broken clavicle...surgery or not?

[alienator]

Aly, I do not know if it is normal but it is normal for me.  I had all kinds of scans, x-rays, and mri's and nobody ever said that something was wrong with my shoulder. I do get some pain in there after I swim or use it a lot in the garden. I just figured that since I was favoring the shoulder and not trying to put to much pressure on the collar bone that it was moving the shoulder structure around or jockeying it into a more favorable position for the extra stress? Thus, the popping or clicking sounds. I do not worry anymore about my clavicle break. My general surgeon at first wanted to let it heal naturally, then for months tried to pressure me into having surgery, finally on my last visit tells me that my sort of break will heal naturally? Go figure? He then feels the break and says yes it is mending nicely.  Then he says that even if it forms a non-union or mal-union you can always have it repaired later.  He should have been a politician... Rob

If you don't like what a doctor has to say, get a second or third opinion. The practice of medicine and especially surgical decisions don't have paint-by-number solutions. The decisions, at least for good doctors, depend on the specifics of each individual case and the complicating factors in that case. Despite the prevailing wisdom in this forum, no one in here is qualified to tell you whether you need surgery or not. You do need to share you concerns with your doctor, no matter how minor they are. You need to ask your doctor for the pros and cons of a given choice. You need to make sure your doctor explains everything in enough detail to satisfy you and answer your questions. That's what good doctors do. You also have the option of seeing a specialist, as in a shoulder specialist.

 

[pnkcoral]

Alienator,

I totally agree. Not only did I probably have around ten xrays altogether taken of my shoulder and clavicle but I saw two other doctors about the situation. However, my situation (being in an auto crash) was most likely a lot different than most people on this board that fell off of a bike. I was originally limited by the hospital and their trauma doctors that I was taken to after the accident. I was also dealing with the at-fault insurance company that I luckily settled with for a six figure settlement. But, I did get some second opinions from two different ortho docs.

Notwithstanding all that and my rapid recovery of my clavicle and actually all my injuries .. here is what I learned. I do not think that their is a more contentious and hotly debated medical issue today than the treatment of a broken clavicle. It is embroiled in all kinds of issues, one of which is the fact that in my state there are very few surgeons that will even look at .. it let alone operate on broken clavicle if you were in an auto accident. But, that paradox just clouds the issue.

The real issue is that their are two schools of thought on the treatment. First, you have the old school which was based on two large studies of over 700 people and another with 400 with broken collar bones. Those studies showed that an overall majority just healed up by themeselves. This was of course somewhat skewed because they used a lot of young people that heal faster and better. Therefore, I found that a lot of older docs still adhere to this old school treatment and thought of "just let nature take its course." Then you have the new school docs that are pressured to get people back into sports faster and of course are motivated by financial rewards, since this is a fairly common operation. My general surgeon seemed to be torn between the two. He was an older guy but worked with younger surgeons in the hospitals trauma center.

I am now and old school adherent. My break (140% displaced) has fused up nicely even though I have a large calcified knot at the break site. You can not see it unless I move my arm and shoulder in a certain direction. And even then it is not to prominent. Now, with a lot of rotation of my arm in swimming I am confident that the knot will wear down to approx. were it was originally. I was lucky that it was a nice clean break even though it became somewhat displaced later on.

Well, time to go swim a couple of miles and do a little bass fishing.. life is tough but someone has to do it..

 

[alienator]

Alienator, I totally agree. Not only did I probably have around ten xrays altogether taken of my shoulder and clavicle but I saw two other doctors about the situation. However, my situation (being in an auto crash) was most likely a lot different than most people on this board that fell off of a bike. I was originally limited by the hospital and their trauma doctors that I was taken to after the accident. I was also dealing with the at-fault insurance company that I luckily settled with for a six figure settlement. But, I did get some second opinions from two different ortho docs. Notwithstanding all that and my rapid recovery of my clavicle and actually all my injuries .. here is what I learned. I do not think that their is a more contentious and hotly debated medical issue today than the treatment of a broken clavicle. It is embroiled in all kinds of issues, one of which is the fact that in my state there are very few surgeons that will even look at .. it let alone operate on broken clavicle if you were in an auto accident. But, that paradox just clouds the issue. The real issue is that their are two schools of thought on the treatment. First, you have the old school which was based on two large studies of over 700 people and another with 400 with broken collar bones. Those studies showed that an overall majority just healed up by themeselves. This was of course somewhat skewed because they used a lot of young people that heal faster and better. Therefore, I found that a lot of older docs still adhere to this old school treatment and thought of "just let nature take its course." Then you have the new school docs that are pressured to get people back into sports faster and of course are motivated by financial rewards, since this is a fairly common operation. My general surgeon seemed to be torn between the two. He was an older guy but worked with younger surgeons in the hospitals trauma center.  I am now and old school adherent. My break (140% displaced) has fused up nicely even though I have a large calcified knot at the break site. You can not see it unless I move my arm and shoulder in a certain direction. And even then it is not to prominent. Now, with a lot of rotation of my arm in swimming I am confident that the knot will wear down to approx. were it was originally. I was lucky that it was a nice clean break even though it became somewhat displaced later on. Well, time to go swim a couple of miles and do a little bass fishing.. life is tough but someone has to do it..

