Collar bone pain physiotherapyBy Nigel Chua
Collar bone (medically termed as "clavicle") pain is a common problem and can be caused and aggravated by a number of different problems.
The bone itself may be broken (fractured collar bone) or suffering from wear and tear, the surrounding ligaments can be injured or occasionally there may be something more sinister going on.
Here we look at the most common causes of clavicle pain, what causes them, how they differ and the best treatment options.
ANATOMY OF THE CLAVICLE
The clavicle or collarbone is roughly 15 cm long and connects our arms to our body through two joints:
- the sternoclavicular joint at the proximal end with the breastbone (sternum)
- the acromioclavicular at the distal end with part of the shoulder blade (acromion).
Both of these joints are surrounded and supported by very strong ligaments that secure and hold them in place, and a number of the neck and shoulder muscles attach to the clavicle.
Any damage to the collar bone or surrounding soft tissues can cause or aggravate clavicle pain.
Let's look at the most common causes of collar bone pain.
BROKEN COLLAR BONE
Clavicle fractures are by far the most common cause of collar bone pain, and the most common bone to break.
Fortunately, they are usually simple to treat and in most cases will have healed within three months, more or less.
Most commonly it's caused by a direct fall onto the shoulder or onto an outstretched arm, or less often, a direct blow to the collar bone or a motor-vehicle accident.
- Clavicular (collar bone) pain especially if you press gentle pressure on the bone, which may spread to the shoulder
- Deformity (a lump over the fracture, in severe cases breaking the skin)
- Limited shoulder movement which may be accompanied by a clicking/grinding noise.
In most cases, clavicle fractures are treated non-surgically with a sling and clavicular and shoulder physical therapy, but in some cases surgery may be required to fix the broken pieces back together.
The clavicle bone typically heals in 4-8 weeks in children, and 6-12 weeks in adults. People usually make a full recovery by around 3 months, give or take.
ACROMIOCLAVICULAR JOINT (ACJ) LIGAMENT INJURY
Our acromioclavicular joint (ACJ) is held in place by four strong ligaments, and damage to any of these ligaments can cause instability and clavicle pain.
These ligaments may be overstretched, partially torn, or completely ruptured depending on the severity of the injury.
- A fall onto the shoulder when the arm is by your side
- A fall onto an outstretched hand
- Repetitive heavy lifting.
- Collar bone pain that is worse with arm movements, particularly reaching up, pulling, pushing or heavy lifting
- Arm range of movement may be restricted.
Minor injuries will be treated with a sling for 3-4 weeks and shoulder physical therapy. If the acromioclavicular ligaments have completely ruptured causing dislocation of the clavicle, then patients may have to undergo corrective surgery.
Ligaments usually take longer to heal than bone, as they have a poor blood supply (ligaments have no direct blood supply, hence have slow healing rate and higher reinjury rates).
It can take months to recover fully from acromioclavicular ligament injuries.
ACROMIOCLAVICULAR JOINT ARTHRITIS
Inflammation and degeneration (arthritis) of the cartilage and bones of the ACJ is another cause of collar bone pain.
With arthritis, the space between the two bones (the clavicle and acromion) reduces, and the surfaces of the bone may become bumpy instead of smooth. Over time, this eventually leads to friction and pain.
Typically it's caused by normal wear-and-tear and the aging process, or it can be caused by diseases or injuries.
In children and young adults, the joint space (space between the two bones) is usually around 1-3mm. By the age of 60, this has usually reduced to around 0.5mm or less.
Aging, repetitive or prolonged over-head activities such as weightlifting or construction work, and contact sports.
Mild to moderate collar bone pain over the distal end of the clavicle (nearest the shoulder) which may spread to the shoulder and chest.
The clavicular pain may get worse if you reach across your chest, known as horizontal adduction, as that particular movement compresses the acromioclavicular joint.
- Shoulder arthritis physical therapy
- Activity modification
- Anti-inflammatory medication
In severe cases (which is rare), surgery may be done to remove a small part of the collarbone so there is more space between the clavicle and acromion – this is known as a resection arthroplasty or ACJ Excision.
After surgery you will need to wear a sling for a few days, and will need at least 2-3 months of physical therapy.
Degenerative changes to the cartilage and bone cannot be reversed. However, with physiotherapy for strengthening the muscles, and ensuring good posture, you can take the pressure off the AC joint and reduce pain and inflammation either altogether or to a manageable level.
After surgery, you can usually return to work after a week or so, but you should avoid any overhead activities for 3 months. It can take up to a year to make a full recovery.
DISTAL CLAVICULAR OSTEOLYSIS
Distal Clavicular Osteolysis is a condition where tiny fractures (breaks) develop in the distal end (nearest the shoulder) of the clavicle.
Repetitive forces through the bone, e.g. from frequent training, mean that it doesn’t get a chance to heal completely and properly.
Over time, the bone gradually breaks down and is reabsorbed, known as Osteolysis, faster than it can be repaired.
Repetitive trauma from heavy overhead activities such as weightlifting and plastering, and excessive traction on the acromioclavicular joint in activities where the elbows end up behind the body, such as bench presses.
Collar bone pain usually directly over the acromioclavicular joint, usually a dull ache. Shoulder movement is not usually affected but it will be painful to cross the arm across the chest.
Pain gets worse with
- overhead activities
- heavy lifting
Weightlifter's Shoulder usually resolves completely within a couple of years, essentially by avoiding aggravating activities.
Medication, injections and shoulder physiotherapy can help to reduce the symptoms of clavicle pain.
If symptoms fail to resolve the condition, surgery may be performed to remove a small portion of the distal clavicle, followed by physical therapy to restore range of movement and strength.
It can take up to two years to recover from Weightlifter's Shoulder, and even then, collar bone pain often returns if you start doing any aggravating activities regularly again.
ACUTE OSTEOMYELITIS OF THE CLAVICLE
Osteomyelitis refers specifically to an infection that develops in the bone, and is a very rare cause of collar bone pain.
Infection may develop after an injury to the bone, or may pass into the bone through the bloodstream after an infection (usually bacterial) somewhere else in the body.
It is also a rare side effect of head and neck surgery.
- severe collar bone pain
- the area may appear/feel red and hot.
Intravenous antibiotics, usually for around 4-8 weeks.
Early treatment is vital to stop the progression of the disease. In severe cases, surgery may be required to remove any infected or dead tissue.
Collar bone pain from Osteomyelitis will usually settle after a month or two of antibiotics, but can return, usually if the patient has an underlying medical condition such as poor circulation or a weakened immune system.
STERNOCLAVICULAR JOINT INJURY
Injuries to the proximal end of the clavicle where it joins the sternum is another rare cause of collar bone pain.
Ligaments hold the joint together, and occasionally one or more of these ligaments may be overstretched or rupture completely, which can lead to dislocation, usually anteriorly (forwards), of the sternoclavicular joint.
A significant blow to the shoulder (front or back) or to the top of the collarbone e.g. from an awkward sporting tackle or car accident.
Proximal clavicle pain (near the breastbone), visible lump over the joint.
Usually a combination of rest from aggravating activities and physical therapy. Rarely, surgery may be required.
It usually takes a few weeks for the collar bone pain to settle, but it may take a few months to make a full recovery.
OTHER CAUSES OF COLLAR BONE PAIN
Other possible causes of collar bone pain include:
- Bone Tumour which may be benign or malignant
- Thoracic Outlet Syndrome happens when there is compression of the vein, arteries or nerves in the space between the collar bone and first rib.