What is the best treatment for a broken (fractured) and/or dislocated collarbone (clavicle)?
Whether you ride a bike, a horse, or participate in contact sports, you must read this!
Bicycles and broken and/or dislocated collarbones go together like a horse and carriage
(or so the song goes!)
Going over your horse's handlebars is not recommended!
If you are a cyclist, or horse rider, for that matter, the odds are that you may fall some time, land on your collar bone and either break it, dislocate it, or both (I did both in an instant, falling off a bike, many years ago and don't recommend it at all!).
This article deals mostly with the fracture kind. However, there is often a dislocation suffered along with the fracture, usually involving avulsing the ligaments that secure the acromioclavicular joint (AC Joint). If the AC ligaments have been fully or partially ruptured, the collarbone will appear to be "floating" above the shoulder. Please refer to Christian's Story later in this article. Christian suffered a nasty fracture of his collarbone and rupture of the AC joint. If the ligaments of the AC joint are not repaired then the "floating" will be permanent. While it is generally considered of not much consequence, I differ. Floating collarbones, other than being unsightly, can cause a lifetime of complications that may only get worse as the years become decades:
Disturbed sleep when sleeping on the previously injured side.
Pain and dysfunction with numerous physical activities, such as throwing and serving in tennis.
Protective muscle spasms in the shoulder and neck due to irritation and inflammation of the AC joint. These can lead to neck problems, migraines and even numbness radiating down the arm due to nerve and blood vessel impingement.
Gradual arthritic degeneration of the joint.
Collarbone injuries are so common that the seriousness of their impact on the victim - short and long term - tends to be underplayed.
Collarbone injuries cause weeks, if not months of sleepless misery and may result in long term disability, including chronic pain, if not treated properly from Day One.
These injuries are horrible because it is almost impossible to sleep well during the weeks that it takes for the bones and ligaments to knit securely. Attempting to roll over in bed is an agonising effort and unhelpful for the cause of uninterrupted healing. I'm talking from experience here folks!
Think of the shoulder and collarbone acting like a car bumper during a crash. As you land on your shoulder, the collarbone crumples, absorbing some of the impact that might otherwise be transferred to the central core of the body, shattering ribs, bruising and tearing vital organs; injuries that may be life threatening, if it was not for the crumpling of the shoulder. Not that this thought is any great comfort after suffering a shattered shoulder!
Clavicle fracture treatment
Clavicle Ligament Injuries
What is the best treatment for you? Get the best advice and make it timely!
From viewing these videos one can conclude that these injuries can be complex and there are risks involved in both conservative and surgical treatment options, including nerve damage. You will gather that the extent of a collarbone injury may not initially be apparent; hence the need for a close examination by an experienced senior doctor and not just a trainee Accident and Emergency Department doctor. The decision as to the best treatment for you must be done with the input of an experienced shoulder surgeon - in consultation with you - taking account all factors, including your lifestyle aspirations.
"Breaking my collar bone was nothing new to me as I had done it twice in the past. The first time the bones though broken were aligned and left to heal on their own. The second they were so far apart that surgery was the only option. I had some complications with the surgery in that the plate separated and another had to be fitted. Given this complication it still healed faster than the first time.
12 months ago I broke a collar bone again, third time! The xray was clear, the bones were miles apart.
The registrar suggested we leave it for a few weeks and see if the bones would realign. Given my job requires the use of my arms and I was keen to get back onto the bike this was not what I wanted to hear.
I contacted Gary Moller, he offered me great advice and introduced me to Marco who had been in a similar situation. I argued my case with the registrar pointing out that if left to heal on its own with a bump as often it does I would be back getting it fixed properly so lets plate it now and avoid extra costs in the future. He agreed and two weeks after the break I had a plate fitted."
