Clavicle: anatomy, functions and treatment

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The clavicle, also called the clavicle, is an elongated, S-shaped bone that sits between the shoulder and the breastbone at the top of the rib cage. It provides structural support between the shoulder and the rest of the skeleton and is one of the most commonly fractured bones in the body.

Composition

The clavicle connects to the scapula or scapula and the sternum, forming two joints at both ends of the bone, namely:

  • Acromioclavicular Joint (AK): The acromioclavicular joint is formed between the acromio of the scapula and the clavicle in the upper arm, held in place by the acromioclavicular ligament.
  • Sternoclavicular Joint: The sternoclavicular joint is formed between the sternum and the clavicle at the front of the rib cage and is supported by the costoclavicular ligament.

The relative size of the clavicle makes it particularly prone to fractures. A clavicle fracture can occur from a fall with an outstretched arm or from a direct blow to the shoulder. The most common fracture is the middle third of the clavicle and accounts for approximately 80% of all clavicle fractures.

Together, the clavicle and scapula are collectively called the thoracic or shoulder girdle.

Function

The clavicle connects the shoulder to the rest of the skeleton. Its location increases the range of motion of the shoulder away from the body and helps protect the arm by dissipating the force transmitted by direct contact .

The clavicle has little movement when lifting and lowering (up and down movement), stretching and retraction (forward and backward movement), and rotation .

The subclavian bone, which means "below the clavicle," is the main muscle that controls the clavicle. It originates from the first rib and attaches to the lower part of the clavicle. As it contracts, the subclavian bone, controlled by the subclavian nerve, causes the clavicle to tighten or move downward .

The anterior deltoid, trapezius, sternocleidomastoid, and pectoralis major muscles attach to the clavicle for support and also cause a small degree of multidirectional movement .

The midclavicular line, a vertical line drawn through the body from the middle of the clavicle, serves as an important anatomical landmark for locating other structures, including the apex of the heart , where a stethoscope can be placed to listen to the heartbeat.

Related conditions

The clavicle and associated joints can be damaged due to injury or repeated overuse of the shoulder. Common conditions associated with the collarbone include the following.

Stretch or cut the acromioclavicular joint

Injury to the acromioclavicular joint, such as a direct blow to the front of the shoulder or falling and landing on an outstretched arm, can damage the ligaments that hold the acromio and clavicle together. This can lead to stretching or dissection of the acromioclavicular joint. Symptoms include localized pain in the acromioclavicular joint at the top of the shoulder .

Clavicle fracture (broken clavicle)

An injury to the shoulder, especially a direct injury to the front of the shoulder, can fracture the collarbone. Symptoms include pain in the collarbone and shoulder, as well as pain and difficulty moving the arm.

Sprain or dislocation of the sternoclavicular joint

The sternoclavicular joint between the clavicle and the breastbone can be dislocated due to an injury to the front of the shoulder, causing pain and swelling around the affected area .

Osteolysis of the distal clavicle (weightlifter's shoulder)

The end of the clavicle or the distal portion that forms the acromioclavicular joint can become irritated and inflamed. Osteolysis, or bone degeneration, can easily occur at the end of the clavicle due to the high degree of stress and repetitive forces transmitted through the small area of the acromioclavicular joint, especially when lifting heavy weights such as the bench press or the military press. . Bone begins to break down faster than it can heal and to form new bone cells. Acute pain usually occurs with pushing and pulling movements of the arm and shoulder, with a dull ache at rest .

Acromioclavicular arthritis (AK) of the joints

Aging and repeated overuse of the shoulder can lead to cartilage degeneration and the development of arthritis in the acromioclavicular joint, leading to shoulder swelling and pain with arm movements.

Rehabilitation

Depending on the degree of your condition, rehabilitation for conditions related to the clavicle or related joints includes the following:

  • Medications: Pain relievers and anti-inflammatory medications can be used temporarily to relieve symptoms after an injury.
  • Cortisone injections: Cortisone can be injected into the acromioclavicular joint to reduce pain and inflammation.
  • Rest: It is often necessary to avoid activities that increase the symptoms of associated clavicle conditions to allow time for inflammation to subside and injured joints to heal. Avoid overhead movements as well as pull-ups, pushing, and lifting.
  • Immobilization – A shoulder strap may need to be worn to protect the collarbone after an injury. Acromioclavicular and sternoclavicular joint sprains or dislocations may require the use of a shoulder band for two to six weeks, depending on the severity of the injury. If your collarbone is fractured, you may need to wear a shoulder band for six to eight weeks until the bone heals.
  • Physical therapy: Physical therapy can help repair the structures around the collarbone after an injury, reduce pain, restore proper range of motion and joint mobility, and strengthen the muscles around the shoulders and shoulder blades.
  • Arthroscopic Surgery: Arthroscopic shoulder surgery is generally performed in active patients with distal clavicle osteolysis who wish to resume weight lifting and sports without pain. Distal clavicle resection is often performed, where a small portion of the swollen end of the clavicle is removed to increase space in the acromioclavicular joint and reduce compression and degeneration of the joint. Arthroscopic surgery can also be done to treat acromioclavicular arthritis symptoms when other treatments have failed to relieve pain.
  • Surgical treatment: Surgery may be required if the clavicle is severely fractured. Most of the time, an open reduction with internal fixation (ORIF) is performed, during which the broken parts of the clavicle are reattached or reduced and then either joined with metal pieces or fixed from the inside.
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