broken clavicle...surgery or not?

[hummer]

About 5 months ago I was involved in a crash on my bicycle where I broke my clavicle, separated my shoulder, broke several ribs (1,2,3,&4) and punctured my lung. Due to the angle and location of the break, the orthopedic surgeon on staff at the hospital decided that surgery was necessary. The location was near the corner of my shoulder and the angle was such that they feared that the remaining large portion of my clavicle would eventually pierce my skin.



Five months later my lung and ribs are healed. I am doing well in physical therapy. Forty push ups twice daily and lots of work with dumbbells and rubber bands. I would say I have about 90 % of my function back but with some shoulder instability particularly with movement overhead.



The shoulder is still separated (type 3). I have quite a large bump on my shoulder not just from the separated shoulder but from the metal plate (attached with 5 screws). My scar runs the length of my clavicle and is about 5 inches long.



I am in pain all the time. Nothing I can't deal with. Naproxen Sodium works well and is all I take for pain. I take between 4 and 8 over the counter pills a day. I would rate the pain at best around 2 and at worse around 4 (out of 10). In general I would say it feels like I am always carrying a heavy back pack around on shoulder. There is a pain around the tip of the bump where my clavicle is no longer attached. This pain gets worse if I don’t do the physical therapy. My front deltoid muscle is painful. This pain increases as I do physical therapy. There is still quite a bit of pain from the incision.



Sleeping has been a problem since the crash. I fall asleep on my back or my good side but wake frequently on my bad shoulder. I do occasionally take Ambien when I need to catch up on sleep.



The scar is a bit strange. On the surface it looks like any other scar. I good straight line with a bit of pink skin in the separation. Quarter inch at most but about a tenth along most the length. No suture marks. Under the skin it is quite bumpy and not just from the plate which is quite visible. It seems like every inch or so there is a little lump of tissue that hurts if you massage it. Why, I have no idea. I ask my surgeon and he just tells me that is normal. Anyone else have this problem?



My orthopedic surgeon tells me that the surgery for the separated shoulder is mostly cosmetic, and won't improve my function. The surgeon tells me he will take the plate out in about 6 more months if I would like. He did say it may help with the pain.



Everyone tells me this will get better with time and I hope they are right. I kind of wish I would have just stayed fat and out of shape. If it weren't for the physical therapy I would be back there by now anyway.

 

[youhaditcoming]

About 5 months ago I was involved in a crash on my bicycle where I broke my clavicle, separated my shoulder, broke several ribs (1,2,3,&4) and punctured my lung.

Hi... nasty crash... how did it happen ?

 

[Curb]

I broke my clavicle in a bike Crash on Sept 5.

Broke in 3 pieces. I have that plate and six screws.

I am doing PT 3x a week. I have moderate pain in the shoulder area.

I can see and feel my plate easily. There is no pain in the incision area but if you touch the plate, I can feel a stinging sensation up and down the length of the plate and at times feels like pins and needles.

If I massage it a little, I can soothe the pain it but it comes back. Sometimes it bothers me sometimes it doesn't. I have to say, I feel the pain most when I am alone or slightly depressed. When I am distracted I don’t notice it as much.



In my shoulder area it's still numb in the front part and it's strange because since I started weight training 3 weeks ago with a 2 pound dumb bell, the numbness comes and goes from being numb back to being slightly painful to the touch with the pin and needle sensation.

Maybe it's trying to heal.

So yes, some kind moderate pain is always in my shoulder area. I truly hate that Plate and pin. I always have some kind of tightness over near that area. They say its scar tissue. I can stretch it out while in PT but it comes back.

I am still classified as not being healed since it's only been 3/12 months so everyone say it will get better over time and could take anywhere from 6 months to a year.



I am surprise you can do that amount of push ups and dumbbells trainings. I hope to advance to that level soon.

Again, everyone tells me also that it will get better and I hope they're correct.



I was a strong and fast cyclist. I was at 157 pounds when I crash and not hovering around 169 170 pounds. Gain most from trying to eat right.

I am confused on the amount and extent of training I can do because I am trying not to aggravate the clavicle and give it the best chance to heal but I am not sure if that is a mistake in that maybe I should ignore the pain and do all out training. All I do is ride my boring cycle trainer and do fast walking.



