Clavicle (Collarbone) Pain
Collarbone Pain and Why You Shouldn't Ignore It
The collarbone is referred to medically as the clavicle. Pain in the clavicle can be due to a variety of causes, some of which are more serious than others. In fact, some of the reasons behind collarbone pain are downright fatal. But before you start becoming too anxious, it's best to consider the most benign possible causes of clavicle pain and start eliminating them one by one. Only then can you get an accurate idea of what your body may be experiencing.
The collarbone is about 15 cm in length. It links your arm with the rest of your body through your sternoclavicular and acromioclavicular joints. The latter attaches the clavicle to the distal part of the shoulder blade whereas the former links the collarbone to the proximal part of the sternum (which is also known as the breastbone located right in the center of your chest). These two joints are encased in ligaments which keep them in place.
Various muscles of the neck and the shoulders are connected to the collarbone. This means that pain in the collarbone may be due to a damage or injury sustained by any of these surrounding soft tissues. Sometimes though, the damaged part may be the collarbone itself.
The Most Common Causes of Collarbone Pain
Fractures of the Clavicle
The most likely cause of pain in the collarbone is clavicle fracture. Its incidence is more common than you might think. The good news is that this condition is very treatable and the collarbone usually patches itself up in three months' time.
A fractured clavicle can be due to a direct fall on the shoulder. Or it may be the result of a fall on the arm while it's in an outstretched position. Another possible cause is a direct trauma sustained by the collarbone such as those obtained in vehicular accidents and sports injuries. Collarbone fractures are experienced more often by individuals who participate in contact sports like wrestling and rugby and even by those who engage in non-contact sports such as skiing and mountain biking. Other possible reasons are when the person has genetically fragile bones or when the bones are rendered weak and brittle because of an illness such as bone cancer or osteoporosis.
About 3% of adult fractures can be attributed to a broken collarbone. Nevertheless, the incidence of clavicle fracture is particularly high in kids and young adults. Both lead a more active lifestyle than older adults and are thus more prone to acquiring injuries. Additionally, a neonate's fragile collarbone may break due to physical trauma during delivery. This is common in infants delivered vaginally while in the breech position.
How do you know if the cause of your clavicle pain is a fracture?
You do this by identifying the symptoms. The most usual symptom is a popping or clicking sound or sensation felt when your collarbone gets broken. This is followed by pain that can only be described as sharp. Eventually, the pain turns into a dull ache. Attempting to move the arm will cause even more pain. This means that the affected individual will manifest a limited range of motion in the shoulders. In fact, even lifting the arm can be extremely difficult.
When you are able to move your arm, it may or may not be accompanied by an abnormal grinding or snapping sound. The pain intensifies when gentle pressure is applied on the area. The pain may radiate towards the shoulder. It's possible for the injured person's arm to droop forward and downward. In some cases, a deformity such as an outward bulging of the skin or bruising may be evident. More severe cases include skin breakage due to the bone puncturing the flesh. That said, clavicle fracture is very rarely accompanied by bleeding. A feeling of numbness, also described as a pins-and-needles sensation, is indicative of injury to the surrounding nerves.
If you suspect that your collarbone pain is due to a clavicle fracture, seek medical assistance immediately. Expect to be asked questions about how the injury came about. The doctor will visually inspect the affected arm by studying the position and range of movement. S/he will carefully palpate the length of the affected bone. An x-ray is usually ordered to find out under which category the fracture belongs. If the patient is a child, an ultrasound may be ordered.
There are three different categories of collarbone fracture depending on its exact location. This is referred to as the Allman classification.
If the fracture was sustained in the mid-third of the collarbone, then it is classified under category one.
This type of fracture comprises up to 85% of collarbone fractures in kids as well as in adults.
In this type, the outer bone is moved to the lateral side and it is pulled downward by the arm's weight. Meanwhile, the inner side is pulled upward by the sternocleidomastoid muscle which is situated on the side of the neck.
When the fracture is situated on the lateral third of the clavicle, then it is classified under the second group.
This type of fracture makes up at least 10% of all collarbone fractures.
Fractures in this category are further divided into three sub-types.
Non-displaced - This is characterized by zero to minimal displacement. That is, the damaged parts of the clavicle are normally aligned. Moreover, in this type of fracture, the ligaments remain in one piece.
Displaced - This is when the medial part of the collarbone is lifted upward because of injury inflicted into the neighboring ligaments.
