Clavicle Fracture

Upper Limb

Overview

Clavicle fracture is one of the most common bone injuries, accounting for 2-3% of all fractures and typically occurring from direct trauma, falls, or indirect axial loading. Most clavicle fractures are mid-shaft fractures with varying degrees of displacement that may be managed conservatively or surgically depending on fracture configuration and patient factors. Osteopathic management focuses on supporting healing, managing secondary restrictions, and restoring functional mobility post-fracture.

Pathophysiology

The clavicle serves as a strut between the sternum and scapula, providing structural support and a broad surface for muscle attachment. Fracture mechanisms include direct blunt trauma to the shoulder, falls onto the lateral shoulder (most common), or indirect forces through axial loading of the arm. The proximal fragment is typically elevated due to pull from the sternocleidomastoid muscle, while the distal fragment is depressed by the weight of the arm and pectoralis major pull. Fracture healing proceeds through inflammation (0-2 weeks), soft callus formation (2-8 weeks), hard callus formation (8-12 weeks), and remodeling (12+ weeks). Non-union or malunion may occur in 5-10% of cases, particularly with displaced mid-shaft fractures.

Patient Education

Clavicle fractures typically heal well with conservative management; early gentle movement within pain tolerance promotes healing and reduces stiffness, while avoiding heavy lifting and impact activities for 8-12 weeks is essential for bony union.

Typical Presentation

Site

Mid-clavicle region (80% of fractures), distal third (15%), or proximal third (5%); pain may radiate to shoulder joint, neck, or anterior chest

Quality

Sharp, acute pain at fracture site with possible aching; may describe grinding or clicking sensations with movement

Intensity

Severe initially (7-9/10) reducing over 2-4 weeks to moderate (4-6/10); pain typically worse with arm movement and shoulder elevation

Aggravating

Horizontal adduction, shoulder shrugging, heavy lifting, load-bearing through affected arm, lying on affected side, rapid arm movement

Relieving

Immobilization or arm sling, rest, ice application in acute phase, gentle pendulum movements after acute phase, anti-inflammatory medication

Associated

Visible deformity or step at fracture site, swelling and bruising, crepitus or clicking with movement, restricted shoulder abduction/elevation, scapular winging if severe, possible brachial plexus irritation symptoms, reduced grip strength

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

No accuracy study

Clavicle Inspection and Gentle Palpation

Procedure

Do not stress a suspected acute fracture with cross-body adduction or compression. Inspect both clavicles for swelling, bruising, deformity and skin tenting, then palpate gently along the clavicle.

Positive Finding

Focal tenderness, swelling or deformity over the clavicle after an injury.

Interpretation

Suggests a clavicle fracture, which is confirmed on X-ray. Skin tented over a bone fragment, an open wound, breathlessness, or reduced pulses or sensation in the arm need emergency referral. This injury is diagnosed by imaging; these provocation/palpation signs have no validated diagnostic accuracy.

Sources

No accuracy study

Clavicular Spring Test

Procedure

Only in follow-up once healing is under way, never on an acute fracture: apply gentle pressure over the fracture site and note pain or movement.

Positive Finding

Pain or movement at the fracture site during follow-up.

Interpretation

Continuing movement or pain at the fracture site months after the injury raises concern for delayed union or non-union, which is confirmed on X-ray.

Further reading

No accuracy study

Palpation for Step Deformity

Procedure

Patient seated. Look along both clavicles and palpate gently for a step, a gap or overlap.

Positive Finding

A visible or palpable step, shortening or bony prominence.

Interpretation

Suggests displaced fragments. The amount of displacement and shortening on X-ray helps the orthopaedic team decide between sling treatment and surgery.

Sources

Not a diagnostic test

Shoulder Shrug Test

Procedure

During follow-up, ask the patient to shrug both shoulders and observe and palpate the clavicle.

Positive Finding

Pain or abnormal movement at the fracture site, or shoulder asymmetry.

Interpretation

A functional check during healing and rehabilitation, not a diagnostic test. Avoid in the acute phase.