Its almost impossible to immobilise a shattered shoulder
Because of the complex structure and mechanics of the shoulder (It's a four joint structure: scapulothoracic joint, glenohumeral joint, acromioclavicular joint and the sternoclavicular joint), it is almost impossible to stabilise the fracture or dislocation with any kind of strapping or sling, no matter how fancy. If they are not immobilised, the damaged bones and ligaments simply will not knit well. This is especially true for the AC joint ligaments. Unless the joint is held firmly in place for several weeks, the ligaments will either not knit back together, or they may remain permanently apart, or lax.
If you want to restore the AC joint to as close to it original state, the best option may be surgical repair and plating and it is best done promptly and not a month or longer after the injury.
Painkillers, sleeping and anti-inflammatory medications
Dosing excessively on painkillers and sleeping medications is not recommended because pain is there to remind you not to move, so that the bones and ligaments can knit securely. If there is movement, such as when sleeping, because the pain has been dulled to excess, then you risk ending up with a non-union healing of the fracture and/or an unsightly deformity of the collarbone and a biomechanically weak shoulder. The bones and joints must be held together. Pain helps you do that. There is advice about pain management later in this article.
I have seen a few cases of non union bone and many floating AC joint over the years. The only solution for those with the bone non-union is surgery, often years after the original injury. For those with an old floating AC joint that is giving them trouble, I'm afraid the only option, as far as I know, is palliative treatment using anti inflammatory medications, or the occasional surgical intervention.
Anti inflammatory medications may actually interfere with the healing processes. While their use may result in a marginally quicker recovery, this may be a false recovery, since the final structure may be less than 100% integrity. Please refer to my blog article about anti inflammatory medications:
Is surgery for a fractured and/or dislocated collarbone the best treatment?
"I broke my collarbone at the shoulder joint this week, and have been to ED last night where they told me they would just let it knit while I wear an arm sling."
In 30+ years of working in sports medicine and rehabilitation, and seeing many fractured collarbones, I have never seen a complication from the surgical plating of these fractures. On the other hand, I have seen many cases of slow and painful healing, non-union of fractures, unsightly deformed collarbones, lop-sided shoulders and permanent biomechanical weaknesses; all as a result of the patient being given a sling, a pile of drugs and being told to go home.
These injuries can signal the end of your time as a high performance athlete, if you are one. The gloss may be permanently taken off your peak performance if not treated properly.
The time it takes for return to work and for resumption of near normal activities is usually less than half the time of merely leaving most of these injuries in a sling.
Even if the ends are miles apart, it is likely you will be told that surgical plating of a broken or dislocated collarbone is not done any more. This is a polite fib - but it is the norm statement nowadays. Why?
Perhaps some emergency medical room doctors do not know the difference between the treatment for a fractured collarbone, versus a dislocated one.
The extent of the injury may not be obvious on first assessment.
Surgery to the collarbone area can be complex and is not without risk.
There is a view that a complete rupture of the AC joint results in little lasting disability; whereas a partial rupture may be more disabling over the long term. By extension of this, surgical repair of an AC rupture may cause the bone ends of the AC joint, which were well apart, to be more approximated, such that they may grind against each other, due to the ligaments being too lax. My answer to this line of reasoning is this: "Do a good repair job in the first place and make it timely!"
Perhaps the medics have seen so many of these injuries that there is no longer a sense of alarm when a fresh case is presented.
Perhaps it is because it is cheaper to send you home than to do a surgical stabilisation of the fracture and then do surgery on the few who come back several years later, due to ongoing problems, such as deformities, pain, or non-union.
Frustration turning to anger as the days become weeks
"Hi Gary, Not too good. Very condescending ortho, now thinking of another tack if possible. What really irks is that no Dr has even looked at my X-ray.
Thoroughly pissed off. Treated me like some old lady, well I am, but a bolshy one who still likes to ride descents fast."
The Hospital Emergency Room will tell you to go home, take lots of painkillers and wear a sling for several weeks. This is usually far from good enough.
The optimum window for doing the surgery is 10-14 days post-injury while the shattered and ragged ends are still fresh and raw.
Not offering surgery may be partly due to it taking too long for funding to come through for the operation. ACC and other insurers have a history of being reluctant to pay for surgery on injuries that may not keep a person away from work for more than a few weeks.