Articular surface fracture - This is characterized by damage to the joint which connects the clavicle to the scapula.
When the fracture is found on the medial third of the clavicle (the area which is closest to the breastbone), then it is classified under group three.
This type of collarbone fracture is rarer than most and only makes up 5% of all fractures of the collarbone.
In this type of fracture, damage to the surrounding tissues has been established.
Seek emergency assistance if you notice the bone jutting through the skin (or if it looks like it is about to). Emergency treatment is necessary if you experience difficulty breathing, severe pain, and/or rapid swelling in the affected area. Immediate care is needed if the fracture is accompanied by numbness, a tingling sensation, or discoloration in the arm.
How do You Treat Collarbone Fractures?
Majority of the cases of collarbone fractures can be treated without surgical intervention. It will be necessary to immobilize the arm with the aid of either a triangle sling or a figure 8 sling to keep it in place. This will provide the bone with sufficient time to repair itself. Ossification refers to the generation of new bone to patch up the broken parts. The sling is meant to be used until no pain is felt during arm movement. At first, the affected individual will have to wear the sling 24/7 even during sleep. That is with the exception of physical therapy sessions. As the bone continues to heal, the patient will be allowed to wear the sling less often. Usually, kids can take the sling off before one month. That's because their cells self-repair at a more rapid rate. Adults, on the other hand, may have to wear the sling for three weeks up to a couple of months. This all depends on the degree of displacement of the fracture.
The collarbone pain can be relieved with the aid of analgesics and anti-inflammatory drugs. As part of first aid for fractures, ice may be applied to the affected part as soon as possible after the injury was obtained. Afterwards, an ice pack is to be applied regularly for the first 14 days to minimize the pain and inflammation. Make sure that the ice pack is sheathed in a towel and is applied for no more than 15 minutes. Then, wait for a couple of hours before the next application.
Physical therapy plays a crucial role in the treatment of clavicle fractures. The patient usually begins with mild range of motion exercises involving the shoulder, the elbow, and the hands. The goal of which is to reduce stiffness of the joints due to immobility. As the bone continues to heal, the physical therapist will assist the patient in progressing towards a stretching routine. The aim of this is to strengthen the affected person's arm. Physical therapy should carry on until the injured person has restored his strength and his full range of motion.
As mentioned, there are only a few cases of collarbone fracture which will have to be treated with surgery. One indication is an open fracture where the bone fragment is jutting out through the skin. Another reason for surgical intervention is when there is severe displacement. That is, when two or more parts of the collarbone fail to align properly. Cases of multiple fractures also necessitate surgery. This is when more than one area of the collarbone has been broken. A shortening of the clavicle occurs either when fragments of the bone overlap or when the collarbone has been shattered. This case also calls for a surgical procedure. Other instances where operative care is required is if there is damage to the neighboring blood vessels and nerves and if the bones have not healed after three months of non-surgical intervention.
One common goal in the surgery of a collarbone fracture is to realign the detached bone fragments. In some cases, a rod may be used to patch the bone up. This rod will pass through the middle part of the bone to keep it in place. This procedure is called an intramedullary fixation. In other cases, a metal plate made of either titanium or steel will have to be used. The plate is placed on top of the clavicle and then it is screwed in place. Sometimes though, the metal is placed around the front. Patients may be sent home immediately or following the day of the surgery. Physical therapy sessions will naturally be recommended by the doctor. During this time, the patient may have to wear a sling for up to one month.
Are there Any Complications to Surgery?
Surgical procedures for collarbone fractures are not without complications. As with any type of surgery, you will be placed at risk for developing infection and hemorrhage. 3% of the time, the surrounding nerves and blood vessels are injured.
There is also a condition referred to as the "frozen shoulder" which is more formally known as adhesive capsulitis. This occurs in about 4% of surgical cases. It is characterized by stiffness and inflammation in the connective tissue in the shoulder joint resulting to severe pain and diminished range of motion. It tends to worsen at nighttime and during cold weather.
Removal of metal plates are done when the bone has healed up completely. That said, when you start experiencing problems like pain or stiffness, call your physician immediately. Sometimes, a plate can move out of position. This happens 30% of the time. It's also possible for the hardware to break. In such cases, the plate may have to be removed.