Question for you, have you been riding on the road since you are now doing pushup and weight training? If you are doing that amount of training you mentioned above you should have no problem getting back on the bike.



I wish I never took that afternoon off from work and went cycling…This really sucks!

I see the othro tomorrow at 3pm. I have questions and I hope the bone is healing (connecting itself) and I will ask him about the sensation when you touch the area/skin above the plate.

About 5 months ago I was involved in a crash on my bicycle where I broke my clavicle, separated my shoulder, broke several ribs (1,2,3,&4) and punctured my lung. Due to the angle and location of the break, the orthopedic surgeon on staff at the hospital decided that surgery was necessary. The location was near the corner of my shoulder and the angle was such that they feared that the remaining large portion of my clavicle would eventually pierce my skin.



Five months later my lung and ribs are healed. I am doing well in physical therapy. Forty push ups twice daily and lots of work with dumbbells and rubber bands. I would say I have about 90 % of my function back but with some shoulder instability particularly with movement overhead.



The shoulder is still separated (type 3). I have quite a large bump on my shoulder not just from the separated shoulder but from the metal plate (attached with 5 screws). My scar runs the length of my clavicle and is about 5 inches long.



I am in pain all the time. Nothing I can't deal with. Naproxen Sodium works well and is all I take for pain. I take between 4 and 8 over the counter pills a day. I would rate the pain at best around 2 and at worse around 4 (out of 10). In general I would say it feels like I am always carrying a heavy back pack around on shoulder. There is a pain around the tip of the bump where my clavicle is no longer attached. This pain gets worse if I don’t do the physical therapy. My front deltoid muscle is painful. This pain increases as I do physical therapy. There is still quite a bit of pain from the incision.



Sleeping has been a problem since the crash. I fall asleep on my back or my good side but wake frequently on my bad shoulder. I do occasionally take Ambien when I need to catch up on sleep.



The scar is a bit strange. On the surface it looks like any other scar. I good straight line with a bit of pink skin in the separation. Quarter inch at most but about a tenth along most the length. No suture marks. Under the skin it is quite bumpy and not just from the plate which is quite visible. It seems like every inch or so there is a little lump of tissue that hurts if you massage it. Why, I have no idea. I ask my surgeon and he just tells me that is normal. Anyone else have this problem?



My orthopedic surgeon tells me that the surgery for the separated shoulder is mostly cosmetic, and won't improve my function. The surgeon tells me he will take the plate out in about 6 more months if I would like. He did say it may help with the pain.



Everyone tells me this will get better with time and I hope they are right. I kind of wish I would have just stayed fat and out of shape. If it weren't for the physical therapy I would be back there by now anyway.

 

[hummer]

Hi... nasty crash... how did it happen ?

While riding in a bike lane, a jay walker dashed out in front of me. It was early in the morning with no traffic on the road or sidewalk. Just me and the oncomming walker. Don't know how he did not see me.

 

[Curb]

Yes, but are you back to riding now?

While riding in a bike lane, a jay walker dashed out in front of me. It was early in the morning with no traffic on the road or sidewalk. Just me and the oncomming walker. Don't know how he did not see me.

 

[hummer]

I feel the pain most when I am alone or slightly depressed. When I am distracted I don’t notice it as much.

Try to stay distracted. If you were riding regularly you were constantly on an endorphin high. Like me, after your crash you could do little or no exercise. No more endorphin high. So it is not just the pain that is causing your depression. Find some aerobic exercise to do and do it as often as you were riding. I run on a treadmill.

I am surprise you can do that amount of push ups and dumbbells trainings. I hope to advance to that level soon.

My physical therapist is aggressive. I think that is good but who really knows. He tells me to let pain be my guide. He is also very encouraging about my progress so far. Quite the cheer leader. Currently I am only seeing him about once every 6 weeks. This professional encouragement also helps with the depression.

Again, everyone tells me also that it will get better and I hope they're correct.

Hope is important.

I was a strong and fast cyclist. I was at 157 pounds when I crash and not hovering around 169 170 pounds. Gain most from trying to eat right..

I have put on about 10 pounds. My physical therapist tells me some of that is upper body muscle mass I did not previously have. I did however have to let the belt out a notch.