Important to know!
The orthopaedic department at your hospital may meet only once every two weeks to review cases that may require treatment that is outside of standard procedures and budget.
Ask when the next review meeting is scheduled and insist on being included, otherwise delays will drag out into weeks and the opportunity for a nice and quick repair job will be lost.
If you are in a job, such as a mechanic, which depends on you having strong and functional shoulders and if the injury is preventing you from returning to work quickly and it looks like dragging on for weeks and maybe months, then, hopefully, you will be into surgery within a week (More about this later). Money talks with agencies like ACC which explains why a worker who is unable to work due to an injury will have faster and better treatment than, say, the proverbial "Little Old Lady".
Another very frustrated patient
I'm still waiting...aaargh!
I met with the surgeon last Wednesday...he thought surgery would be required but at the last minute asked me to wear the sling for one more week!"
"A few years ago I broke my collarbone MTB racing in Nelson going OTB. On the way home on the Ferry 2 guys asked about my arm in a sling, so I explained what happened. They said they were orthopaedic surgeons and told me to push very hard for surgery. They explained that the shoulder drops when the collar bone breaks. The sling does not raise the arm back up to the correct position. Bone growth will eventually grow across the gap and rejoin, but you will always be lop sided or misaligned. If you wear a pack the raised bone will dig into the pack strap and rub. Health Board budgets are such that very few operations are done. They will send you home with a Disprin for a long recovery.
So I pleaded my case that I was a top NZ Masters Champion and wore a pack every day commuting/training. After 5 days they agreed to do an op. They put in a stainless steel plate and 4 screws and I was riding 5 days later on the road on MTB with comfy tyres.
1 week later I did Karapoti but had to walk the steep stuff. Without the op I would have been out of action for 3 months on ACC. With the op I was back at work in 10 days saving on ACC costs. The plate will likely stay there forever and I can’t feel it. Once Jorge Lorenzo MotoGP Champ broke his collarbone on a Thursday. They flew him to Spain to be screwed together and that Sunday he finished 5th. Amazing, because the braking and turning loads on the upper body a motorcycle are extremely high.
So it’s a pity that Health Boards save money by sending you home, but ACC costs become higher with a longer recovery!"
Always insist on getting the Presidential Treatment
When a person seeks my advice following a collarbone injury I may ask them the following question:
"If you were the President of the United States, would your treatment be any different?"
I asked my brother in law, Ioasa, this question the other day while we were out riding. He is known for his wit and he replied:
"For a start, one of my bodyguards would have taken the fall!"
If you were our Head of State and without the services of a bodyguard at the time, then you would have been thoroughly assessed by a specialist and possibly straight into surgery that day, or soon after. We are supposed to still be an egalitarian society, so demand the Presidential Treatment.
Insist on surgical repair as the first treatment option - not the last
If you are an active person, regardless of age, recreation or occupation, insist that you be thoroughly assessed for surgical repair of the collarbone, if the fracture or dislocation is complete and especially if the bones are visibly displaced. Surgical repair should be standard practice for an active person, like you, unless the bones are nicely positioned or merely cracked.
Surgical repair is the usual Presidential Treatment: insist on being thoroughly assessed and insist on surgery, if your injury qualifies! This will ensure an uncomplicated recovery and full return to an active lifestyle. Cost, or lack of funding should never come into it when we are dealing with your precious and irreplaceable body.
Bear in mind that, if there is to be surgical plating to secure a ruptured AC joint, the plate may have to be removed so as to allow restoration of normal shoulder function (refer to Christian and Ash's Stories below). For plating of collarbone fractures, removal of the plate after healing is complete is usually also recommended; but go with the surgeon's recommendations on these matters - of course!
"My story was that a car turned in front of me while i was road racing (individual time trial). I was going about 50 kph and had no time to react, but avoided a head-on collision by sliding my bike sideways into the car. I impacted with my left shoulder just behind the drivers door.