Non-surgical treatment of clavicle fractures are also accompanied by complications. In some cases, a bony prominence may develop. It's not uncommon for a tiny lump to form over the area of fracture. This can be permanent or it may gradually disappear after a few months. Cases of mal-union are also not unusual. In other words, the clavicle may heal but it may do so in an abnormal position. This complication is likely to cause shoulder problems in the long run. Moreover, if you've suffered from a shortened collarbone, then you can expect diminished shoulder strength and movement. Thankfully, this is something that can be corrected through an effective rehabilitative program.
What's the Recovery Process Like?
While most healthy individuals will recover from a broken collarbone in three months' time, for those who are suffering from diabetes, compromised immune systems, or chronic bone diseases, recuperation may take longer. The same truth applies to chronic smokers.
If your collarbone pain is due to a fractured clavicle, there are a few things that you can do to help speed up the healing process. First, you should make sure that you wear your sling when you need to. You may gradually wean yourself off it but as soon as you experience soreness or pain, put it back on.
Take your meds exactly as instructed by your physician. This will aid in managing the pain and the swelling, hence, enabling your body to concentrate on healing and you to focus on your physical therapy.
Comply with the planned exercises made by your physical therapist. Exercise your fingers, your hand, and your elbow as soon as you can. This will help minimize the problem of stiffness. That said, refrain from lifting your arm over your shoulder during the first few weeks after the injury. No heavy lifting (more than 5 lbs.) should be done for one month and a half.
Before bedtime, use pillows to prop yourself up to a position of comfort. Strive to maintain good posture. Do not allow your shoulders to fall forwards.
Refrain from engaging in contact sports for three weeks after treatment or until your physician tells you that it's safe.
Injury to the ACJ Ligament
Another possible cause of pain in the collarbone is an injury to the acromioclavicular joint. This joint is kept in place by four powerful ligaments. If any of these ligaments are injured, then you are bound to suffer from pain in the clavicle area. An injury like this may be caused by overstretching of any of the ligaments. In some cases, the ligament may be partially or completely ripped apart. This occurs commonly as a result of a fall on the shoulder when the arm is situated close to the side of the body. When you fall on your shoulder, the tip of your shoulder is pushed downward by the force. Your clavicle usually remains in its normal anatomical position but the shoulder is pushed downward and the force then causes a bone fracture or injury to the various ligaments.
ACJ ligament injury may also be the result of a fall on a stretched out hand or a strong downward force applied onto the upper extremity. Sometimes, the injury is brought about by constant heavy lifting. Like collarbone fractures, ACJ ligament injury often occurs during contact sports, vehicular accidents, and bicycle mishaps. It is also common among laborers who do heavy manual lifting.
How will you know if the clavicle pain is due to ACJ ligament injury and not from other causes?
The collarbone pain associated with acromioclavicular joint injury is felt at the end of the collarbone. It increases when you try to pull, push, lift, or reach up toward something. The arm's range of motion becomes limited as any arm movement tends to worsen the pain. It is not rare for swelling to occur. A lump where the joint has been dislocated may or may not be evident, depending on the severity of the injury. Initially, the pain may spread throughout the shoulders. Eventually, it will wane and become more localized on the joint.
There are six types of ACJ ligament injury depending on its severity. A definitive diagnosis can be done only by a physician.
Type I is characterized by a minor sprain in the AC ligament. The joint capsule and the coracoclavicular ligament, however, remains intact. The latter is responsible for providing the joint with vertical up and down stability. In this type of ACJ injury, the deltoid and the trapezius muscles are also undamaged. These two play an important role in providing active stabilization when the ligaments are injured. Persons with this level of injury are likely to experience discomfort upon palpation of the joint and also pain during movement.
Type II injury occurs when the AC ligament as well as the joint capsule are torn. In this type of injury, the coracoclavicular ligament is sprained. However, the deltoid and trapezius muscles are only minimally detached. The lateral collarbone becomes more prominent.
Type III ACJ ligament injury happens when the AC ligament, the coracoclavocular ligament, and the joint capsule are all torn. In this case, the clavicle is moved upward and is displaced at less than 100%. As a result, the bump on the shoulder, specifically on the lateral clavicle, becomes even more prominent and the pain becomes more severe. In this injury, the deltoid and the trapezius are fully detached.
Type IV injury is also accompanied by the tearing of the AC ligament along with the coracoclavicular ligament and the joint capsule. However, the clavicle is moved into a posterior position into the trapezius. There is full detachment of the deltoid and the trapezius muscles.