That's a good post. You've summed things up nicely.

 

[bsbs1876]

Originally Posted by pnkcoral .

Alienator,

I totally agree. Not only did I probably have around ten xrays altogether taken of my shoulder and clavicle but I saw two other doctors about the situation. However, my situation (being in an auto crash) was most likely a lot different than most people on this board that fell off of a bike. I was originally limited by the hospital and their trauma doctors that I was taken to after the accident. I was also dealing with the at-fault insurance company that I luckily settled with for a six figure settlement. But, I did get some second opinions from two different ortho docs.

Notwithstanding all that and my rapid recovery of my clavicle and actually all my injuries .. here is what I learned. I do not think that their is a more contentious and hotly debated medical issue today than the treatment of a broken clavicle. It is embroiled in all kinds of issues, one of which is the fact that in my state there are very few surgeons that will even look at .. it let alone operate on broken clavicle if you were in an auto accident. But, that paradox just clouds the issue.

The real issue is that their are two schools of thought on the treatment. First, you have the old school which was based on two large studies of over 700 people and another with 400 with broken collar bones. Those studies showed that an overall majority just healed up by themeselves. This was of course somewhat skewed because they used a lot of young people that heal faster and better. Therefore, I found that a lot of older docs still adhere to this old school treatment and thought of "just let nature take its course." Then you have the new school docs that are pressured to get people back into sports faster and of course are motivated by financial rewards, since this is a fairly common operation. My general surgeon seemed to be torn between the two. He was an older guy but worked with younger surgeons in the hospitals trauma center.

I am now and old school adherent. My break (140% displaced) has fused up nicely even though I have a large calcified knot at the break site. You can not see it unless I move my arm and shoulder in a certain direction. And even then it is not to prominent. Now, with a lot of rotation of my arm in swimming I am confident that the knot will wear down to approx. were it was originally. I was lucky that it was a nice clean break even though it became somewhat displaced later on.

Well, time to go swim a couple of miles and do a little bass fishing.. life is tough but someone has to do it..

I agree with everything in your post, but I want to add something. Though it is true that the "new school" doctors push for surgery for a faster return to sports and activity, you should also be aware that there can be long term issues with a non or malunion. I say this from experience because my malunited clavicle resulted in shortening of ~2cm and caused muscle imbalance among other problems. Letting the bone heal naturally is a great thing if it is possible, and I think at least giving it a try initially is obviously very smart. I just want to make sure that people are aware of how important the anatomical position of your bones can be. The word "heal" can mean so much. Does the bone knitting together mean healed? Sure, I guess so, but it has "healed" in a fashion that may cause functional problems like weakness and pain.

 

[bsbs1876]

Originally Posted by willy81 .

you are right, sorry,
there were 4 copies of the same message posted
never mind
I hope the mods will take care of the mess


I was saying that,
I have not visited my doctor yet because the surgery will take place after the end of the next October, November anyway,
so no schedule yet, it is way to early, I can plan my surgery in short notice, say 10 days or less.
probably I wait until autumn to visit my doctor,
the muscles are getting tighter and the collar bone becomes more protrude, visible that's nice to see in the mirror.


I am quite busy with different sports, even with soccer,

what about you?
you must be about 15 weeks post op, your post op complications did not delay the bone heeling anyway,
do you feel strong? lift some weight? what about the muscles? are they tighter now?

Hey *****, I am interested in that you say you notice the collarbone protruding more now and you are like a year post op. I notice right now that the operated side does not protrude as much as my other. At first I was wondering if maybe the doctor pushed this one down lower than it's supposed to be but then I figure swelling can take a full year to completely go away and also i have lost muscle mass and definition there so that must be it?

 

[pnkcoral]

BSBS,

Yes, and that has been my major concern from the gitgo. When both my trauma surgeons were pressing me for a plate surgery, they kept bringing up the possibility of bone shortening and the problems it could cause. However, at the time I had so many multi-injuries I was more concerned with all the possible negative consequences that was possible with having a clavicle surgery. Although the majority of surgeries appear to be successful, the thought of possible nerve damage, floating screws, plate breakage and infection was a big deterent for me early on.