I flipped over the front of the car and landed on my hip. When i was able to check myself over, the only injury i found was a lump in the top of my shoulder. I knew I probably broke my collarbone. Luckily i had no other injuries and my bike didn't have a scratch on it.
Xrays taken in Samoa showed a fractured left clavicle (collarbone) near the shoulder joint.
A NZ physio who was also in the race referred my xray to a NZ orthopedic surgeon who recommended i have surgery as soon as possible, and preferably no later than 10-14 days after the accident.
I returned to NZ as soon as I could get on the next flight and presented myself and my xrays to ED at Christchurch hospital.
I was put in a sling and given an appointment with an orthopedic surgeon 5 days later.
The surgeon initially suggested that surgery would likely be necessary but then advised me to wear my arm in a tighter sling and he would re-assess me 1 week later. At this point I stressed that I wanted surgery asap, that i was a commuter cyclist carrying backpacks every day, and an elite cyclist and triathlete. This seemed to have little effect on his decision.
In the meantime I sent my xrays to a 2nd orthopedic surgeon who also recommended surgery.
I followed the hospital instructions and returned 1 week later. I had new xrays, which showed the bones had started to overlap but only by 10%, and not the 50% overlap required to support continuation of a conservative treatment protocol (sling only / no surgery).
Email excerpt from an increasingly desperate and frustrated Christian Wengler to the orthopaedic surgeon:
I'm concerned a collarbone left to knit by itself without surgery could leave me unbalanced, due to a shorter/lower shoulder, and cause issues down the track through my spine, pelvis, and knees, as well as issues with heavy backpacks on my regular commute. - I'm an extremely fit and competitive age group cyclist and triathlete (43yrs old). I win multiple races every year - I commute to work every day by bike (30k round trip + 20k-50k extra training per day) - Some days I commute by running to and from work - I carry a backpack with work papers/laptop/groceries on most days - I regularly travel for work and carry a laptop with me in a shoulder bag - I'm training to qualify for the work age group triathlon champs in either Canada or Netherlands - I train up to 20-25 hrs per week (cycling, swimming, and running) - I'm entered for a triathlon in Australia in 6 weeks. I'm worried that I'm not going to have this injury treated properly (given my circumstances), and I just don't know what I can do to get a second opinion, or what I should do to help me to get the surgery as soon as possible, so I can start rehab, and get back to work quicker.
The surgeon and registrar met in private and then the surgeon advised me that he would recommend surgery in my case. I was admitted to the ward with the hour, and less than 1 hour after that i was wheeled into surgery it took about 2 hours.
Because of the location of the fracture, the surgeon inserted a hook plate into the shoulder to connect the main collarbone to the fractured portion and that was connected to the shoulder. The plate will need to be removed after 3 months.
I stayed in hospital overnight (24 hrs) and was discharged the next afternoon with a prescription of Tramadol and Paracetamol, some light exercises prescribed by the physio, and some occupational therapy tools to help me in the kitchen at home. I have a follow up consultation in 2 weeks, and i have a medical certificate allowing 6 weeks off work.
I am taking natural healing supplements as recommended by Gary Moller. I'm feeling very tired, but am improving quickly. The surgery was a success and my recovery will progress quickly."
How to get the Presidential Treatment
Christian, Mark and Marco's stories show the way to go forward. You have to present a compelling case for getting the best treatment, otherwise you will be given the "lowly citizen's treatment" which is painkillers and a sling and out the door!
If you have fractured or dislocated a collarbone:
Prepare a one page, point-by-point case, arguing why you require the Presidential Treatment and hand this to the medical team at the earliest opportunity. The kind of points to make are if:
Your job requires you to have strong arms and shoulders. Nurse, mechanic, drain layer, builder?
You commute to work with a heavy backpack which contains your work tools such as a computer.
If you carry a shoulder bag at work, when visiting clients.
Plating the injury will have you back at work much sooner and save ACC income related costs.
You are physically active and place great value on an active lifestyle. Think hiking with a heavy back pack. Perhaps you do judo? Volunteer coach?