I am confused on the amount and extent of training I can do because I am trying not to aggravate the clavicle and give it the best chance to heal but I am not sure if that is a mistake in that maybe I should ignore the pain and do all out training. All I do is ride my boring cycle trainer and do fast walking.

Keep up the aerobic exercise. Pushing the aerobic exercise will up the endorphin you lost after your crash. Don't ignore the pain. Talk to your physical therapist about it. I do push it a bit. If I find that the pain is increasing on consecutive work outs I cut back or quit the exercise that caused the pain all together for a while.

Question for you, have you been riding on the road since you are now doing pushup and weight training? If you are doing that amount of training you mentioned above you should have no problem getting back on the bike.

I have not yet been riding. It's winter where I live now so I would not generally be riding now anyway. I had been riding spring, summer, and fall for about 5 years. Really only heavy rain or strong wind would stop me. I would ride 20 miles on weekdays and 30 miles on weekends. I would take sunday and an occasional day off when I felt run down. I'm sure I could ride but I don't know if I will again.

I wish I never took that afternoon off from work and went cycling…This really sucks!

I know how you feel.

 

[Curb]

Thanks Hummer. Let's see what the othro says tomorrow about my healing!

 

[Curb]

Hello all, 16 weeks after my surgery I've been given the clear by my othro to get back on my bike and resume my training activities. Ya Hoooooo!
For those who don't know, on my bike, I use to rack up close to 250 - 300 miles per week in the summer and during the winter/spring I did trail running that consisted of 12 miles of hilly terrain both e sat and sundays
But of course I want try any of this now. Will approach everything with caution and do a little at a time.

I would welcome any advice anyone can share.

I still need strength training by the the PT but the othro told me to drop the PT and do my strength training and other range of motion stuff on my own at home. but I don't know. Any advice?

Thanks Hummer. Let's see what the othro says tomorrow about my healing!

 

[hummer]

With regard to the physical therapist, I went every week for a few weeks but now go no more than once every 6 weeks. My crash was in August. If I had not set the terms, I'm sure my physical therapist would have had me coming twice a week. I do very little work out at the physical therapist's office. When I do go he evaluates my improvement and performance. He also gives me new exercises and he gives me a schedule as to when I should do them. I do all the work outs at home. The exercises he gives me generally are to isolate and strengthen one muscle or shoulder muscle group. I have found this coaching to be helpful. My health insurance covers up to 12 visits a year so there is no out of pocket for me.



Do I think you could get by without a physical therapist? Perhaps you could get this coaching at your local gym or from some other trainer. Perhaps you could find instruction on-line or from a book. It is up to you.

Hello all, 16 weeks after my surgery I've been given the clear by my othro to get back on my bike and resume my training activities. Ya Hoooooo!
For those who don't know, on my bike, I use to rack up close to 250 - 300 miles per week in the summer and during the winter/spring I did trail running that consisted of 12 miles of hilly terrain both e sat and sundays
But of course I want try any of this now. Will approach everything with caution and do a little at a time.

I would welcome any advice anyone can share.

I still need strength training by the the PT but the othro told me to drop the PT and do my strength training and other range of motion stuff on my own at home. but I don't know. Any advice?

 

[horseRider]

I've been reading this thread all day. About half way through I decided I had to post my collarbone story. And since I fell off my horse I wanted to make my user name that of my horse HUMMER! Much to my surprise, it was already taken.

I had my accident in Aug. 24,07. Came off the horse and landed on my left shoulder taking the full force of my weight when I landed. Broke the clavicle midway with two fragments and severely displaced. One broken rib and torn muscle in my lower back which would not let me breathe as the muscle was spasming.

My story is so similar to many I have read here, I'll cut it short. I was sent home from hospital with immobilizer and told to see Orth. Surgeon which I did. He was not for surgery saying only one in 400 needs surgery. However, here I am over 4 months later with a non-union. After reading this thread, I am ready for surgery and/or second opinion if the Doc is still not on the same page as me. I'm scheduled to see him on the 22nd if I can wait that long.



To those that have most recently broken that dread bone. Here are a few tips for coping:
*Sleep in the recliner! If you don't have a nice one, invest.
*Get one of those reacher/grabber gadgets (mine is ARCOA). This helps with picking things up off the floor etc. I found that bending over was painful as my shoulder would slump forward.
*When you do start to drive, skip the shoulder strap and just wear the lap strap. My Dr was willing to right me a note incase I got pulled over. If you wear a bra just leave the strap down on the bad side. You'll still be covered and you will have some support. Ice is helpful with the swelling.


