Clavicle of right side viewed from below (left image) and from above(right image)
The clavicle is a long bone that connects trunk with upper limb.
It is also known as collar bone.
Its main function is support of the shoulder and transmittal of upper limb weight to the trunk through the sternum.
Clavicle can be divided into a cylindrical part called the shaft, and two ends – medial and lateral.
The lateral end is also called acromial end and is flat from above downwards. It articulates with the acromion process of the scapula through a facet. The articular surface for the acromioclavicualr joint gives attachment to the joint capsule.
The medial end is called sternal end, is quadrangular in shape. This part articulates with the clavicular notch of the manubrium sterni to form the sternoclavicular joint. It also articulates with first costal cartilage via extension of the articular surface. The articular surface for the sternum gives attachement to the fibrous capsule all round, to the articular disc posterosuperiroly; and to the interclavicular ligament superiorly.
The shaft of the clavicle can be divided into the lateral one third and the medial two thirds.
The lateral one third of the shaft is flattened from above downwards. It has two borders, anterior which is concave anteriorly and posterior which is convex posteriorly. Between the two borders are two surfaces- the superior surface and inferior surface. While the superior surface is subcutaneous, the inferior surface has elevation called the conoid tubercle and a ridge called the trapezoid ridge.The anterior border gives origin to the deltoid muscle and the posterior border provides insertion to the trapezius muscle. The conoid tubercule andtrapezoid ridge give attachment to the conoid and trapezoid parts of the coracoclavicular ligament.
The medial two thirds of the shaft of the clavicle is rounded and has four surfaces.
- The anterior surface- It is convex forwards.
- The posterior surface- It is thickened and smooth.
- The superior surface- This surface iss rough in its medial part.
- The inferior surface- It has a rough oval impression at the medial end. It harbors a longtitudinal groove called subclavian groove in its lateral half.
The anterior surface gives origin to the pectoralis major. The rough superior surface gives origin to the clavicular head of the sternocleidomastoid. The oval impression on the inferior surface gives attachment to the costoclavicular ligament. The subclavian groove gives insertion to the subclavius muscle and the margins of the groove give attachment to the clavipectoral fascia.
Determination of Side.
- The lateral end is flat, and the medial end is large and quadrilateral.
- The shaft is slightly curved, so that it is convex forwards in its medial 2/3, and concave forwards in its lateral 1/3.
- The inferior surface is grooved longitudinally in its middle 1/3.
Gender Variations
Female clavicle is shorter, lighter, thinner, smoother, and less curved than in males . The lateral end of the clavicle is a little below the medial end in females whereas In males, the lateral end is either at the same level or slightly higher than the medial end.
Text adapted from BD chaurasia
I am 6 weeks post open left clavicle excision from chronic AC joint arthropathy. My problem is I still have a lot of pain, swelling and soft tissue inflammation. I was told to ice and go to PT which I did ince the surgery. Now I'm told to use heat by my physician and my swelling is worse now than it has ever been. Is this normal???? Did I have surgery for nothing??? My PT has been stopped. Which is it? Stop the swelling or encourage it? And if it doesn't resolve he is talking about more cortisone injections in 6 weeks. Can anyone add insight?
@Gerard Rinaldi,
What is the cause of swelling? How bad is the pain?
Dr Singh. Thanks for responding. The pain is worse than it ever was. I'm taking Vicodon to help the pain along with NSAIDS. My surgery was 5/19/11. Yesterday it was very swollen. Mostly in the space created from removing the end of the clavicle. That is not where I feel the most pain though. I feel it posterior to the incision site. Something is rubbing back there with every movement of my arm. Like crepitus when you feel it. I'm not a doctor but it feels like the posterior edge of my clavicle is scraping across tendons and muscle with every movement causing chronic inflammation. Today the swelling is down and it is sore but bearable. I'm a nurse and I pushed a patient in her bed yesterday and that agitated my shoulder. I work in a cath lab and we were swamped yesterday so I had to be more physical with my shoulder. I'm still on restrictions but it is almost impossible not to use my left arm. Will this get better when the scarring is completed? What if the distal end of my clavicle is the problem? Will I need surgery again to round the edges. I saw the post X-ray and it is a very clean and smooth excision. My pre MRI showed alot arthropathy and encroachment into the rotator cuff area. Should I have been scoped. Could my doctor have missed some tears or more arthritis? The MRI report did say I had a subtle tear of my anterior superior labrum. Can that be visualised with an open excision. All I know is I have to get this shoulder more functional. My job depends on it and I am left handed.
