Last Updated on Thursday, 15 September 2016 09:32
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I was sprinting into the attacking zone with the puck when I got checked hard in the middle of my right shoulder. I have had pain and swelling over my right collarbone, and x-rays showed a fracture – how long will it be until I can get back to playing hockey?
Answer: The clavicle, often referred to as the collarbone, is frequently broken in contact sports such as hockey. The clavicle connects the sternum (chest bone) to the shoulder, has many neck, chest, and shoulder muscles that attach to it, and protects blood vessels and nerves that run from the torso into the arms. Clavicle fractures are commonly caused by falls onto an outstretched arm or hits to the shoulder or clavicle. Pain located along the collarbone, especially with moving the arm, is a common symptoms, as well as swelling and a visible or palpable deformity. X-rays can help determine the severity of the fracture, and will often be taken of both clavicles for purpose of comparison.
Treatment of clavicle fractures depends on many factors, especially where the fracture is along the bone and how much one broken end is displaced from the other. The vast majority of fractures occur in the middle third of the bone that is the weakest segment, and fortunately most of these can be treated without surgery. Operative treatment with a plate along the outside of the bone or a rod down the middle of the bone to hold the pieces together may be necessary if there are multiple fractures, the broken ends are displaced from each other more than the width of the bone, there is an open wound, if the bone is causing the skin to protrude at the site of the fracture (skin tenting), there is damage to the vessels or nerves underneath the fracture, or the fractures location (especially ones closer to the shoulder) results in the muscles and ligaments attached to the bone pieces pull them apart. If it is a high priority that an athlete returns within a few weeks to playing a sport where contact is likely, surgery may also be considered.
Nonoperative treatment typically involves immobilizing the shoulder with a sling for at least 2-4 weeks and pain control with pain medications as needed. After this time if x-rays demonstrate healing, gentle range of motion exercises can be initiated with full range of motion usually restored by 6 weeks. There should be x-ray evidence of solid bony healing, no tenderness to palpation, and full strength and range of motion before returning to on-ice activities or training that requires shoulder motion. It is probably best to avoid returning to full contact play until 2 months after the injury. With nonoperative treatment of displaced midshaft fractures, there will often be some degree of deformity that may be felt or seen, but in 75% of cases there will be no functional deficits or symptoms. However, compared to surgical treatment, there is a higher chance of the bone fragments not healing together (in about 15%) or healing in such a way as some discomfort is experienced. Therefore, it is important that you have a discussion with your physician about your options and to weigh the risks of surgery and anesthesia with the risks of unsatisfactory healing without surgery.
In summary, clavicle fractures are one of the most common bone fractures, especially in hockey. Some types of clavicle fractures require surgical treatment, while many clavicle fractures will heal fine with use of a sling and allow return to play after 6-8 weeks. If returning to play sooner is a high priority, or if the 15% risk of not healing within a couple months in unacceptable, surgery may be the best option.
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.