I find it ironic now that a person such as myself that spent a lifetime in the water never really knew much about the collarbone or its importance. Essentially, it is what kept my arms and shoulders in the right position for all the swimming strokes. It also protects the nerves under it and has some six major muscles attach to it. I am now regularly swimming about a mile freestyle and then a mile backstroke in a local lake. I am keeping a pretty good pace and really do not have any pain associated with the swims now. However, I can certainly feel the muscle that is attached to the neck because the strain goes all the way up..practically into my jaw bone. I guess the one thing I find really interesting with a broken collarbone is that you really can't set it like a leg or a broken arm. Though I was on my back for the first two weeks in bed and rarely moved it. So, my first concern was that if I started moving my arm all around it would re-break it or never get a chance to mend. But, that did not seem to be the case because once the initial pain subsided I stretched the arm and shoulder all the time and did dry land swimming type rotations with it. And, low and behold it seem to like whatever I was doing to it and subsequently calcified over the break. However, I stay away from putting any real stress on it from the shoulder side. For instance, I still do not sleep on the shoulder side of the break. I probably could but why risk it?

Early, on I went in and had some more xrays because I was concerned that it was not healing.
But, even then it was putting out those fibrous threads which was king of cool to see. But, now as long as I can exercise, do yoga, and pretty much do any type of work with it (except heavy lifting) I am happy with the progress. And, if later on it turns out to be a bad union (which i kind of doubt now) I will deal with it like everything else..one day at a time.

Take care, good board everyone..

 

[alienator]

BSBS, So, my first concern was that if I started moving my arm all around it would re-break it or never get a chance to mend. But, that did not seem to be the case because once the initial pain subsided I stretched  the arm and shoulder all the time and did dry land swimming type rotations with it. And, low and behold it seem to like whatever I was doing to it and subsequently calcified over the break. However, I stay away from putting any real stress on it from the shoulder side. For instance, I still do not sleep on the shoulder side of the break. I probably could but why risk it?

Actually in the early weeks, passive movement can speed healing. Within 2 weeks of shattering my collarbone (along with a shattered scapula; 3 broken ribs, each in two places; and a broken neck) I got into see a PT who agreed that an aggressive program might work. So for the next 3-4 weeks, he would move my arm through its range of movement in several different exercises, increasing the range of movement all the time. As soon as the shoulder specialist saw enough healing (around 6 weeks), he gave the okay for active exercises. Throughout all of PT, I was instructed to take the max dose allowed for my pain killers (Percocet and Percodan, every 4 hours each, with one being offset by the other by 2 hours. The arrangement was made to maximize the narcotic does but not go beyond recommended dosing of the two primary component meds: Tylenol in the Percocet, and aspirin in the Percodan). Even with all those narcotics, the three months of PT were gruesome, but we never would have made the gains we made if I weren't able to push the efforts and dull the pain. A few years later, as a result of another racing accident, I introduced a bunch of discontinuities into my right tibia and fibula. Healing was really slow despite the Ti rod in my tibia and the PT. Eventually to speed things along, the doc removed the screws from one of the rod so that when I walked in my splint, the bone pieces would slide up and down the rod and bump into each other, thus initiating bone growth at the fracture sites. It did speed healing up a bit but wasn't exactly pleasurable.

 

[willy81]

Hey *****, I am interested in that you say you notice the collarbone protruding more now and you are like a year post op. I notice right now that the operated side does not protrude as much as my other. At first I was wondering if maybe the doctor pushed this one down lower than it's supposed to be but then I figure swelling can take a full year to completely go away and also i have lost muscle mass and definition there so that must be it?

when your muscles are cut during the operation they become lose as time passes they get back to their normal shape and tome, my CB now is protruding and definition is also better, just give it time

 

[pnkcoral]

Alienator,

Our accidents seem similiar with a lot of multi-injuries. Along with my clavicle, my sternum broke, with eight ribs busted on the left and two on the right side. In back three fractured veterbrae..along with both knee caps fractured. The concussion, when I hit the windsheild screwed up my left eye peripheral vision for some reason and it is still blurry out there. So, with the injuries running across my torso, I was sort of immobilized until I learned how to use my stomach muscles to move around and by pass the whole mess. They had me on dualidid (pump) which was a godsend and later on the percs @ 4-6 hour intervals. I started backing off those at about 6-7 weeks and then my surgeon put me on Aleve gels caps for the inflamation.