In a Type V injury, the AC ligament, the coracoclavicular ligament, and the joint capsule are all completely ruptured. The clavicle is 100% dislocated. The deltoid and the trapezius are markedly detached.
Type VI ACJ ligament injury occurs quite rarely. It is also characterized by the tearing of the AC and coracoclavicular ligaments and the rupture of the joint capsule. In this case however, the distal clavicle is downwardly displaced below the acromial or coracoid process. The collarbone is dislocated behind the tendons of the biceps and the coracobrachialis. The latter is the smallest muscle affixed to the scapula (shoulder blade) and is necessary for flexion and adduction.
How is ACJ ligament Injury Treated?
A minor injury can be managed with the use of a sling for up to three weeks. This is accompanied by physical therapy. Complete rupture of the ligaments, however, will require surgery especially if the clavicle has been dislocated.
The standard emergency response for ACJ ligament injury is the RICE:
- Rest - Immobilization of the arm is done with the use of a sling.
- Ice - Use an ice pack and refrain from applying the ice directly on the skin. Application should be 20 minutes every couple of hours.
- Compression - The goal of emergency care is to arrest bleeding and to minimize joint damage.
- Elevation - The shoulder should be placed in an elevated position.
This care is to be provided within 24 hours to 3 days after the injury was acquired and it is to be followed by prompt referral to a medical professional. Meanwhile, ensure that the NO HARM rule is followed:
- Running (movement)
Compared to broken bones, torn ligaments take longer to heal. That's because they receive only a minimal supply of blood. Thus, it could take up to several months for you to recover from an ACJ ligament injury.
Severe forms of this injury (from level 3 onwards) come with debilitating complications. The clavicle becomes unstable. The strength and range of motion of the shoulder becomes affected. Often, ACJ ligament injuries occur hand in hand with fractures. Other complications include neurovascular symptoms, muscle fatigue, and cosmetic deformities. To manage these complications, surgical reconstruction may be required.
One chronic complication that may arise in levels one and two ACJ ligament injury is symptomatic chronic arthritis. Surgery may be ordered to help get rid of the symptoms.
ACJ ligament injuries that have been treated via surgical procedures can predispose the individual to several postoperative complications. This includes problems associated with the sutures, screws and K-wires that have been used to repair the tears. Faulty hardware may end up migrating to different parts of the body especially in the case of small pins and wires. The post-surgical patient is also prone to developing wound infection although this happens only about 1% of the time.
Acromioclavicular Joint Arthritis
One possible cause of collarbone pain is the inflammation and the deterioration of the bones and cartilage of the acromioclavicular joint. In this condition, the space between the acromion and the collarbone are reduced. As a result, the naturally smooth surfaces of these bones become rough. Friction occurs as a consequence and this is responsible for the pain.
For geriatric individuals, such a condition could be a part of the aging process. The normal space between the acromion and the clavicle is about 1 to 3 mm. By the time you reach your sixties, that space will have already shrunk to 0.5 mm or even less. That said, kids and young adults are also at risk of developing this kind of arthritis especially if they regularly engage in contact sports, weight-lifting, and construction work.
Clavicle pain due to acromioclavicular joint arthritis is identified by a mild to moderate pain over the distal area of the collarbone. That's the part that's closest to your shoulder. The pain may radiate towards the shoulder and the chest. The pain intensifies each time you attempt to reach across your chest. That's because this movement causes compression to the injured joint. The onset of pain is gradual rather than sudden. It minimizes the range of motion.
Acromioclavicular joint arthritis may present itself in two forms namely osteoarthritis and rheumatoid arthritis, the former being the more common of the two.
This is a degenerative joint disorder that occurs with the breakdown of the cartilage in the joints and the development of anomalous bony growths called osteophytes. These growths form where the ends of the clavicle and the acromion rub together.
Osteoarthritis usually affects the elderly. However, it can also occur in younger people due to physical trauma such as one that results to a fractured shoulder. If such is the case, then it is referred to as posttraumatic arthritis. Sometimes, osteoarthritis in individuals occur as a result of heredity.
The pain in osteoarthritis may persist even as you sleep. Moving the shoulder will yield a creaking sound. X-rays and blood tests will be requested in order for the doctor to make a final diagnosis of osteoarthritis. In some cases, aspiration of the synovial fluid may be done. That is, the doctor will insert a needle into the joint and collect some of the lubricating fluid for analysis. MRI scans might be ordered too.