Thanks to all you folks for sharing your experience and your pain! You have helped me greatly! I am once again hopeful that I may be able to get back on the horse again!

 

[Curb]

Well, horseRider, the only thing i can only stress is make sure you get a good othro surgeon. not saying mine was not good but i had to make a quick decision in the emergency room so i had to settle for him. after searching the intranet and coming this site and the other site "Thumper" (motorcycles) I learned a tremendous amount of information from these people in this site. If i ever break my other side and it needs surgery, i am now well informed on what to do. Because there is no reason why you have to sit around for 4 months with a broken bone. it's not a natural thing...(unless you are a realiy young person who's collar bone will heal fast).

I've been reading this thread all day. About half way through I decided I had to post my collarbone story. And since I fell off my horse I wanted to make my user name that of my horse HUMMER! Much to my surprise, it was already taken.

I had my accident in Aug. 24,07. Came off the horse and landed on my left shoulder taking the full force of my weight when I landed. Broke the clavicle midway with two fragments and severely displaced. One broken rib and torn muscle in my lower back which would not let me breathe as the muscle was spasming.

My story is so similar to many I have read here, I'll cut it short. I was sent home from hospital with immobilizer and told to see Orth. Surgeon which I did. He was not for surgery saying only one in 400 needs surgery. However, here I am over 4 months later with a non-union. After reading this thread, I am ready for surgery and/or second opinion if the Doc is still not on the same page as me. I'm scheduled to see him on the 22nd if I can wait that long.



To those that have most recently broken that dread bone. Here are a few tips for coping:
*Sleep in the recliner! If you don't have a nice one, invest.
*Get one of those reacher/grabber gadgets (mine is ARCOA). This helps with picking things up off the floor etc. I found that bending over was painful as my shoulder would slump forward.
*When you do start to drive, skip the shoulder strap and just wear the lap strap. My Dr was willing to right me a note incase I got pulled over. If you wear a bra just leave the strap down on the bad side. You'll still be covered and you will have some support. Ice is helpful with the swelling.


Thanks to all you folks for sharing your experience and your pain! You have helped me greatly! I am once again hopeful that I may be able to get back on the horse again!

 

[Curb]

Thanks Hummer, I just don't want to do anything stupid and end up back in a sling again. And actually, when i go to PT, i end up doing the exercises on my on anyway while the PT guy is working on someone else. He shows me what to do and walks away then comes back and shows me the next exercise and walks away. 3x a week at $50 a pop! insurance pays though.

With regard to the physical therapist, I went every week for a few weeks but now go no more than once every 6 weeks. My crash was in August. If I had not set the terms, I'm sure my physical therapist would have had me coming twice a week. I do very little work out at the physical therapist's office. When I do go he evaluates my improvement and performance. He also gives me new exercises and he gives me a schedule as to when I should do them. I do all the work outs at home. The exercises he gives me generally are to isolate and strengthen one muscle or shoulder muscle group. I have found this coaching to be helpful. My health insurance covers up to 12 visits a year so there is no out of pocket for me.



Do I think you could get by without a physical therapist? Perhaps you could get this coaching at your local gym or from some other trainer. Perhaps you could find instruction on-line or from a book. It is up to you.

 

[horseRider]

Curb, Unfortunately I'm not young (46) and time is passing me by. This is my first break ever and I want to get back on that Horse! thanks for advise and I will make sure I have the best. My Ortho. surgeon is good and works on the Aggies here at TAMU. But I will delve further into his credentials and experience. He does seem puzzled each time I go in and the xrays show no union. But each time he just says "do these exercises and come back in 6 weeks". The last time he gave me a pully to help stretch my arm up over my head. I think he may be waiting for me to put my foot down and request surgery. Which I did not want to do at first. Now I'm ready. Wish me luck!

Well, horseRider, the only thing i can only stress is make sure you get a good othro surgeon. not saying mine was not good but i had to make a quick decision in the emergency room so i had to settle for him. after searching the intranet and coming this site and the other site "Thumper" (motorcycles) I learned a tremendous amount of information from these people in this site. If i ever break my other side and it needs surgery, i am now well informed on what to do. Because there is no reason why you have to sit around for 4 months with a broken bone. it's not a natural thing...(unless you are a realiy young person who's collar bone will heal fast).

