Treatment for a broken collarbone depends on several factors, including the patient's age, the severity and location of the fracture, whether the bone fragments are aligned, and the individual's activity level and occupation. The vast majority of collarbone fractures heal well with conservative (non-surgical) treatment, which is excellent news for patients and families.

The cornerstone of non-surgical treatment is immobilization of the arm to allow the bone to heal. This is typically achieved using a sling, which supports the weight of the arm and limits shoulder movement. Unlike some other fractures, collarbone fractures do not require a rigid cast because the surrounding muscles and soft tissues provide adequate support for healing. The sling is usually worn for 2-6 weeks, depending on the severity of the fracture and how quickly healing progresses.

Non-Surgical Treatment

Conservative treatment typically includes the following components:

• Sling or arm support: Worn for 2-6 weeks to keep the arm still and reduce pain
• Pain medication: Over-the-counter or prescription pain relievers as needed
• Ice application: To reduce swelling in the initial days after injury
• Physical therapy: Usually begins with gentle pendulum exercises shortly after the injury, progressing to strengthening exercises as healing allows
• Follow-up X-rays: To monitor healing progress and ensure the bone is staying aligned

Physical therapy is an important component of recovery, even for fractures treated without surgery. Initially, the goal is to prevent stiffness in the shoulder, elbow, and hand through gentle range-of-motion exercises. As healing progresses, the focus shifts to restoring full shoulder mobility and rebuilding strength in the muscles around the shoulder. A physical therapist can provide guidance on appropriate exercises and help ensure safe progression through the recovery process.

Surgical Treatment

Surgery is recommended in approximately 10-15% of collarbone fractures. The most common surgical approach is called open reduction and internal fixation (ORIF), which involves making an incision over the fracture, realigning the bone fragments, and holding them in place with metal hardware—typically a plate and screws. This hardware usually remains in place permanently, though it can be removed later if it causes discomfort.

Indications for surgery include:

• Significant displacement: When the bone fragments have shifted far out of alignment
• Shortening: When the fracture has caused the collarbone to become significantly shorter
• Open fracture: When the bone has broken through the skin
• Multiple fragments: Severely comminuted fractures may benefit from surgical stabilization
• Neurovascular compromise: When the fracture is threatening nerves or blood vessels
• Floating shoulder: When both the collarbone and shoulder blade are fractured
• Nonunion: When the bone has failed to heal after several months of conservative treatment

Treatment in Children

Children's collarbone fractures almost always heal well without surgery. Even fractures that appear significantly displaced on X-ray typically heal beautifully in children because of their remarkable bone-remodeling ability. Treatment usually consists of wearing a sling until the pain subsides, which is often just 2-3 weeks. Formal physical therapy is rarely necessary for children, as they naturally regain full function through normal play activities once the pain has resolved.

Newborns who sustain collarbone fractures during birth require no specific treatment. Parents are advised to handle the baby gently, avoiding lifting under the armpits and supporting the affected arm when possible. The fracture heals rapidly, typically within 10-14 days, and causes no long-term problems.

How Does a Broken Collarbone Heal?

A broken collarbone heals through a natural process where new bone tissue forms between the broken ends. Children heal in 3-6 weeks, while adults typically need 6-12 weeks for complete healing. A small bump may be visible or palpable at the fracture site after healing—this is normal callus formation and often becomes less prominent over time, especially in children.

Bone healing is a remarkable biological process that occurs in several overlapping phases. Understanding this process can help set realistic expectations for recovery and explain why certain precautions are necessary during the healing period.

The first phase of healing begins immediately after the fracture occurs. Blood from the broken bone ends and surrounding tissues forms a clot (hematoma) at the fracture site. This blood clot contains cells and growth factors that initiate the healing process. Over the next few days to weeks, the body begins producing soft, fibrous tissue called callus at the fracture site. This callus gradually becomes firmer and eventually transforms into new bone.

The new bone that forms during healing initially creates a visible and palpable bump at the fracture site. This is perfectly normal and represents the body's natural healing process at work. In children, this bump typically smooths out and becomes barely noticeable within several months to a year as the bone continues to remodel and reshape itself. In adults, a small ridge or bump may remain permanently, though it usually becomes less prominent over time. This cosmetic change has no functional significance and does not affect shoulder strength or mobility.

