What should I do immediately if I suspect a dislocated clavicle?

Immediately immobilize the arm with a sling, apply ice to reduce pain and swelling, use over-the-counter pain relievers, and seek prompt medical attention without attempting to "pop" it back yourself.

How is a dislocated clavicle diagnosed?

Diagnosis involves a physical examination to assess pain and range of motion, followed by imaging studies such as X-rays, MRI for soft tissue, or CT scans, especially for SC joint dislocations.

Is surgery always required for a dislocated clavicle?

No, non-surgical treatment with immobilization and pain management is common for low-grade AC separations and many SC dislocations; surgery is typically reserved for high-grade separations, posterior SC dislocations, or chronic instability.

What does rehabilitation for a dislocated clavicle involve?

Rehabilitation progresses through phases, starting with immobilization and pain management, then gradually introducing early mobility, followed by strengthening exercises, and finally functional and sport-specific training to regain full function.

Can dislocated clavicle recurrence be prevented?

While not always preventable, recurrence can be reduced by completing physical therapy, maintaining strong shoulder and core muscles, using proper technique in activities, wearing protective gear, and practicing fall prevention.

How to treat a dislocated clavicle?

Treating a dislocated clavicle primarily involves immediate medical evaluation to confirm the diagnosis and determine the specific joint affected (acromioclavicular or sternoclavicular) and the severity, followed by a tailored approach that may include immobilization, pain management, physical therapy, and in some cases, surgical intervention.

Understanding Clavicle Dislocations

The clavicle, or collarbone, forms two crucial joints:

Acromioclavicular (AC) Joint: Where the clavicle meets the acromion (part of the shoulder blade). Dislocations here are commonly referred to as "shoulder separations" and are graded based on the severity of ligament damage.
Sternoclavicular (SC) Joint: Where the clavicle meets the sternum (breastbone). These are less common but can be more serious, particularly posterior dislocations which may affect vital structures behind the sternum.

A true "dislocated clavicle" refers to the displacement of the clavicle from one of these joints, not a fracture of the bone itself. Treatment strategies vary significantly depending on which joint is affected and the degree of displacement.

Immediate First Aid

If you suspect a dislocated clavicle, immediate action is crucial to minimize pain and prevent further injury.

Immobilize the Arm: Support the injured arm in a comfortable position, ideally with a sling. This reduces movement at the shoulder and clavicle.
Apply Ice: Use an ice pack (wrapped in a cloth) to the affected area for 15-20 minutes every 2-3 hours. This helps reduce pain and swelling.
Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort.
Avoid Movement: Do not attempt to "pop" the clavicle back into place yourself or allow anyone else to do so. This can cause further damage to ligaments, nerves, or blood vessels.
Seek Medical Attention: Prompt evaluation by a healthcare professional is essential for accurate diagnosis and appropriate treatment.

Medical Diagnosis

Upon presentation, a medical professional will perform:

Physical Examination: Assessing pain, swelling, deformity, range of motion, and nerve/vascular status.
Imaging Studies:
- X-rays: Standard for visualizing the bones and joint alignment, often taken with weights in hand to accentuate AC joint separation.
- MRI (Magnetic Resonance Imaging): May be used to assess soft tissue damage, including ligaments and surrounding muscles, especially for higher-grade AC separations or complex SC dislocations.
- CT Scan (Computed Tomography): Particularly useful for SC joint dislocations to visualize the joint in 3D and assess any posterior displacement impacting internal organs.

Medical Treatment Options

Treatment pathways are determined by the type and severity of the dislocation.

Non-Surgical Treatment

This is the most common approach for low-grade AC joint separations (Grade I-III) and many SC joint dislocations.

Reduction: For some SC joint dislocations, a doctor may attempt a closed reduction, manually manipulating the clavicle back into place under sedation. This is rarely attempted for AC joint dislocations.
Immobilization:
- Sling: A simple arm sling or shoulder immobilizer is typically used for 2-6 weeks to support the arm and restrict movement, allowing ligaments to heal.
- Figure-of-Eight Bandage: Less commonly used now, but historically applied to retract the shoulders and reduce pressure on the AC joint.
Pain and Inflammation Management: Prescribed or over-the-counter anti-inflammatory medications.
Rest: Limiting activities that stress the shoulder and clavicle.

