Last Updated on Thursday, 20 February 2014 09:54
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I was recently checked hard into the boards and felt a sharp pain in my shoulder area. After getting x-rays, I was diagnosed with a clavicle fracture. How long until I can get back to practice and games?
Answer: The clavicle is one of the most commonly broken bones in the body. The clavicle is an “S” shaped bone that sits horizontally in the shoulder region and acts as a strut, or bridge, between the scapula (shoulder blade) and sternum (chest). In addition, the clavicle helps to connect your arm to your upper torso and protects the underlying blood vessels and nerves in your shoulder.
Traditionally, it was thought that fractures in the middle third of the bone (the most common type of clavicle fracture) occur after falling on an outstretched arm. Some recent research, however, points to other mechanisms of injury including a direct blow to the shoulder or point of the shoulder. In hockey, this commonly occurs when a player is checked hard into the boards or goes down hard on the ice.
When the clavicle is fractured, players will often experience pain, bruising, scrapes, or deformity such as drooping or tenting of the skin. There are many different types of clavicle fractures. Fractures can occur anywhere along the bone. However, fractures in the middle third are most common, especially in children and adolescents. The fracture can be partial or complete and can break along a single line or into multiple pieces. If you think you have a clavicle fracture, the first and most important step in management is to seek medical attention and obtain an x-ray to determine what type of fracture you have. Your doctor can discuss with you the best treatment to get full function back in your shoulder and allow the fracture to heal without deformity.
Clavicle fractures can be treated nonsurgically with rest, bracing, and therapy. Nonsurgical treatment is typically recommended for players whose fracture is in one piece and the broken ends of bone have not moved or have only moved minimally. In non-surgical treatment, a sling or figure-of-eight brace is recommended while the arm is immobilized for 2 to 6 weeks. Return to on-ice activities can occur roughly 4 weeks or longer after x-rays show that the bone has completely healed back together.
Clavicle fractures can also be treated surgically, in which a pin or plate and screws is inserted in or on the bone to allow for better healing. Surgical treatment is typically reserved only for severe cases where the fracture consists of several pieces or there is associated injury to neighboring structures in the shoulder. The benefit of surgical treatment for clavicle fractures is an earlier return to sporting activities, with some high level athletes returning after as little as 2-3 weeks.
In summary, clavicle fractures are relatively common in ice hockey and should be evaluated by a medical professional to determine the type and severity of your fracture. Treatments consist of wearing a sling or brace or surgery. Players can return to on-ice activities once the fracture is fully healed and as pain, strength and range of motion allow for skating, stick handling, and contact.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