Timeline for Recovery

Recovery from a broken collarbone follows a general timeline, though individual healing rates can vary significantly based on age, overall health, fracture severity, and adherence to treatment recommendations.

Children under 10 years: Typically require rest from school or daycare for a few days immediately after the injury. They should avoid running, jumping, climbing, and sports for about 2 weeks. Most children can return to full activities within 3-6 weeks.

Older children and teenagers: Can often return to school shortly after the injury, though they should avoid physical education and sports. Full healing typically takes 6-8 weeks, after which gradual return to sports is usually possible.

Adults: May need to take time off work, depending on their job. Desk workers can often return within a few days with accommodations, while those in physically demanding jobs may need several weeks off. Complete healing takes 6-12 weeks, with full return to all activities typically possible by 3-4 months.

What Are the Possible Complications?

Most collarbone fractures heal without complications. Rare complications include nonunion (failure to heal), malunion (healing in a poor position), and injury to nearby nerves or blood vessels. Prompt treatment and following medical advice significantly reduce the risk of complications.

While the vast majority of collarbone fractures heal without any problems, it is helpful to be aware of potential complications so they can be recognized and addressed promptly if they occur. Understanding these possibilities allows patients and caregivers to monitor for warning signs and seek appropriate care when needed.

Nonunion refers to a fracture that fails to heal despite adequate treatment time. This complication is relatively rare, occurring in approximately 5-10% of conservatively treated fractures. Risk factors for nonunion include severe initial displacement, smoking, diabetes, and inadequate immobilization. If nonunion occurs, surgery is usually required to stimulate healing, often involving bone grafting and plate fixation.

Malunion occurs when the bone heals but in a suboptimal position, potentially resulting in shortening of the collarbone, prominence of the fracture site, or shoulder asymmetry. While mild malunion may cause no functional problems, significant malunion can occasionally lead to weakness, pain, or cosmetic concerns. Surgical correction may be considered in severe cases.

Nerve and blood vessel injury is an uncommon but serious complication. The brachial plexus (nerves controlling the arm) and subclavian vessels (major blood supply to the arm) pass just beneath the collarbone. Severely displaced fractures can potentially damage these structures, causing numbness, weakness, or circulatory problems in the arm. This complication is more common with high-energy injuries and is one reason why emergency evaluation is recommended for severe fractures.

Post-traumatic arthritis can develop if the fracture extends into the joint surface at either end of the collarbone. This is more common with fractures of the outer third of the clavicle, which can affect the acromioclavicular (AC) joint.

How Can You Prevent Collarbone Fractures?

While not all collarbone fractures can be prevented, risk can be reduced by wearing appropriate protective gear during sports, using proper technique when falling, ensuring safe environments for children, and maintaining bone health through adequate calcium and vitamin D intake.

Collarbone fractures often result from accidents that are difficult to predict or prevent. However, understanding the common causes and taking appropriate precautions can help reduce the risk, particularly for those engaged in higher-risk activities.

Sports safety: Many collarbone fractures occur during sports activities. Wearing appropriate protective gear, such as shoulder pads in contact sports like football, hockey, and lacrosse, can help absorb impact and reduce injury risk. Cyclists should always wear properly fitted helmets and consider additional protection for competitive or mountain biking. Learning proper falling techniques in sports like martial arts, gymnastics, and skateboarding can also help reduce injury severity.

Bone health: Maintaining strong bones through adequate nutrition helps reduce fracture risk throughout life. Ensure sufficient intake of calcium (found in dairy products, leafy greens, and fortified foods) and vitamin D (obtained through sunlight exposure and certain foods). Regular weight-bearing exercise also promotes bone strength.

Home safety: For young children, ensure safe play environments by securing furniture that could tip over, using safety gates on stairs, and providing appropriate supervision during active play. For older adults, reducing fall risk through adequate lighting, removing tripping hazards, and using assistive devices when needed can help prevent fractures.