 

[Curb]

Oh, and BTW, from my knowledge I learned here, there are 2 types of plates and screws and one type of pin that gets inserted onto the bone to put them together. (you may already know this from reading these posts here)
Good luck and let us know when you get out of surgery.

Curb, Unfortunately I'm not young (46) and time is passing me by. This is my first break ever and I want to get back on that Horse! thanks for advise and I will make sure I have the best. My Ortho. surgeon is good and works on the Aggies here at TAMU. But I will delve further into his credentials and experience. He does seem puzzled each time I go in and the xrays show no union. But each time he just says "do these exercises and come back in 6 weeks". The last time he gave me a pully to help stretch my arm up over my head. I think he may be waiting for me to put my foot down and request surgery. Which I did not want to do at first. Now I'm ready. Wish me luck!

 

[jetnjeff]

I am 43 and did not get surgery but did get a figure 8 brace and kept it as tigh as I could stand. I saw my Doc every 3 weeks and got a bone stimulator after about 4 weeks. I got on the indoor bike the first week, then took a week off and did more walking. The Doc gave me no exercises. I only did stuff that I felt I could (taking nothing for the pain, I used it as a guide). I feel the Figure 8 brace is essential. I started easy rides outdoors after 4 weeks, before doctors consent. Did not get official permission to ride until 12 weeks. I could stand for a reasonable amount of time out off the saddle by then.

I was training hard by 3 months and MTBing by 4 and raced in less than 5.

Kept up the calcium. Nothing to say that really matters though.

Ice is only for swelling, it may actually slow healing by slowing circulation. Recliners are good.

My bone lump is getting big now and aches now and then. A good rub helps that out.

Don't over do it but don't under do it either!

Living was my PT.

Good luck.

Curb, Unfortunately I'm not young (46) and time is passing me by. This is my first break ever and I want to get back on that Horse! thanks for advise and I will make sure I have the best. My Ortho. surgeon is good and works on the Aggies here at TAMU. But I will delve further into his credentials and experience. He does seem puzzled each time I go in and the xrays show no union. But each time he just says "do these exercises and come back in 6 weeks". The last time he gave me a pully to help stretch my arm up over my head. I think he may be waiting for me to put my foot down and request surgery. Which I did not want to do at first. Now I'm ready. Wish me luck!

 

[hummer]

This sounds similar to what I started with at my PT. Since I was only getting new exercises infrequently I told my PT that all these visits were stupid. I told him to show me exercises, watch me do a few to make sure I am doing them correctly and give me a schedule as to when I need to do them. He did resist this plan, but agreed as long as I promised to do the workouts he would agree to cut back to once every two weeks. I made my appointment with his receptionist for three weeks out. Since he was happy with my progress after the following 3 weeks he agreed to set the next appointment 4 weeks out. I made the appointment 6 weeks out. On my next visit, if he does not give me meaningful new exercises I will cut back further or quit all together.

I think the PT has been very helpful for me personally. I don't think the guy will ever say "I have done all I can for you, don't make any more appointments." Like I said, you have to set the terms with these people. They are not going to cut off the insurance money flowing their way.

Thanks Hummer, I just don't want to do anything stupid and end up back in a sling again. And actually, when i go to PT, i end up doing the exercises on my on anyway while the PT guy is working on someone else. He shows me what to do and walks away then comes back and shows me the next exercise and walks away. 3x a week at $50 a pop! insurance pays though.

 

[alienator]

I think the PT has been very helpful for me personally. I don't think the guy will ever say "I have done all I can for you, don't make any more appointments." Like I said, you have to set the terms with these people. They are not going to cut off the insurance money flowing their way.

I don't know what PTs you people see, but the PTs I've seen, from different offices, different practices, different states, have all let me know when I've reached the point that I could continue on my own without them....and no it wasn't years down the road.

The insurance money quip is pretty much an insult to any good PT out there and demonstrate you really don't have a clue what they do. Sure there are some bad ones, and sure there are some PTs out there that are in in for the money, but they're the minority.

