Acute shoulder injuries commonly occur in contact sports. A direct blow to the front or side of the shoulder, or a hard fall on an outstretched hand may cause the clavicle (collarbone) to fracture. This is one of the most common fractures in sports. Most of these fractures in the middle of the bone, where there is less ligament support.

Signs and Symptoms

• Pain in the front of the shoulder along the clavicle, usually focused in the middle of the bone. All arm and shoulder movements are painful.
• A "step" deformity can be evident.
• Swelling usually comes later (within 4-6 hours).
• The athlete describes a "rubbing" of bones together, and their shoulder may droop forward or downward.
• The athlete usually supports their injured arm and tilts their head towards the injured side.

On-Site Management

P.R.I.C.E. PROTECT the area (see immobilize below). REST the area to promote healing. Gently apply ICE over the area for 15 minutes. NO COMPRESSION should be used in this case or with any fractures. DO NOT ELEVATE the area because it will put the shoulder in an dangerous (and uncomfortable) position. Treat the athlete for shock if necessary.

Immobilize. Support the injured side with a sling (the athlete will usually hold his/her arm in a position of comfort). Secure the arm to the body with an elastic wrap, to protect the injury and for transportation purposes.

Rehabilitation. After getting cleared by your physician go to physiotherapy. In children a figure 8 bandage is often used to hold the shoulders in a better positionl. In adults good alignment use the same type of bandage or more agressive bracing.

Referral. Refer to emergency medical services for further assessment and treatment.

Return to Activity. The athlete cannot return to activity until she/he is released by the physician and has full shoulder strength, and range of motion. The shoulder usually remains strapped for 3 to 4 weeks, which is then followed by an aggressive rehabilitation program.

Prevention

• Proper pads should be worn in contact sports around the shoulder area.
• The athlete should be educated on the dangers of falling on an outstretched arm.

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