Collarbone dislocation is condition in which, the collarbone or the clavicle gets separated from the joints it forms at either of its attached ends. Dislocation of the collarbone is commonly an injury and can occur due to various causes, the most common is a direct blow on the shoulder. Collarbone dislocation is a mostly traumatic condition and is very painful. The injury to the collarbone often involves injury to the surrounding structures, ligament tears and other muscle injuries as well.
Collarbone or clavicle is the bone that extends from the breastbone (sternum) to the shoulders on both sides of the body. The collarbone forms a joint with the sternum on the inner or medial side, while it forms a joint with a part of the shoulder joint on the outer or the lateral side. Injuries are a common cause of collarbone dislocation, which can occur at either ends of the collarbone in varying degrees of severity.
Types of Collarbone Dislocation
Dislocation of the collarbone at the outer end, where it is connected to the shoulder joint is more common type of collarbone dislocation and is also known as shoulder separation or acromioclavicular joint (ACJ) injury.
Sternoclavicular Joint Dislocation:
Dislocation of the collarbone at the inner end, where it is connected to the sternum, is also known as sternoclavicular (SC) joint dislocation and is a fairly rare injury.
In case of sternoclavicular joint injuries causing collarbone dislocation, the collarbone can get displaced in both the directions.
- The collarbone dislocation can occur due to pressure on the shoulder being pushed backwards, which turns the collarbone towards the front of the sternum (anterior dislocations). These are more common and occur when the shoulder receives a blow from the front.
- In other case, if the shoulder is forced forward, the collarbone can get displaced backwards (posterior dislocations). These are less common and occur when the shoulder receives a blow from the back.
Depending on the area affected, the symptoms of collarbone dislocation may range from mild to severe and also vary from person to person. For simple understanding, collarbone dislocation can be categorized into grades, which depend on the severity of the injury and the extent of tissue damage. The milder cases of collarbone dislocation include those, in which the ligaments are mildly injured with minimal dislocation of the collarbone. The moderate cases or types of collarbone dislocation may include completely torn ligaments with considerable dislocation of the collarbone and severe cases may include those with complete dislocation of the collarbone, resulting in severe symptoms.
Understanding the types, causes and symptoms of collarbone dislocation is important. Treatment of collarbone dislocation depends on the causes and the type of dislocation and a proper therapeutic regimen must be planned for efficient recovery.
Causes of Collarbone Dislocation
The most common causes of collarbone dislocation is trauma to the shoulder joint or the upper part of the body. Some of the traumatic causes of collarbone dislocation include:
- Sports Injury Causing Collarbone Dislocation – Collarbone dislocation can commonly occur as a sports injury, particularly when the player is hit hard on the shoulder. This can result when the player receives a direct blow on the shoulder, either by being hit by someone or by falling on the ground, where the shoulder hits the ground receiving a direct blow. Shoulder injuries are common amongst players and collarbone dislocation or ACJ injuries can be one of those. Contacts sports, high impact sports, adventure sports and other activities that can involve falling increasing the risk of collarbone dislocation.
- Accidents and Collarbone Dislocation – Direct falls on the shoulders result in shoulder or collarbone dislocation. This can result when a person falls after losing balance or falls from a height and the shoulder hits hard on the ground. Vehicular accidents are also a common cause of dislocation of collarbone, when a person falls off the vehicle and hits the ground, causing injury to the shoulder and collarbone.
As the soft tissues, ligaments and muscles get stretched, torn or damaged, the collarbone can get displaced from its position resulting in dislocation.
Symptoms of Collarbone Dislocation
Collarbone dislocation usually occurs as a traumatic event and often results in immediate symptoms that may be related to the injury. Common symptoms of collarbone dislocation include
Pain – Pain is the most common symptom of collarbone dislocation. Severe pain can be noted in the shoulder area (in case of injury to the outer end of the collarbone) or the sternal area (in case of injury to the inner end of the collarbone). Pain can even radiate from the shoulders to the front part towards the chest, backwards to the upper and middle back and to the arms and hands.