What really helped me was going up to the new hotsprings resort. They had two pools: a small one at around 105' and a 24 yarder at about 100'. Normally, I do not like anything over 68' but these where great for getting everything moving again (it hurt too). They also had a steamroom which was perfect for the respiratory problems that seemed to pop up. I think the pain meds are essential in the early stages of recovery. However, later on it is sort of a tightrope walk where you want to push the exercise in recovery but you do not want to overdue it to the point that you are breaking down what you have built up. I am now putting a little more pressure on my swims by only using fins every other swim. This gives me more drag and thusly puts more pressure on the collarbone. But, I have to watch it because I definitely do not want to screw with the break. It has taken to much time and energy to get here!

 

[bsbs1876]

I have been back to the gym for almost 3 weeks now and I feel myself getting strong and the muscles coming back in my chest mainly. I have noticed that as a result I have lost some ROM. At one point about a month ago I had full ROM but I would say I only have about 80-90% all of the sudden. Any correlation to the muscles regrowing and tightening again? Maybe just getting lazy on the wall stretches? I didn't think I would have to do them forever. Sorry to ask here, I just don't want to have to make another expensive trip to physio for a simple curiosity. I am not concerned and know I can get the range back. Just a bit odd.

At any rate, my doctor has recently informed me that a delayed malunion repair case such as mine actually indeed takes much longer to heal. He says recovery has been known to take 6-12 months in these cases because you have to stretch everything back out and the body has already adjusted to the improper location over those 3 years. I wasn't sure if this was just his opinion or not so I actually asked a second orthopedic surgeon who agreed. I guess I am just at the beginning of a long road.

 

[willy81]

*****, Funny that you should be concerned about the click in your shoulder.  I went through the same sort of noise consternation with a lot of my breaks. I have eight broken ribs on my right side that have been quiet as a church mouse throughout the entire 4 months since my accident. But, they still hurt like the dickens especially after swimming or sleeping on that side all night. However, the two broken ribs on the left side make all kinds of noise. They make clicks, pops, and some weird noise I cannot even describe. The broken clavicle used to make a kind of click-pop up to about a month ago when I would put pressur on it in a certain way. I mentioned that in my earlier post. I was so concerned about these noises that I talked to my general surgeon about them. He seemed to think they were caused by bone fragements moving around but I tended to disagree. I believe they are coming from the breaks themselves or from surrounding bones or ligaments. I think it would be pretty hard to break or shatter your collar bone and not have the surrounding shoulder or sternum somewhat affected? Furthermore, this is conjecture but I think that the surrounding skeletal structure is jockeying around and trying to fall back into position with these noises. Personally, I would not be to concerned unless you are in a lot of pain or think that you have rebroken it. I gave up lifting weights after my accident, even though today I was in a sport store that had some weights. I was curious about the strenght on my arm on that collar break side. So, I did some curls with only about twenty pounds. It felt good and didn' t seem affect the break at all. But, I have no doubt that if I tried to do some heavy bench presses or something that would put extreme pressur on the clavicle that it would most likely seperate again. That is why I am sticking to swimming to build up my arms and legs again. Good luck.. 

these clicks of yours are quite different, yours come from broken ribs. When you break your clavicle all muscles around there become lose, if you have the surgery then they become loser, this could affect the Rotator Cuff muscles and develop all those clicks. Besides my initial question to alyson was meant to find out if there was some kind of problem with her plate/screws, we have seen in this board cases where plates/screws are not fixed correctly and they start to click after a while. Of course in this case they produce a lot of pain too.

 

[willy81]

I have been back to the gym for almost 3 weeks now and I feel myself getting strong and the muscles coming back in my chest mainly. I have noticed that as a result I have lost some ROM. At one point about a month ago I had full ROM but I would say I only have about 80-90% all of the sudden. Any correlation to the muscles regrowing and tightening again? Maybe just getting lazy on the wall stretches? I didn't think I would have to do them forever. Sorry to ask here, I just don't want to have to make another expensive trip to physio for a simple curiosity. I am not concerned and know I can get the range back. Just a bit odd. At any rate, my doctor has recently informed me that a delayed malunion repair case such as mine actually indeed takes much longer to heal. He says recovery has been known to take 6-12 months in these cases because you have to stretch everything back out and the body has already adjusted to the improper location over those 3 years. I wasn't sure if this was just his opinion or not so I actually asked a second orthopedic surgeon who agreed. I guess I am just at the beginning of a long road.

just follow a normal work out with 20-25 repetitions and moderate weight and your muscles will come back to their proper shape and size with time, you can't force it, after so many years of abnormal position, recovery can't simply happen overnight. too much training will slow down recovery too, work on them every 3rd day, even when you sleep at night your muscles reshape, you need to rest them too