Further reading

No accuracy study

Clavicular Percussion Test

Procedure

Tap very gently along the clavicle from the ends towards the middle, stopping at the first pain.

Positive Finding

Sharp pain at one point on the clavicle.

Interpretation

Focal bony pain supports a fracture and needs an X-ray. Do not tap directly over an obvious deformity.

Further reading

No accuracy study

Resisted Horizontal Adduction (Follow-up Only)

Procedure

Not for acute fractures. Once the fracture has healed, ask the patient to push the arm across the body against gentle resistance.

Positive Finding

Pain at the clavicle or acromioclavicular joint.

Interpretation

Useful in later rehabilitation to find remaining pain at the lateral clavicle or acromioclavicular joint. It has no role in diagnosing an acute fracture.

Sources

⚠ Red Flags

  • •Open/compound fracture with skin penetration
  • •Neurovascular compromise: absent distal pulses, paresthesia/paraesthesia in hand, color changes or temperature differences
  • •Severe soft tissue injury or wounds requiring surgical intervention
  • •Multiple injuries suggesting high-velocity trauma (assess for pneumothorax, rib fractures, spinal injury)
  • •Signs of non-union or malunion persisting beyond 12 weeks with functional impairment
  • •Reflex sympathetic dystrophy/Complex Regional Pain Syndrome development

⚡ Yellow Flags

  • •Delayed healing or non-compliance with immobilization suggesting possible secondary gain
  • •Catastrophic thinking about permanent disability or cosmetic concerns
  • •High anxiety or fear-avoidance behavior disproportionate to injury severity
  • •Workplace or litigation involvement affecting rehabilitation motivation
  • •History of non-union or delayed healing in previous fractures
  • •Poor coping strategies or limited social support

Osteopathic Techniques

Refer first

A suspected clavicle fracture needs medical assessment first. Most mid-shaft fractures are treated with a sling, pain relief and orthopaedic follow-up; neurovascular signs, an open fracture or skin tenting need urgent orthopaedic review.

Rehabilitation Exercises

Pendulum Shoulder Circles (Codman's Pendulum Exercises)

Range of MotionBeginner

Supine Passive Shoulder Elevation (Wall Slide Progression)

Range of MotionBeginner

Cross-Body Shoulder Stretch (Horizontal Adduction Stretch)

StretchingBeginner

Doorway Pectoral Stretch (Corner Stretch)

StretchingBeginner

Scapular Retraction (Prone Shoulder Blade Squeeze)

StrengtheningIntermediate

Quadruped Shoulder Stabilization (Quadruped Hold with Arm Lift)

StrengtheningIntermediate

Side-Lying Shoulder External Rotation (Prone Press-Out)

StrengtheningIntermediate

Resistance Band Shoulder Abduction (Standing Side Raise)

StrengtheningIntermediate

Scapular Setting and Posture Retraining (Standing Wall Posture)

PosturalBeginner

Single-Arm Balance on Stability Ball (Core and Shoulder Stability)

BalanceAdvanced

Push-Up Progression (Modified to Standard Push-Up)

StrengtheningAdvanced

Stationary Cycling or Lower Body Cardiovascular Work (Protected Upper Limb)

CardiovascularIntermediate

Referral Criteria

  • •Initial presentation with suspected clavicle fracture should be referred for radiographic imaging (X-ray: AP, lateral, and axial views) to confirm diagnosis and assess fracture configuration
  • •Displaced or comminuted mid-shaft fractures should be referred to orthopedic surgeon for assessment of operative versus conservative management
  • •Signs of neurovascular compromise or open fracture require immediate emergency department referral
  • •Fracture with associated brachial plexus injury requires specialist neurological assessment and orthopedic consultation
  • •Lack of callus formation or persistent severe pain beyond 8 weeks warrants re-referral to orthopedics to assess for non-union or malunion
  • •Development of Complex Regional Pain Syndrome or reflex sympathetic dystrophy requires specialist pain management and physiotherapy referral
  • •Distal clavicle fractures with acromioclavicular joint disruption may require orthopedic evaluation for surgical stabilization
  • •Patient unable to comply with conservative management or develop significant psychological distress requires mental health or pain psychology referral