Conservative treatment of osteoarthritis includes giving the joint ample rest. Certain lifestyle changes might be made. For instance, you may be asked to wear clothes with a zipper in front instead of the back. This way, you wouldn't have to reach back and overstrain the joint.
NSAIDs like naproxen might be given in order to minimize the pain and inflammation. An analgesic like acetaminophen may also be taken. Other medications to manage collarbone pain due to osteoarthritis include topical analgesics like Ben-Gay and topical NSAIDs like Flector. There are also lidocaine patches which can be applied directly onto the affected area but these are prescription only. Oral or injectable corticosteroids to minimize severe inflammation and pain may also be prescribed by the physician. That said, they are to be used sparingly as they have the potential to weaken the surrounding tendons.
You might be asked to work with a physical therapist. If so, you will be assisted in performing range of motion exercises daily to improve flexibility.
To loosen a rigid joint, moist heat can be applied to the area. This is done with a warming pad or with a whirlpool. This is best administered a few minutes prior to exercise.
To provide quick relief from pain, an ice pack can be applied on the area thrice a day for 20 minutes. Other non-pharmaceutical measures to minimize pain include visual imagery, meditation, and hypnosis.
If the osteoarthritis is not successfully managed through conservative therapy, then surgical treatment will be required. Resection arthroplasty, which is also known as ACJ excision, is done by removing a tiny part of the clavicle to create more space between the collarbone and the acromion. The area will be immobilized with a sling a few days post-surgery. Physical therapy will also be ordered.
An AC joint osteotomy is done to remove osteophytes. This will help a lot in reducing the friction between the clavicle and the acromion. Meanwhile, an AC joint arthroscopy is performed to get rid of loose fragments of damaged cartilage. Most individuals are able to go back to work seven days or so after the operation. However, you will be asked to refrain from reaching over your head for about 12 weeks or so. Complete recovery can take up to 12 months.
Unfortunately, damage to the bone and the cartilage caused by a degenerative condition cannot be undone. However, there is still hope for strengthening the muscles. By maintaining proper posture and participating in the rehabilitative exercises, it's possible to remove the pressure off the AC joint and minimize the pain and swelling to a point that it becomes more bearable.
Rheumatoid arthritis is a long-term auto-immune disorder in which the body's immune system ends up targeting its own tissues. That includes the fragile tissues which sheathe the joints.
The common symptoms of RA include a warmth and tenderness in the joints, stiffness in the shoulders particularly upon waking in the morning, and the presence of rheumatoid nodules. The latter are pea-sized bumps which are palpable beneath the skin of the shoulders. You may also experience a general feeling of tiredness, loss of weight, or high temperature. You might feel as though you've caught the flu.
Rheumatoid arthritis affects the joints symmetrically. In other words, if your collarbone pain occurs both in the left and the right, there's a possibility that the cause is rheumatoid arthritis. The area will appear red and when you press it, it will feel spongy. Moreover, the early morning rigidity tends to last for more than 60 minutes.
Rheumatoid arthritis causes the synovial tissue of the joint to be inflamed. As a result of this inflammation, the synovial tissue cells end up dividing and multiplying at an abnormally rapid rate. The synovial tissue grows thick and this brings about even more swelling and pain. Eventually, the continuously growing cells reach the joint space. A new tissue is formed and it is referred to as rheumatoid pannus. The pannus ooze enzymes which injure the cartilage and underlying skeleton. In time, this causes the joints to grow misaligned and this misalignment not only increases the pain but also causes deformity.
Early detection and treatment plays a great role in minimizing the incapacitating effects of rheumatoid arthritis. Receiving treatment within the first couple of years from the onset of symptoms can make a great deal of difference to the prognosis. The goal of early treatment is to limit tissue damage and preserve the function of the joints. As of today, the specific cause of RA remains unknown. Nevertheless, it continues to affect up to 1.3% of the global population.
RA has been found to be more common among females than in males. The symptoms of RA are more often seen in individuals in their forties, fifties, and sixties. Moreover, one can be genetically predisposed to rheumatoid arthritis. Other risk factors include hormonal imbalance, an imbalance in the intestinal flora, and chronic exposure to harmful environmental factors (ex. first-hand or second-hand smoking). Furthermore, studies reveal that individuals who are overweight are more likely to develop rheumatoid arthritis than others.