 

[bsbs1876]

Originally Posted by willy81 .


just follow a normal work out with 20-25 repetitions and moderate weight and your muscles will come back to their proper shape and size with time, you can't force it,
after so many years of abnormal position, recovery can't simply happen overnight.
too much training will slow down recovery too,
work on them every 3rd day, even when you sleep at night your muscles reshape, you need to rest them too

Thanks for the tips, *****. I have done some research and I think I know what I have done wrong. I was doing a lot of pushing exercises and working my chest/anterior deltoid which causes an imbalance and the shoulders to roll forward (both scapulas are kind of winging now). My good friend who is a sports physio told me to concentrate more on back strengthening and stretch the pecs out so my shoulders go back. Also being conscious of my posture during the day especially at work (desk job).

I follow a MWF routine which consists of full body. Trying to throw in cardio on off days but I am also dealing with an IT band issue (runner's knee) which doesn't want to resolve itself. I'm 26 but feel 56 these days...

On another note, I think that with my smaller frame the plate does not allow the muscles to grow into the right spots. I truly think removing it is the best option for me, even though it's irritation is diminishing slowly. Sometimes I wondering - right now my operated clavicle is less noticeable than my none operated one, so if I remove the hardware will it be even less noticeable and sunken in almost??? Haha

 

[willy81]

probably you don't pay attention to what I told you, your cb (with plate) is not noticeable because the muscles are loose because they "suffered" during the operation, thus takes quite some time to restore, for me it took about a year, now my CB is much more noticeable and it will remain noticeable even when I have the plate removed. This can't happen overnight it takes time, months for me it took a whole year. If your scapula is winging you need to strengthen the Serratus Anterior and the Rhomboid, SA is the No1 muscle to keep the scapula close to the thoracic cage. try several "PullOvers" too search Utube you will find all the exercises you need.

 

[bsbs1876]

Originally Posted by willy81 .

probably you don't pay attention to what I told you,
your cb (with plate) is not noticeable because the muscles are loose because they "suffered" during the operation,
thus takes quite some time to restore, for me it took about a year, now my CB is much more noticeable and it will remain noticeable even when I have the plate removed.
This can't happen overnight it takes time, months for me it took a whole year.

If your scapula is winging you need to strengthen the Serratus Anterior and the Rhomboid, SA is the No1 muscle to keep the scapula close to the thoracic cage.
try several "PullOvers" too

search Utube you will find all the exercises you need.

Yes, also there is residual swelling which stays around for a year or more in some cases. Back in 2007 I broke my nose very badly (completely crushed over to one side) playing hockey. I had to have an entire reconstruction nose job and septoplasty. Though the majority of the swelling went down after about a month, my nose was kind of wide and bulbous for about a year until it came back to a defined look like before. You are right that the muscles need to tighten up through strengthening too, but also swelling can stick around for quite some time.

You're right, the serratus anterior holds the scapula to the rib cage. Due to the shortening caused by my malunion that I had for years, I had smaller back muscles on that side because the shoulder was pushed in closer to my body. This made it very difficult to activate these muscles such as the rhomboid and trapezius as well.
This on top of the fact that the serratus anterior is actually considered one of the hardest muscles in the body to activate make it tricky for me to work out and strengthen my new found muscles now that my bone is realigned.
My physiotherapist has given me specific exercises which I think are kind of waking it up.

 

[willy81]

these days I worry about the second operation and how long it will actually take until my muscles return to their normal shape. I was told that this time recovery is much faster, two months, because there will be no metal inside and muscles/bone will bond faster and better together. we will see, there is still 4-5 months till then

 

[bsbs1876]

Originally Posted by willy81 .

these days I worry about the second operation and how long it will actually take until my muscles return to their normal shape.
I was told that this time recovery is much faster, two months, because there will be no metal inside and muscles/bone will bond faster and better together.

we will see, there is still 4-5 months till then

I have researched the removal operation a bunch and pretty much everyone I have spoken to on forums or in person has said that it is a "walk in the park" compared to the metal going in. One guy told me that he just took some Motrin for one day after surgery and the pain was gone. Everyone claims that the worst of it is just the incision and getting it to heal up nicely. I'm also getting mine removed in 4-5 months. Most likely November.

 

[willy81]

today is my first annual anniversary since the surgery, I feel strong but I believe if I have the plate removed I will feel the same as before.

 

[ashi12]

O congres if you feel better. After the one year of your surgery. I hope you will join again cycling.

 

[bsbs1876]

Happy clavicle birthday, *****. Now go get that chunk of metal taken out of you.