Surgical Treatment

Surgery is typically reserved for:

High-Grade AC Joint Separations (Grade IV-VI): Where there is significant displacement and severe ligamentous disruption, leading to persistent instability or cosmetic deformity.
Posterior SC Joint Dislocations: These are considered medical emergencies due to the risk of compression of the trachea, esophagus, or major blood vessels.
Chronic Instability: If non-surgical treatment fails to provide stability and function.
Open SC Joint Dislocations: Due to trauma leading to an open wound.

Surgical procedures aim to reconstruct or repair damaged ligaments and stabilize the joint. This may involve:

Direct Repair: Reattaching torn ligaments.
Ligament Reconstruction: Using grafts (from the patient or a donor) to replace severely damaged ligaments.
Internal Fixation: Using pins, screws, or plates temporarily to hold the joint in place while healing occurs.

Rehabilitation and Recovery

Rehabilitation is a critical component of recovery, regardless of whether treatment is surgical or non-surgical. It typically progresses through several phases:

Phase 1: Immobilization and Acute Pain Management (Weeks 0-4/6)

Goal: Reduce pain and swelling, protect the healing joint.
Activities: Strict adherence to sling use, ice, and pain medication. Gentle passive range of motion (PROM) exercises for the elbow, wrist, and hand to prevent stiffness, as instructed by a therapist. Avoid any active shoulder movement.

Phase 2: Early Mobility (Weeks 4-8)

Goal: Restore pain-free range of motion.
Activities: Gradually introduce active-assisted and then active range of motion (A-ROM) exercises for the shoulder.
- Pendulum Swings: Gentle circular motions of the arm while leaning forward.
- Wall Slides: Using fingers to crawl up a wall to increase shoulder flexion.
- Scapular Retractions: Squeezing shoulder blades together without moving the arm.
- Light Isometric Exercises: Gentle contractions of shoulder muscles without joint movement.

Phase 3: Strengthening (Weeks 8-16+)

Goal: Regain strength, endurance, and stability in the shoulder girdle.
Activities: Progressive resistance exercises focusing on the rotator cuff, deltoid, and scapular stabilizer muscles.
- Resistance Band Exercises: External and internal rotation, rows, chest presses.
- Light Dumbbell Exercises: Front raises, lateral raises, overhead press (as tolerated), rows.
- Push-ups (Modified): Against a wall or on knees, progressing to full push-ups.
- Core Strengthening: Essential for overall stability and power transfer.

Phase 4: Functional and Sport-Specific Training (Months 4-6+)

Goal: Prepare for return to full activity, including sports or demanding occupations.
Activities: Incorporate exercises that mimic movements required for the individual's specific activities.
- Proprioceptive Drills: Exercises to improve joint awareness and balance (e.g., stability ball exercises).
- Plyometrics: For athletes, introducing controlled jumping and throwing motions.
- Gradual Return to Activity: Slowly reintroduce sports or heavy lifting, with proper warm-up and cool-down.

Throughout rehabilitation, the guidance of a physical therapist is invaluable to ensure proper progression, prevent re-injury, and optimize outcomes.

Preventing Recurrence

While not all dislocations can be prevented, especially those from high-impact trauma, certain strategies can reduce the risk of recurrence:

Consistent Rehabilitation: Completing the full course of physical therapy to ensure full strength and stability.
Strength and Conditioning: Maintaining strong shoulder and core muscles to support the clavicle and shoulder joint.
Proper Technique: In sports and weightlifting, using correct form to avoid undue stress on the shoulder.
Protective Gear: Wearing appropriate padding or protective equipment in contact sports.
Fall Prevention: Being mindful of surroundings, especially in icy conditions or on uneven terrain.

When to Seek Professional Medical Attention

Always seek immediate medical attention if you suspect a dislocated clavicle. Beyond the initial injury, consult a healthcare provider if you experience:

Persistent Pain: Pain that does not improve with rest, ice, and medication.
Limited Range of Motion: Inability to move your arm or shoulder through its full range.
Numbness or Tingling: In the arm or hand, which could indicate nerve involvement.
Weakness: Significant loss of strength in the arm.
Deformity: Any visible lump or asymmetry around the clavicle that persists.
Signs of Infection (post-surgery): Redness, warmth, increased pain, or pus around an incision site.

Effective treatment of a dislocated clavicle requires a comprehensive approach, from immediate first aid and accurate diagnosis to structured rehabilitation, ensuring a safe and effective return to full function.

Dislocated Clavicle: Understanding, Treatment Options, and Rehabilitation