X-ray, MRI, and ultrasound machines are used for the diagnosis of rheumatoid arthritis. RA is a chronic condition and as such, the treatment is centered on achieving a condition of low disease activity. At present, there is no known cure for this illness. One can only make efforts to manage the symptoms, avoid further damage to tissues and joints, and diminish the disease's effects on the quality of one's life. Treatment usually consists of a combination of pharmaceuticals, physical exercise, diet, and lifestyle changes.
The most commonly prescribed drugs are NSAIDs such as celecoxib, corticosteroids like prednisone, and DMARDs (disease modifying anti-rheumatic drugs). An example of the latter is methotrexate. Some drugs may also be prescribed to suppress the body's immune functions. Drug therapy usually goes on for several weeks to several months before the medication shows any sign of effectiveness. Therefore, a corticosteroid is usually prescribed to provide immediate albeit temporary reprieve from the symptoms.
The Weightlifter's Shoulder
Another possible cause of collarbone pain is distal clavicular osteolytis (DCO) which is more commonly known as the weightlifter's shoulder. In this condition, a fracture develops in the distal end of the collarbone usually as a result of repetitive trauma. This frequently occurs in athletes who over-train and body-builders who overexert themselves from heavy overhead exercises. Because the trauma is repetitive, there is no sufficient time for the bone to heal itself. Eventually, it dissolves and is resorbed by the body. This process is known as osteolysis. During these failed attempts to self-heal, a system of blood vessels end up forming in the affected area. Scar tissue develops at the site of chronic inflammation.
Despite the name, the weightlifter's shoulder can affect air hammer operators, ball players, and even soldiers who do way too many bench presses. In fact, it can happen to anyone who frequently engages in activities where the elbows repeatedly drop below or behind the body.
The pain associated with DCO can be described as a dull aching sensation localized at the front part of the shoulder. When you press the AC joint, the pain intensifies. The symptoms also tend to intensify at night after a day of increased activity. In DCO, the shoulder's range of motion is rarely affected. However, it's painful to move the arm across the upper part of the body. The pain is also exacerbated after performing lifting activities or overhead reaching.
The diagnosis of DCO is done through x-rays, bone scans, and steroid injections. If the pain disappears after the instillation of steroids to the AC joint, this confirms that the problem lies in the AC joint.
The non-surgical treatment of mild DCO involves rest and modifying one's weightlifting routine. You may be asked to refrain from engaging in aggravating activities for at least two years. In more severe cases, surgery is indicated especially if symptoms don't go away after conservative treatment. A tiny portion of the distal clavicle will be excised. Afterwards, you'll have to participate in post-operative physical therapy exercises to regain your strength and range of motion. This surgery is referred to as distal clavicle resection. In the intraoperative stage, ruptured soft tissues are also patched up. To stabilize the joint, the surgeon may relocate the coracoacromial ligament over the excised end of the bone.
Rare Causes of Clavicle Pain
Acute Osteomyelitis of the Collarbone
One possible culprit behind your collarbone pain is osteomyelitis of the clavicle. This rare infection occurs after sustaining an injury to the bone. However, it can also be the result of a bacterial infection from another part of the body that reaches the bone via the bloodstream. Sometimes, osteomyelitis is a consequence of a head or neck operation gone wrong.
The symptoms of osteomyelitis of the clavicle include severe pain of the collarbone accompanied by fever that's 100.4 F or above. The affected area is swollen and red and hot to the touch.
The treatment for this condition is usually antibiotics administered via the intravenous route and given for one to two months. Early detection and treatment is crucial to halt the development of the disease. In extreme cases, surgical intervention may be needed to excise infected tissue or dead tissue out of the body as well as to drain pus from the wounds.
The pain associated with osteomyelitis typically resolves in about four to eight weeks after antibiotic therapy. However, the symptoms can be recurrent especially if you are immunocompromised or if you have a clinical condition which interferes with your blood circulation. If such is the case, then you're at risk for developing chronic osteomyelitis.
Osteomyelitis can affect anyone regardless of age or sex. Hematogenous osteomyelitis or osteomyelitis due to bacterial infection via the bloodstream more commonly occurs in kids than in adults. If you have diabetes or any other condition that minimizes blood supply to certain parts of your body, you can prevent the development of osteomyelitis by cleansing wounds immediately with water and soap. Maintaining a healthy weight and a clean lifestyle also helps a lot in preventing the development of osteomyelitis even when you're predisposed to having it.