You are a swimmer, cyclist, martial artist, tennis player, or triathlete and especially if training for a national or international championship or similar. Maybe there is a tight deadline?
You are caring for someone at home who has mobility and other issues that require you to be strong and mobile.
You have private insurance. If not, tell them you will pay no matter the cost (of course that offer will not be accepted; but you are sending the message that your long term health is very important to you).
You are getting stomach pain and serious discomfort from taking even small amounts of the pain medications to the extent you must stop. If you have any diseases of the digestive tract, such as Crohn's, prolonged use of pain medications may not be safe.
You are in extreme pain despite the medications and have been unable to sleep at all to the extent your suffering is making you mentally unstable and extremely fragile (if you have a history of mental issues such as depression or suicide ideation, then let them know).
Be honest about what you say - no fibs please - but be to the point and assertive, otherwise you may be overlooked.
"The politely squeaky wheel will get the oil"
If you sense you are getting nowhere ask for a second opinion. I do not know how successful this ploy is. It seems to work at times; other times it may be that all it does is antagonise an already arrogant person on whom you so desperately rely.
Be respectfully tolerant of your orthopaedic surgeon
"Gary, I saw XXX, not very nice at all; usual condescending surgeon".
Why do some surgeons come across as being arrogant?
Orthopaedic surgeons are notorious for their arrogance and lack of bedside manner. This has been the case for over a hundred years. I got to witness some shocking examples when in my first real job
Back in the old days, before medical wonders such as anaesthesia and blood transfusions, it took a very brave person to be a surgeon. There was no place for dithering. They had to be bold and decisive. They had to get in and out with the least of delays. Hesitation equaled prolonging excruciating pain and risk of bleeding to death on the operating table. Surgery was not a job for the faint-hearted. Death was a frequent outcome. One could easily understand why one's surgeon might come across as reluctant to become your friend prior to surgery!
To better understand the historical undertones of brusque arrogance that still persist today, I recommend you read "The Emperor of All Maladies: A Biography of Cancer", a book written by Siddhartha Mukherjee, an Indian-born American physician and oncologist. Its a compelling, gut-wrenching read.
Of course, most surgeons have the most delightful and respectful bedside manner nowadays. I can immediately think of some very good ones, by the way. Yes - they do exist.
Be respectful of the specialist before you. Who cares about their personality? All that matters is that you want the best treatment done by the best person. Its not a personality contest.
I for one, do not want to make enemies of the person who is about to cut me open!
Bite your lip, if you have to, smile and state your case firmly, supported in writing, if you had time, all the while being very careful that you do not commit the ultimate sin, which is to tell the specialist how to do his or her job. Listen carefully to the surgeon's expert advice, then make your decision about which, of the choices placed before you appears to be the most suitable for you.
Go easy on pain killers and sleeping medications and do not take anti inflammation drugs
Healing is only as good as your liver. All pain and sleeping medications are hard on your liver. Pain is fine - suffering is not. Pain tells you when to back off and when to stop. Pain warns you that, whatever it is you are doing, you may be doing more damage if you persist. Hence its not as good idea to kill pain to the point where you do more harm.
Suffering is different. Suffering is pain that is too intense and been going on for too long, to the extent that it is doing harm of itself. This is where cautious medication is called for.
You are going to have to work it out, between you and your doctor as to what is just right for you at each stage of healing, because we all are different and have a huge range of pain tolerances among us. Just make sure that it is sufficient to get you through the day and night while retaining a degree of sanity.
Surgery on a broken or dislocated collarbone will almost certainly result in a quicker reduction in pain (after the fresh bout of pain following surgery). Sleep will be much better and months of pain will be compressed into a matter of weeks. So, if pain is really getting you down, then this is all the more reason to insist on surgical repair.
Love your Body with suitable exercise and Functional Nutrition
There's a lot you can do to expedite healing from the moment you break a bone or rupture ligaments. In addition, if you are an older man or woman, or a manic athlete who has spent years dicing with chronic fatigue, you will probably have lower than ideal bone mineral density.
