Dislocated Collarbone: Understanding, Treatment, and Recovery

How do you treat a dislocated collar bone?

Treating a dislocated collarbone, most commonly an acromioclavicular (AC) joint separation or, less frequently, a sternoclavicular (SC) joint dislocation, primarily involves immediate medical evaluation, followed by a structured approach of rest, pain management, immobilization, and a comprehensive physical therapy rehabilitation program tailored to the severity of the injury.

Understanding the "Dislocated Collarbone"

The term "dislocated collarbone" is often used broadly, but anatomically, it refers to two distinct injuries involving the clavicle (collarbone):

• Acromioclavicular (AC) Joint Separation: This is by far the more common injury. It occurs when the ligaments connecting the clavicle to the acromion (part of the shoulder blade) are stretched or torn. AC joint separations are graded from I to VI based on the severity of ligamentous damage and displacement.
• Sternoclavicular (SC) Joint Dislocation: This is a much rarer and potentially more serious injury, involving the joint where the clavicle meets the sternum (breastbone). SC dislocations can be anterior (forward) or posterior (backward), with posterior dislocations posing risks to vital structures behind the sternum.

Understanding which joint is affected is critical, as treatment protocols differ significantly. This article will primarily focus on the more common AC joint separation, but general principles apply to both, with specific considerations for SC joint injuries.

Immediate First Aid and When to Seek Medical Attention

Upon suspected dislocation of the collarbone, 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, to prevent movement of the shoulder and clavicle.
• Apply Ice: Apply an ice pack to the affected area for 15-20 minutes at a time, several times a day, to help reduce pain and swelling. Ensure a barrier (towel) between the ice and skin.
• Avoid Movement: Do not attempt to "pop" the joint back into place. This can cause further damage.
• Seek Medical Attention Immediately: A suspected collarbone dislocation requires prompt medical evaluation by a healthcare professional (e.g., emergency room, urgent care, orthopedic specialist). This is not an injury to self-diagnose or self-treat.

Medical Diagnosis

A thorough medical diagnosis is essential to determine the type and severity of the dislocation.

• Clinical Examination: The physician will assess pain, swelling, tenderness, deformity, and range of motion. They will typically palpate the AC and SC joints.
• Imaging Studies:
  • X-rays: Standard X-rays are crucial to confirm the diagnosis, rule out fractures, and assess the degree of joint displacement. Specific views (e.g., Zanca view for AC joint, serendipty view for SC joint) may be used. Stress X-rays (taking X-rays while holding a weight) may be used for AC joint injuries to better visualize instability.
  • MRI or CT Scan: These advanced imaging techniques may be used for more complex cases, particularly to assess soft tissue damage (ligaments, capsules) or to evaluate posterior SC joint dislocations and their potential impact on underlying structures.

Non-Surgical Treatment Approaches

For most AC joint separations (Grades I, II, and many Grade III) and some SC joint dislocations, non-surgical management is the primary course of action.

• Rest and Immobilization:
  • Initially, the arm and shoulder will be immobilized in a sling for a period, typically 1-4 weeks, depending on the injury's severity. This allows the injured ligaments to begin healing and reduces stress on the joint.
  • Activity modification is essential, avoiding overhead movements, heavy lifting, or activities that put direct pressure on the shoulder.
• Pain Management:
  • Over-the-counter NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can help reduce pain and inflammation.
  • Prescription Pain Relievers: For more severe pain, a physician may prescribe stronger analgesics.
  • Ice Application: Continued use of ice packs remains beneficial.
• Physical Therapy/Rehabilitation: Once initial pain and swelling subside, and with physician clearance, physical therapy is critical for restoring function.
  • Early Phase: Focus on gentle, pain-free passive and active-assisted range of motion exercises to prevent stiffness.
  • Mid Phase: Progress to active range of motion, scapular stabilization exercises, and light strengthening exercises for the rotator cuff and periscapular muscles.
  • Later Phase: Introduce progressive resistance training, focusing on restoring strength, endurance, and proprioception (joint awareness) in the entire shoulder girdle.

Surgical Interventions

Surgical treatment is typically reserved for severe cases of AC joint separation (Grades IV, V, VI), cases where non-surgical management has failed, or for most SC joint dislocations, especially posterior ones due to potential life-threatening complications.

• AC Joint Surgery: Various surgical techniques aim to restore the anatomical alignment of the clavicle and acromion and reconstruct or augment the torn ligaments. Common methods include:
  • Coracoclavicular (CC) Ligament Reconstruction: Using grafts (autograft or allograft) or synthetic materials to stabilize the joint.
  • AC Joint Repair/Reconstruction: Directly repairing torn ligaments or using plates/screws for stabilization.
• SC Joint Surgery: Surgical intervention for SC dislocations often involves reduction (repositioning the bone) and stabilization, particularly for posterior dislocations where immediate reduction is critical to relieve pressure on vital structures.

Post-surgical rehabilitation is extensive and follows a similar progressive model to non-surgical treatment but with stricter initial precautions.

Rehabilitation Phases and Return to Activity

Rehabilitation is a cornerstone of recovery, whether the treatment is surgical or non-surgical. It follows a progressive, phased approach.

• Phase 1: Acute Protection and Pain Control (Weeks 0-4)
  • Goals: Reduce pain and inflammation, protect the healing joint, prevent stiffness.
  • Interventions: Sling immobilization, ice, gentle passive range of motion (ROM) exercises (e.g., pendulum swings), education on activity modification.
• Phase 2: Restoration of Range of Motion (Weeks 4-8)
  • Goals: Regain full, pain-free active and passive ROM.
  • Interventions: Progressive ROM exercises, gentle stretching, initiation of scapular stabilization exercises (e.g., wall slides, rows with light resistance).
• Phase 3: Strength and Endurance Training (Weeks 8-16)
  • Goals: Restore full strength, endurance, and neuromuscular control of the shoulder girdle.
  • Interventions: Progressive resistance training for rotator cuff, deltoid, and periscapular muscles. Focus on controlled, pain-free movements. Introduction of light functional movements.
• Phase 4: Return to Sport/Activity Specific Training (Weeks 16+)
  • Goals: Prepare for safe return to pre-injury activities, including sport-specific demands.
  • Interventions: Advanced strengthening, power training, plyometrics (if appropriate), agility drills, sport-specific movements, and progressive loading specific to occupational or athletic demands. This phase requires careful monitoring and often involves a gradual reintroduction to activity.

The timeline for each phase is highly variable and depends on the injury's severity, individual healing capacity, and adherence to the rehabilitation program.

Prognosis and Long-Term Considerations

Most individuals with AC joint separations, particularly lower-grade injuries, achieve a full recovery with non-surgical management. Even higher-grade injuries, whether surgically or non-surgically treated, often lead to good functional outcomes.

• Potential Complications: While rare, complications can include persistent pain, stiffness, degenerative arthritis of the AC joint (post-traumatic arthritis), or residual deformity (a "bump" at the AC joint, common even after successful treatment).
• Return to Activity: A safe return to contact sports or overhead activities typically takes several months and should only occur after medical clearance and successful completion of a comprehensive rehabilitation program.

Important Disclaimer

This article provides general information and is not a substitute for professional medical advice, diagnosis, or treatment. If you suspect a dislocated collarbone or any other injury, seek immediate evaluation and care from a qualified healthcare professional. Always consult your physician or other qualified health provider with any questions you may have regarding a medical condition or treatment.