Signs of Injury – Swelling and bruising is a common symptom of collarbone dislocation. Shoulder area is often swollen and tender to touch. A bruised, bluish black appearance may be noted, particularly in cases of direct blow to the shoulder causing collarbone dislocation. A noticeable bump or a localized swollen area may be noted on the shoulder, at the point of injury. The entire area from the shoulder to the collarbone and sternum must be evaluated as it may show signs of injury and inflammation.
Difficulty in Movement – Movements involving the collarbone are difficult and painful. In case of shoulder separation or collarbone dislocation at outer end, the person may find it difficult to move or raise the arms. Overhead reaching activities may be difficult and painful. With injuries to the sternal end of collarbone, movements of the upper body, chest or even breathing can be painful. Limited range of motion and painful movements of the shoulder and arm is a common symptom of collarbone dislocation.
Weakness in Arms – Difficulty in movement is often due to strained joint and soft tissue structures. The torn muscles and ligaments are unable to hold and result in weakness in the area. The person may find it uncomfortable and painful to hold objects in the hands and may feel weak to make any movements.
Dislocation of collarbone results from torn soft tissues that displaces the collarbone from its place. This gives a feeling of giving way as the collarbone moves from its original position. Collarbone dislocation gives a weak feeling, as if something between the shoulder and the sternum is not in place, is detached or is let loose, which not only causes discomfort but results in severe pain too.
In case of sternoclavicular joint injuries causing collarbone dislocation, the affected area is around the chest. Hence, such injuries can result in difficulty in breathing, feeling short of breath, having choking sensation with difficulty in swallowing, talking or any movement of the throat and the chest.
Chronic Symptoms of Collarbone Dislocation - Chronic cases of collarbone dislocation can present with chronic pain in the injured area and structures around it. With time, the injured area may remain weak and result in use of accessory muscles or compensatory overuse of supporting structures. This can extend the pain and discomfort from the injured area to those parts surrounding it. Chronic pain in collarbone dislocation can extend to the neck region, front of chest, upper back, shoulders, arms and hands too. Pain in neck, extending to the head can also be a common symptom of chronic collarbone dislocation.
People with chronic conditions may eventually develop osteoarthritis and show symptoms of degenerative changes from collarbone dislocation. Arthritis of the joint can cause chronic pain, stiffness in the joint and affected mobility of the joint. These complaints can be managed well with adequate rest, therapeutic exercises to maintain the strength and flexibility of the injured joint and nearby structures.
Diagnosis of Collarbone Dislocation
Collarbone dislocation can be diagnosed with the help of history regarding previous injury, falls and sports activities just prior to the complaints. Clinical examination often reveals signs of inflammation and injury to the clavicle, shoulder or upper body. Range of motion and reflexes are evaluated to understand the severity of injury and possible causes of the condition.
If collarbone dislocation is suspected, certain investigations are performed to confirm the diagnosis of collarbone dislocation and to rule out other conditions. Some investigations for diagnosis of collarbone dislocation include:
X-rays – X-ray of the shoulder joint and of the ribs can help to evaluate any damage to the clavicle or collarbone. Any displacement or collarbone dislocation can be noticed well in the X-ray. It can also help to detect any other associated injury, like fractures or problems with the bony structures. This is more important in case of serious injuries or accidents, when there are chances of multiple injuries affecting the area. Diagnosis of collarbone dislocation can be made with the help of X-rays.
In some cases, CT scan may be advised to note further details, if required.
An MRI scan helps to study the soft tissue structures and helps to detect any abnormality around the collarbone and shoulder. Ligaments injuries, muscles tears and other damage to cartilage or soft tissues can be detected.
Treatment of Collarbone Dislocation
Collarbone dislocation can be usually managed with conservative treatment and most persons can achieve full recovery.
Medical Management for Collarbone Dislocation –
Medicines for collarbone dislocation include anti-inflammatories, muscle relaxants and other medicines to relieve pain and swelling. Nutritional supplements, calcium and vitamin D supplementation may be considered, if appropriate. Joint reduction for collarbone dislocation may be considered, if appropriate and is best done by an expert under medical supervision. Various treatment options for collarbone dislocation need to be considered according to the severity of the case.
