Midshaft clavicle fracture – Royal Sussex County Hospital and Princess Royal Hospital

What is this information about?

This information is about a midshaft collar bone (clavicle) fracture.

It tells you:

• How to look after yourself when you go home from hospital with a midshaft clavicle fracture
• What exercises you can do to help heal and strengthen your arm
• What follow-up treatment you might have
• Who to contact if you need further help and support.

What is a midshaft clavicle fracture?

A midshaft clavicle fracture is a break in the middle of your collarbone. Along with your shoulder blade (scapula) your collarbone forms the ‘shoulder girdle’. This is a bony link that connects your upper arm to the main part of your body.

Most breaks to the collar bone happen around the middle section of the bone.

Do I have a fracture or a break?

If you have a fracture, it means you have a broken bone. ‘Fractured bone’ and ‘broken bone’ both mean the same.

How long is it likely to take for my injury to heal?

It usually takes 6 to 12 weeks to heal. Once your collarbone has healed you may have a small, painless lump over the fracture site. This should not affect your ability to do things.

Will smoking or vaping slow down my healing?

Yes. Smoking slows healing so if you smoke or vape try to stop or cut down. This is most important in the first 2 weeks after your injury. If you would like help to stop smoking talk to your GP or visit Quit smoking for further information.

What should I do if I am in pain after my clavicle fracture?

If you are in pain, take your usual pain killers or pain killers given to you in the emergency department. Follow the dose instructions on the packet. If you are struggling with pain do speak to your GP or pharmacist.

Put ice or a cold pack over the painful area for short term pain relief.

When should I be wearing my arm sling?

Use your sling for 3 weeks or until you are seen in clinic for a follow-up appointment. You can take it off to wash, dress and do your exercises. It does not need to be worn at night.

What should I do if I am struggling with my sling?

When should I start exercising?

It is important to start gentle exercises straight away to prevent stiffness. Your exercises are shown later in this care plan.

Will I have a further (follow up) appointment?

You have will have an appointment with an upper limb specialist 3 weeks after your injury. They may organise another X-ray to check the position of your fracture and will discuss the next stage of your management. You will be sent an appointment in due course.

What should I do from week 1 to week 3 after my injury?

• Rest your arm for the first 24 to 72 hours (1 to 3 days). However, it is important to keep moving around.
• Apply cold packs (ice pack or frozen peas wrapped in a damp towel) to the sore area for up to 15 minutes, every few hours. However, the ice must never be in direct contact with the skin.
• Use your sling as already instructed. You may find it more comfortable to sleep propped up on pillows.
• Aim to do all the exercises below 5 times a day. They should not cause too much pain. Do fewer if they are making your pain worse. Hand, wrist and elbow exercises are only needed while you are wearing a sling. You can stop these once they become easy and you have full movement.

Hand, wrist and elbow exercises

Finger and wrist bending and straightening

Open and close your hand as shown 10 times. Then move your wrist up and down 10 times.

After around 3 to 5 days progress to holding a soft ball or ball of socks. Squeeze the ball as hard as possible without pain. Hold for 5 seconds and repeat 10 times.

Elbow bend to straighten

Bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to. Repeat 10 times if there is no increase in pain.

Forearm rotations

Keep your elbow at your side and bent to 90 degrees (a right angle). Slowly turn your palm up and down. You should not feel more than a mild to moderate stretch. You can use your other arm to help if you need to. Repeat 10 times if there is no increase in pain.

Posture exercise

Bring your shoulders back and gently squeeze your shoulder blades together. Hold for 30 seconds. Repeat 5 times.

Shoulder pendulum (swing) exercises

Stand next to a firm surface. Support yourself with your un-injured arm and lean forwards. Let your injured arm relax and hang down to the ground.

Gently swing your arm, making a small movement. Try to do this forward and backward, side to side and in small circles.

Aim to do this for 1 to 2 minutes in total.

This exercise can cause some discomfort when you first start to do it. This will usually ease off after you have repeated the exercise a few times. Remember to keep your arm relaxed.

What should I do from week 3 to week 6 after my injury?

• Follow the advice that you are given during your follow-up appointment about when to stop using your sling and returning to light activities.
• Continue to avoid any heavy lifting and loading until 6 weeks after your injury.
• Start the new exercises below using your non-injured arm to support your injured arm. Aim to do these 5 times a day. These exercises should not cause too much pain. Do fewer if they are making your pain worse.

Exercises

Supported arm elevation:

Use your other hand to lift your injured arm up in front of you, as shown in these pictures. Repeat 10 times if there is no increase in pain.

Supported arm rotation

With your elbow touching the side of your body, bend your injured arm as shown below.

Hold onto a stick, umbrella, or something similar. Then use your good arm to gently move your forearm outwards away from your body. If you don’t have a stick, hold your injured arm at the wrist and guide it outwards with your other hand. 

As you do this, keep your elbow bent and tucked into your side. Repeat 10 times if there is no increase in pain.

What should I do from week 6 after my injury?

The fracture should be healed. Return to normal activities gradually but be guided by any pain you get.

You can try returning to sports between 6 and 12 weeks when your pain has settled and you have good movement back in your arm. The specialist at your follow-up clinic should have advised you further about returning to higher impact activities and sports. If you are still unsure, please contact your consultant’s secretary.

Exercises

Start the new exercises below, trying to use your arm on its own. Aim to do these 5 times a day. These exercises should not cause too much pain. Do fewer if they are making your pain worse.

Arm elevation

Lift your arm forwards in front of you. Try to raise the arm as high as you can. You do not need to raise your arm so high or for so long that it causes too much pain. If this is too difficult, try the same movement with a bent elbow. Repeat 10 times.

Raising your arm out to the side

With your palm facing forwards, move your arm out to the side in a big arc. Try to raise your arm as high as you can. If this is too difficult, try the same movement with a bent elbow. You do not need to raise your arm so high or for so long that it causes too much pain. Repeat 10 times.

Arm rotation

Start with your elbow bent by your side. Move your forearm out to the side, keeping your elbow bent and near your waist. Repeat 10 times.

What other things can the Virtual Fracture Clinic help me with?

Please contact the Virtual Fracture Clinic if you:

• are concerned about your symptoms
• are struggling to return to exercise or your usual activities
• would like further information or support after you have read this information.

When can I start driving?

You can return to driving when you:

• are no longer using your arm sling
• can turn the steering wheel as much as you need to without it hurting
• can safely deal with all emergency situations without being in pain or hesitating. For example, you must be able to stop the car quickly and in full control and safely avoid obstacles
• are covered by your insurance company.

How can I get a fit note for work?

You can get a fit note from the Virtual Fracture Clinic, or the specialist when you are seen in clinic.

If I need further advice about my injury, who can I contact?

If contacting by phone, please leave a message with your date of birth, name and clear contact details, along with a brief message about what problems you are having.

We will contact you back as soon as possible.

We aim to get back to you within 24 hours.

Contacting us by email would be preferable as the phone line can be very busy.