It is time to start loving your body more and doing so with Functional Nutrition - in this case, nutrition that is proven to expedite healing.
Video about how fractured bones heal
This incredibly complex process of bone healing is completely dependent on there being a rich supply of all of the "base" nutrients, that are used in every stage of this amazing process. These include all the trace and macro minerals, vitamins, fatty acids, amino acids and many more that are ultimately provided via the diet. Hence the reasoning for adding special dietary ingredients to aid the healing processes.
Medications, chronic stress and ageing can all have a negative effect on the healing processes, especially when combined with an inadequate diet (many experts argue that modern foods, even organic, lack many essential nutrients in sufficient quantities necessary for good health). More about this later.
Please read this article about low bone mineral density in exhausted athletes and follow the advice about how to build strong bones (this advice applies to everyone - not just over trained athletes).
Are your regular medications making you injury prone?
Did you hit really hard when you broke your shoulder, or was it more of a tap than a brutal smack? Are you healing quickly or poorly? If the injury was unusual and/or the healing is poor, it could be worth having somebody, like myself, take a careful look at your medications, if you are on any. You may be in for an unpleasant surprise!
When reading the article about low bone mineral density in exhausted athletes, take special note about the possible role of many prescription and over the counter medications in weakening body tissues and even bone. If you take a medication, such as for asthma, allergies, blood pressure, thyroid, or hormone replacement, you may be making your body weak and vulnerable to injury and prone to poor healing.
Special Functional Nutrition supplements you can take to ensure healing is quick, uncomplicated and complete
There are a number of amazing nutritional products that can expedite tissue healing, including bone. These are very well researched and take it from me, personally and professionally, these do work!
Please read the technical stuff on each product page to learn more about them and consult with me first to work out which are most important for you and how best to take each:
ICL Reparen provides calcium phosphate monobasic, the form of calcium that is found at the site of bone regrowth (we sell most of this into rugby league and for good reason).
Cell Logic Cardios has a unique form of vitamin K and other ingredients that drive minerals and other nutrients into bone. Amazing!
Allergy Research Group Tocomin is a mix of tocotrienols that have novel bone building properties.
AST Eclzyme is a potent mix of Systemic Enzymes that help regulate healing and inflammation.
AST Serrapeptase is a Systemic Enzyme that removes cell debris, including scar tissue once it has completed its job of shoring up a damaged and unstable structure. Amazing stuff!
Cell Logic Defencell has substances that are proven to up and down regulate the genes involved in healing and inflammation, such that healing is enhanced. Science fiction stuff today! It works.
Support these amazing Functional Nutrition products with a diet that is rich in fresh fats, oils and protein from the widest variety of sources, including vegetarian as well as sea food and animal. A couple of eggs a day with runny yolks are great! Eggs have all the fats, oils and proteins, including all the fat soluble vitamins (vitamins A, D, E and K) that are essential for healing and bone health. Include whole grains, root crops, pumpkin, marrow and even taro with coconut cream and raw fish. Use the bright, cool spices such as turmeric and paprika liberally.
There are more things that can be done nutritionally because we are unique in our own special ways and there may be factors, such as medication for asthma or blood pressure, or HRT complicating matters. It is best that you consult me to help work it all out.
Getting back into exercise
Unless you are Lorenzo with a World Moto GP to contest next weekend, I recommend that you take your time for at least 12 weeks. Gradually ease back into things and you must follow the advice and guidance of your medical specialist, doctor and physiotherapist, including what you can do before and after removal of any plating, if this is the case for you.
Taking it slow and easy does not mean you don't do your physio exercises. Just don't risk overdoing it and please do not risk falling on that shoulder again!
Possibly the best exercise to begin with is the "Lift and Press", starting with little more than a bare bar, or even just a broom stick, repeating the lift and press about 12 times once or twice a day, then gradually adding a little more weight to the bar as the weeks pass. Counter the lift and press with chin ups, beginning with merely hanging on the bar like an Orangutan. Of course there are many other excellent exercises that you must do but you really do need to be with an exercise prescription expert, on the spot to guide you.
