Clavicular fractures are nasty and bio-mechanically they cause us lots of problems.
The clavicle is an attachment point for several muscles namely sterno- cleidomastoid, pectoralis major, subclavius, deltoid, and trapezius muscles, quite a few then! So what will happen to these muscles if the clavicle is fractured? They won’t have a stable fixation point.
Many of these muscles insert onto the clavicle and an insertion point moves a bone, humm , not a great idea if that bone is trying to heal!
Take the Upper Trapezius, it originates on the occipital bone and inserts into several areas but one of these areas is the lateral 3rd of the clavicle, it is supposed to elevate the clavicle. In the picture above, the lateral third of the clavicle has dropped, due to the fracture, so this muscle will be working overtime to try to stabilise this bone. This will result in a very tight upper trapezius which won’t respond at all to loosening, leading to headaches and a stiff neck.
Think about Pectoralis Major. This originates from the medial 2/3rds of the clavicle. An origination point is supposed to be a fixed point, allowing the humerus to medially rotate when it shortens. But, in the picture above, the medial 2/3rds of the clavicle is now sitting in an elevated position and will now move around in response to humerus movements… ouch. Subclavius’ job is to depress the Clavicle so in this scenario, it will be working incredibly hard to try to stabilise the medial 2/3rds so it can continue to do its job.
The Anterior Deltoid muscle is also of concern, it originates onto the lateral 3rd of the clavicle, forming a fixation point so the humerus can be flexed and medially rotated and with the clavicle broken, this will struggle to do its job.
So a fractured clavicle creates several issues. On one side, muscles will be working very hard to try to stabilise the damaged bone and will be tight and painful as a result, on the other hand it will severely affect the workings of the shoulder and arm. So what can we do?
Well the first thing is to use a sling, to immobilise the shoulder, so it stops tugging on the clavicle allowing it to heal. Secondly, it will help the muscles that are overworking to relax a little, now the sling is doing some of the work. Once the fracture has healed, there is a great deal of work needed to restrengthen all these muscles. Some will be tight and stiff from overworking, some will be weak from lack of use. So plenty here for the therapist or the trainer to be working on to help get their client back to full function.
If using this for CPD try to answer these questions:
1. Your client arrives in the gym 6 weeks after fracturing their clavicle, they are struggling with weakness in their arm and stiffness in their neck but want to get back to training. Design a strength and stretching program to relieve their symptoms and get them back to full strength. Hint: Remind yourself of all the muscles which attach and insert into the clavicle.
2. You are working pitchside and you suspect a fractured clavicle in your client. Remind yourself of the tests for clavicular fractures, how will you deal with the initial injury? Once the fracture has healed what early rehabilitation can you give your client to ensure they do not suffer any long term issues from their injury?
Then write it all up in your CPD log. For your Free Reinge Education CPD logbook, click here.
Reinge Education provide CPD courses for therapists and trainers across the country, these are in both an online format and in face to face workshops. Our unique combination of knowledge allows us to provide a fresh approach, looking at how anatomy affects function within the body, merging therapy and sports science to give a unique perspective.
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