The doc and PT have far more knowledge about such things than you or I. Hell, maybe your PT let you go, let you "think" that it was the limits you set that defined things, because you were a less than decent patient.

It is entertaining, though, to hear the dumb ass opinions, though, of some folks on how medical things work.

 

[Curb]

Alienator, what do you think about my thread below # 428. The Orthopedic told me I don’t need to go to PT anymore. But we have just begun strength training with just 1 and 2 pound little dumbbells.

Also there are still some points in my range of motion that needs to be work on, especially when I try and put on my jacket!

I am not so sure if I should be strength training by myself at 16 weeks out from surgery with heaver weights.

The otrho refuse to write me a new prescription. So either I pay for the additional PT myself or go to my primary doctor and see if he will write the prescription?

What would you do?



The funny thing at this orthopedic visit, the Orthopedic looked and felt my plate and Clavicle and said “this bone is heal man, get back on that road bike and resume your training! He also said that they did not put that plate in me for me to sit around and gain weight! I was like speechless and happy at the same time.

But he did not take X-rays this time.How does he know the bone is healed? I suppose he has the experence and knows better....



Any comments?

I don't know what PTs you people see, but the PTs I've seen, from different offices, different practices, different states, have all let me know when I've reached the point that I could continue on my own without them....and no it wasn't years down the road.

The insurance money quip is pretty much an insult to any good PT out there and demonstrate you really don't have a clue what they do. Sure there are some bad ones, and sure there are some PTs out there that are in in for the money, but they're the minority.

The doc and PT have far more knowledge about such things than you or I. Hell, maybe your PT let you go, let you "think" that it was the limits you set that defined things, because you were a less than decent patient.

It is entertaining, though, to hear the dumb ass opinions, though, of some folks on how medical things work.

 

[alienator]

Alienator, what do you think about my thread below # 428. The Orthopedic told me I don’t need to go to PT anymore. But we have just begun strength training with just 1 and 2 pound little dumbbells.

Also there are still some points in my range of motion that needs to be work on, especially when I try and put on my jacket!

I am not so sure if I should be strength training by myself at 16 weeks out from surgery with heaver weights.

The otrho refuse to write me a new prescription. So either I pay for the additional PT myself or go to my primary doctor and see if he will write the prescription?

What would you do?

Go to your primary doc. Another alternative would be to talk with your PT, tell them your concerns, and have the PT talk to the ortho and/or your primary. Usually, if the PT thinks you need more help, the doc will go along with that.

As for the x-rays.....it's hard to say why the doc didn't take more x-rays. How many or how often did he take x-rays previously?

One thing that orthos sometimes forget is that the PT isn't just about healing a bone, it's also about regaining proper ROM and use, while avoiding the adoption of some incorrect compensatory movement. For many months after breaking my hip--also after shattering a leg a few years earlier--the PT and I worked on a proper gait, i.e. walking without a limp. Improper compensatory movements or adaptations can lead to further injury, new injury, or decreased use of the affected body part.

 

[hummer]

Alienator,

Your forum name was quite well chosen on your part. If you read my posts you will see that I am quite pro PT. In my last post for example I wrote "I think the PT has been very helpful for me personally." In previous post I also wrote "I have found this [PT] coaching to be helpful." I continue to go to my PT.



Perhaps my comment on insurance was a bit over the top. I have often discussed the number of visits I need and the progress I have been making when I visit my PT. He is always quite happy with my progress. He generally reviews past exercises to make sure I continue to do them correctly. He has never had to correct my technique. As time has progressed the number of new exercises have dropped to zero. Yet, when my appointment comes to an end he wants to set a new appointment for the next week. This generally leads to a discussion about the majority of his patients. He tells me most of his patients don't or won't do the exercises unless they are in his office. Perhaps lots of visits are just habit on his part. After such a discussion he then very easily agrees to a longer period of time until my next visit. The day is coming when I won't see the value of further PT advice and coaching. Advice and coaching that I have stated many times have been and continue to be important to my recovery. At that time I will discuss it with my PT. I will be surprised however if my PT comes to that conclusion before I do.



Perhaps Curb's ortho has had similar experiences with other patients.



Curb,

As you have requested, I have tried to give you my opinion. You now know what others think of it.

It is entertaining, though, to hear the dumb ass opinions, though, of some folks on how medical things work.