Image: Fit Kiwi demonstrating the "Lift and Press"
Learn how to fall
Many years ago I made a cycle safety video for the "What Now" children's television programme. I was teaching children how to safely fall off a bike! It was a hit at the time and I'm so disappointed not to have a copy of the film.
After at least twelve weeks of uncomplicated post surgery recovery, depending on medical advice, and assuming you have been taking your pills, eating well, gradually building on doing your lift and presses and impersonations of an Orangutan (again, doing these in accordance with medical advice), find a rubberised children's playground or an artificial sports ground and practice basic judo rolls.
You must practice these basic tumbles over and over again, over several weeks, until you can do this roll instinctively and then do refreshers for the rest of your life, whenever you come across a suitable practice area.
Refer to this video:
Ash's story (we want to finish with a feel-good tale)
"Hi Gary, after reading you articles about shoulders I thought I’d like to contribute my “great result” story. I was competing in the 2014 MTB Karapoti Classic, M3 division, almost home (and a near 3hr time)- heading towards the river crossing I had last gel - next second I was on the ground shoulder 1st- I lay there for a bit- in shock I think. A rider stopped to assist, I sat up for a bit then went to stand up I knew it was my end of the ride - my right shoulder was hanging low and couldn’t take any weight or pressure. 2 hrs later with the assistance of the medical team they got me back to the finishing village. Further assessment by the medic’s and then Gary retied the support sling, a mate took me to A&E where I don’t think they even x-rayed it, the doctor had a good look and feel, said it wasn’t broken, gave me pain killers, put it in a sling and told me to come back if the pain gets worse! I wasn’t happy with that so fortunately I knew an orthopaedic surgeon who also specialized in shoulders! A quick call to him and he saw me the next day. He took one look and said its more my AC joint that has given way (he said it would have been better to break the collar bone as its easier to repair). An xray confirmed this. A few cortisone injections added a wee bit of comfort then 2 agonising months later he operated - the outer tendon was stretched like a floppy rubber band and had no tension so by transferring the middle tendon to where the outer was - fixing it in place by cutting the bone back and drilling a hole to tie the tendon on, fitting a temporary plate to keep the shoulder in the right place for 3 months. For 3 or so days after the op the pain was intensive, very little sleep and an extremely grumpy patient (my wife and family will be quick to back verify that I’m sure!).
Time did heal this and after a while the only thing that hurt was if I tried to extend my arm more than 30 degrees from vertical. After 3 months he removed the plate, within a week I was able to do press-ups! Amazing. So I was immediately back on the bike, the upper body was quite weak so I had a sports trainer friend design me an upper body exercise programme, (which I still try to do regularly) . His theory is that by keeping the muscles strong this will significantly reduce the chance of serious damage for the next accident!
Had I not had the support from the surgeon I think my quality of life would be far worse now- I have spoken to too many people with permanent shoulder disabilities from what sounds like could have been avoidable had they had the correct treatment. This is a very sad situation. Luckily I don’t have any issues whatsoever- lifting, stretching, extending and sleeping are 100% and I continue to bike regularly without any aggravation whatsoever. My advice to anyone with shoulder injuries is insist on specialized care. Thanks"
We have covered what you need to know and what to do to ensure that your recovery from a collarbone injury is quick, uncomplicated and complete.
There are several treatment and healing options. The injury may be more complex than may initially appear to be the case, which is why it is important that the final treatment you receive is best made with the input of an experienced surgeon and not just the Accident and Emergency Department doctors who may lack the specialist experience.
You will realise from the patient stories in this article that getting the best treatment is usually far from easy. It is essential that you politely, yet firmly, state your case for the best treatment possible, be that surgical or conservative.
If you ever suffer one of these injuries, feel free to get hold of me immediately and I'll do my best to help, which includes working out how to get you the "Presidential Treatment".
Give your body the love!
Your body is precious and irreplaceable and it must faithfully serve you well for the best part of 100 years, or longer, so always insist on the very best - always!