Injury in the Sternoclavicular Joint
The pain in your clavicle may also be caused by injury sustained at the proximal end of your collarbone. This is the part where the clavicle connects with the sternum. Though this occurs rarely, it's still worth discussing. This condition is due to the overstretching or tearing of any of the ligaments which hold the joint together. This rupture can lead to a forward or backward displacement of the sternoclavicular joint. The main cause of this dislocation is significant trauma on either the anterior or the posterior part of the shoulder. The blow may also be sustained by the top part of the clavicle.
Symptoms associated with an injured sternoclavicular joint include pain in the part of the clavicle that's closest to the breastbone. There is also the development of an obvious lump over the affected joint.
This type of injury is divided into three categories depending on the level of seriousness.
First degree strenoclavicular injury is a non-complicated sprain which is characterized by the stretching or tearing of the sternoclavicular ligament and the costoclavicular ligament. The latter is a short and flat ligament found in the shoulder girdle.
Second degree sternoclavicular joint injury involves subluxation of the collarbone either posteriorly or anteriorly. Subluxation occurs when a joint is partially dislocated and then repositioned. Though the sternoclavicular ligament is completely breached, the costoclavicular ligament is only partially torn.
Third degree sternoclavicular injury happens when the sternoclavicular and costoclavicular ligaments are both completely ruptured, thus allowing absolute dislocation of the collarbone from its natural position.
The treatment for mild sternoclavicular injury includes rest and abstaining from activities that can aggravate the condition. Physical therapy is also recommended. Meanwhile, the goal of primary management of severe cases of sternoclavicular injury is to restore the joint back to its proper place. This means you'll have to be admitted to the hospital where an anesthetic can be given. Some extreme conditions will require surgery. A tiny incision will be made over the affected joint. The joint will be kept in place in its anatomical position. A tendon graft will then be introduced through the bone at the end of the clavicle. The graft will be taken across the joint and through the breastbone in order to create support at the anterior portion of the joint. After surgery, you'll have to wear a sling for about one month and a half. Continuous physiotherapy should be performed in order to preserve the motion of the shoulders. Recovery time may take months although the collarbone pain may disappear after a few weeks.
Thoracic Outlet Syndrome
The thoracic outlet refers to the space found between the first rib and the collarbone. It is filled with muscles, nerves, and blood vessels. Thoracic outlet syndrome occurs when veins, arteries, or nerves in this passageway become compressed due to trauma, a disease, or a congenital defect. If the shoulder muscles in your chest are too weak to keep the clavicle in place, the collarbone can slip downward and forward and it can apply pressure on the underlying nerves, veins, and arteries.
It has been established that obesity and poor posture are both huge risk factors linked to thoracic outlet syndrome. Moreover, this condition is more prevalent in females in than in males.
Symptoms associated with this syndrome tend to differ depending on which particular blood vessel or nerve has been affected. If, apart from the clavicle pain, you are experiencing a vague ache in the neck and shoulder area which extends to your arm and all the way to your hand, then your brachial plexus nerves may have been compressed. Other related symptoms include a numbing sensation in the inner part of the forearm and a tingling feeling in the fifth and fourth fingers.
A red and swollen arm is indicative of blood vessel compression. The redness and swelling is due to reduced blood flow from the arm. Sometimes, however, blood flow toward the arm may be reduced. In such cases, the affected arm and hand will feel cold to touch. The affected arm or hand also tends to tire easily.
Another symptom of thoracic outlet syndrome is difficulty in performing overhead activities. Overall, the range of movement is restricted. There are instances wherein a depression on the shoulder area is present. Sometimes, it is swollen or discolored.
One way to treat thoracic outlet syndrome conservatively is through physical therapy. The goal of which is to strengthen the muscles around the shoulder so that it would be more capable of supporting the clavicle. Exercises to improve the posture will also aid in lessening the pressure on the arteries, veins, or nerves.
Pharmaceutical treatment of this condition includes NSAIDs to minimize collarbone pain and inflammation. Certain lifestyle changes may need to be made. For instance, some patients may have to eat healthier to reduce weight as obesity places excessive pressure on the shoulder muscles which support the clavicle. You may also need to stop performing vigorous activities which trigger the symptoms.
No matter what's causing the pain in your collarbone, seeking immediate medical treatment can make a great deal of difference in recovery and in avoiding the many devastating complications.
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