COLLARBONE (CLAVICLE) CONTUSION |
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General Information
DEFINITION--Bruising of skin and underlying tissues at the clavicle (collarbone) caused by a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue. A collarbone contusion is usually accompanied by injury to the sternum (breastbone) or shoulder joint.
BODY PARTS INVOLVEDTissue over the clavicle, shoulder and breastbone, including blood vessels, muscles, tendons, nerves, covering to bone (periosteum) and connective tissue.
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SIGNS & SYMPTOMS
Local swelling--either superficial or deep.
Tenderness over the injury, but no additional pain when moving.
Feeling of firmness when pressure is exerted at the injury site.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted shoulder and chest activity proportional to the extent of injury.
CAUSESDirect blow to the clavicle, usually from a blunt object.
RISK INCREASES WITH
Contact sports such as football, wrestling, ice hockey and basketball, especially if the shoulders and chest are not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
Use of anticoagulants or aspirin.
HOW TO PREVENTWear appropriate protective shoulder and chest pads during competition or other athletic activity if there is risk of a clavicle contusion.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Self-care for minor contusions, or for serious contusions during rehabilitation.
Physical therapy for serious contusions.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the clavicle, shoulder and sternum to assess total injury to soft tissue and to rule out the possibility of an underlying fracture or shoulder dislocation. The total extent of injury may not be apparent for 48 to 72 hours.
POSSIBLE COMPLICATIONS
Excessive bleeding leading to disability. Infiltrative-type bleeding can (rarely) lead to calcification and impaired function of injured muscle.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
Unstable or arthritic joint following repeated injury.
PROBABLE OUTCOMEHealing time varies with the extent of injury, but all but the most serious contusions should heal in 6 to 10 days.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Use a sling if it makes you more comfortable.
Continue ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage gently over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when movement is comfortable and a sling is no longer necessary.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have a clavicle contusion that doesn't improve in 1 or 2 days.
Skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness or a general ill feeling) occur.
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