The main approach to treatment of collarbone dislocation is to give rest and apply ice.
- Rest – Giving rest to the injured area is crucial for the healing process. It is advisable to avoid activities that involve the injured joint, movements of the shoulder, arms and the chest. Twisting movements of the upper back, lifting objects and bending or awkward postures must be avoided by all means. Adequate rest to the inflamed, injured area in collarbone dislocation can help in the healing of strained ligaments and also prevent further injuries.
Immobilization of the shoulder and complete rest to the area around dislocated collarbone may be done by placing a cast, if found appropriate. The physician may advise the use of braces or a sling to keep the dislocated collarbone, injured shoulder or the arm supported. This helps to release pressure over the injured area and helps in healing. The type of support needed mainly depends on the type of injury in collarbone dislocation, the grade and severity.
- Ice – Applying ice to the inflamed, swollen area in collarbone dislocation can be of great help. Acute injuries must be managed with application of ice packs or ice cubes wrapped in a cloth. This not only helps to relieve pain, swelling and inflammation but also promotes rapid healing.
This may be continued for a period of few weeks, depending on the severity of the condition. After few weeks the treatment, rest and effects of joint reduction are reviewed and if found satisfactory, further line of treatment and physical therapy may be planned.
Surgery for Collarbone Dislocation
If joint reduction is not helpful or sometimes, if the dislocation of collarbone becomes chronic and does not respond to treatment, surgical correction may be considered.
Surgery for collarbone dislocation may include procedures to correct the torn ligaments, repair of the injured structures and stabilization of the injured joint.
Shoulder arthroscopy for collarbone dislocation is a procedure in which an instrument is inserted through a small incision, which can help to visualize the area and repair the structures. It is also used as a diagnostic modality for some cases, in which it helps to detect abnormalities and changes in the affected part.
Surgical procedures considered for treatment of collarbone dislocation and degenerative arthritis include resection arthroplasty. This is done to prevent the surfaces of bones from rubbing each other and reduce friction to protect the joint.
Physical Therapy for Collarbone Dislocation
Physical therapy plays a very important role in treatment of collarbone dislocation. It is advised after joint reduction, rest and also after surgical correction. The main aim of physical therapy is to reduce pain, swelling and discomfort in the affected area of the collarbone or shoulder. It also helps to strengthen muscles, regain the joint function, mobility and improvement range of motion. Post-surgical physical therapy is essential to ensure success of the surgery and complete recovery from collarbone dislocation.
Complications of Collarbone Dislocation
Collarbone dislocation involves many structures of the upper body and can result in certain complications if the condition is not managed well. Some common complications of collarbone dislocation can include severe damage to the shoulder, upper body, collarbone and sternum. Posterior dislocations of the sternoclavicular joint injuries in collarbone dislocations can be serious as there is a risk of damaging internal organs in the chest cavity. Such cases, need to be managed well and proper rehabilitation is essential.
Persistent pain in the shoulder and upper back area which affect range of motion can be one of the common complications of collarbone dislocation, particularly in cases, which are not treated properly.
Collarbone dislocation also increases the risk of degenerative changes in the shoulder joint or the sternoclavicular joint. Early degeneration in injured joints can lead to osteoarthritis earlier than otherwise. Some people with severe damage to the surrounding structures may experience pain and other symptoms of collarbone dislocation for a longer period, but should respond well to a properly planned treatment regimen.
Prevention of Collarbone Dislocation
Collarbone dislocation can be prevented by taking appropriate safety measures while playing. This usually includes creating a safe environment for play and sports, wearing sports gear, following rules and taking precautions to prevent falls, accidents and sports injuries. Proper warm up before exercises or sports and cool-down stretches after exercises can help to keep muscles strong. This can help to prevent injuries to the shoulder and collarbone, particularly in those who have suffered injuries in the past or have degenerative changes.
With timely intervention, effective treatment and proper rehabilitation, most cases of collarbone dislocation heal well and most persons show complete recovery without any problems.
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