If you have done your collarbone recently, I'll sign off now by saying, "heal well Good Friend!"
Authoritative Resources about collarbone injuries and their treatment
Derek Tan's story
"Here's my story:
In 10 years of racing bikes on both road and track I have never broken anything and never suffered any injuries apart from loosing a bit of skin here and there. That all changed about 6 weeks ago in a local road race when a fellow competitor misjudged a corner and collided with me with such force that my bike got swept out from under me causing me to land heavily on my left shoulder. As I lay on the road I thought to myself "really?" This is the second crash in 7 weeks! Any way my shoulder felt a bit odd, felt like I had slightly dislocated it. I eventually got back on the bike and rode one handed to the finish line. The race manager was a physiotherapist. After checking me out he said without doubt that I had broken my left clavicle.
It was quite fitting, but a few days earlier I read an article that Gary wrote, titled "What is the best treatment for a broken and / or dislocated collarbone". I kinda just skim read it as it didn't apply to me. But as soon as I got back from A and E (broken clavicle diagnosed), I read the article with due diligence! And several times. The article got me a little concerned, so I rang Gary that evening to get expert advice on what to do. Gary was great, explained how the system worked and what to do. He also mentioned that I needed to keep that sling tight to support the shoulder, the lovely folk at A & E didn't mention that and neither did they clean up my road rash.
The following day was Sunday but I decided to go back to the hospital to get a copy of my X-ray, you see you don't get to see this when the doctors consults with you. Pretty easy to get a CD rom of your X-ray as long as you ask nicely. Looking at the X-ray it looked to be a decent break with the amount of overlap the vertical width of the clavicle itself. But not being a orthopaedic surgeon I didn't know what the status of it was. That is where the videos in that article of Gary's come in handy so you can question the doctor. It is important to know that 2 centimes shortening is significant and at that amount I would say it be best to get it plated to restore the length. (at that stage I didn't know how much mine had shortened). Surgery is usually only granted at 3 cm of shortening so it is good to know this as you could be left short changed with a biomechanically weak shoulder if you don't know that 2 cm is significant.
Come Tuesday I went to visit my GP, I said to him that I wanted to see a specialist ASAP! He said I had to wait a few weeks to see what the x-rays show and that the doctors at the fracture clinic were specialists. So I had to wait, but I didn't want too so I went to ACC to see what they could do. They were very friendly and a nice lady spoke to me explaining how the system worked. And that if I got a referral from my doctor to see a specialist then ACC would cover the cost. But other than that advice ACC can't influence the medical practitioners so its no point trying to explain to them why you need the best care, that lies in the hands of the doctors. So a few days later I went to the fracture clinic to hand them a letter stating my case for the best possible treatment. The letter gave the reasons why it was so important that I make a successful recovery due to my job as a massage therapist and active lifestyle. So now I had to wait the 8 days till my fracture clinic appointment in the mean time I started on the supplements Gary sent me to help with healing the fracture.
At my fracture clinic appointment I was consulted by an experienced registrar. She said that she read my letter regarding my concerns, and realised how important it was for me to get the best possible treatment due to my job and lifestyle. She told me it had only shorted by approximately one centimetre. But if I wanted to, I could still have surgery no problems. I decided to go conservative as the 1 cm should not effect my biomechanics.
I am glad I went without surgery, my shoulder is now back to full function six weeks on. I still need to continue with physio strengthening and stretching exercises to further that function and go beyond the level of before the injury. You see I had a lot of imbalance issues prior to this fracture. The experience has made me realise all the muscle imbalance I already had that I haven't addressed until now. So I believe I will have better function after all the rehab than before.
Without a doubt Gary's article and assistance has been invaluable, it gave me all the information to get the best care possible. In order to get this preferential treatment you must write a letter stating your case for the possibility of surgery by giving it to the fracture clinic and making sure it is seen by the doctors before your appointment. Because of this I had the option of surgery as a first option rather than a last resort. Most importantly the video information gave me the necessary information to make an informed decision on which option was best for me.
Thanks again Gary your a lifesaver!