@Gerard Rinaldi,
There are lot of factors that could cause pain after this surgery, though it is very effective in most of patients.
As you are from medical field, I urge you to go through this article.
http://www.sportssurgerynewyork.com/articles/the-…
Then please discuss with your treating doctor. Let me know if you have any query about anything.
I have passed 12 weeks of calvical fracture. When can i start riding my bike to go to office?
@Aru,
What does your treating doctor say?
Thanks for your response Dr. Singh. Great article. I still have a lot of pain almost three months post op and will see my doctor 8/16/11. I'm almost certain I will be getting the cortisone shot. I have a lot of grinding going on in my shoulder when I move my arm. I feel most of it at the superior posterior part of what's left of my distal clavicle. I also feel pain in the subacromial space. I guess I'll just have to see what my doctor thinks. I have one other question. Is a subacromial decrompression done with open distal clavicle resection? I've seen videos on how there can be a lot of thick inflammatory tissue there. Thanks again for yor responses.
@Gerard Rinaldi,
Yes! It is a procedure but whether it should be done would vary frm case to case.
Two years ago I was lifting something and I heard a pop in my shoulder. A week later I started feeling pain. I went to the dr and was referred to an ortho. The only thing they could find was a bicep strain. I started physical therapy and during that time my collar bone became swollen. I was given a mild anti inflamatory and referred to another dr that said I had a pectoral tear and need to just give it time. The problem is my collar is still swollen and the pain radiates over to my shoulder and up my neck and down the back by my shoulder blade. Every time I do something at work or even try to sleep I am in pain. Do I go back to these drs again and have it ignored or start over.
@michelle,
You need to have a solution for your problem if medical science has it.
If you think that previous two doctors are not helpful, a third opinion would be a good option.
Dr. Singh. I saw my physician 8/16/11. He diagnosed joint capsule inflammation and gave me more steroids. So far the pain is better but the rubbing and grinding is still there. He recommends more surgery to remove the lining of the joint cpasule if it persists. He also said I could end up with shoulder instability if he does this. I think I have that now. He removed 1cm of my clavice but the top back end of my clavicle still scrapes soft tissue with every movement of my arm. Even feel pain up my neck if I move my arm the wrong way. So it is clear that it is affecting my muscle as well. I'm going to give it a good solid three more months and see if this doesn't resolve. I'm not keen on having more surgery that could make it even worse.
@Gerard Rinaldi,
All the best. I hope you get well soon.
Since 2008 my right clavicle was a little bit bigger than my left clavicle i have been having a sevier pains and clicks and stiffness and pains and tightness and discomfort in my right hand shoulder and clavicle and a swollen movement from that clavicle to my neck and throat tightness and discomfort as if mucuos is fulled in their, i went for xray but the doctor couldn't see anything till now after a stressful labour with that my right hand, my right scapula pop outter than the left one and that my little swollen right clavicle also shoot more outter than the other makes me look abnormal please i am in serious pains and feeling this swoll up in my right collar bone and should how can it be diagnose since xray shows nothing please help me out what should i do what could be the cause of this problems help me tanx
@Dave,
With so much pain and discomfort that you are living with my only sincere advise to you is to see a specialist.
I wish I could but I would not be able to help from distance. All the best.
Dr Singh,
Just wanted to update you on my left shoulder. As you know I have sought your advise in the past. I had an open left distal clavicle excision six months ago. Last week I went to my doctor because I had swelling and more pain. He diagnosed me with a ganglian cyst. He drained the cyst and injected more steroids. Today my pain was worse then it ever has been in the 5-6 years i've had this nagging problem. I am seeking a second opinion because my doctor wants to do more surgery and remove my joint capsule lining if the swelling comes back. Well today the joint capsule is filled with fluid again. Nine days later and with absolutely no pain relief from the steroid. I have a question. Can a prosthetic distal clavicle connected into what is left of my clavicle? I am almost certain that my posterior clavicle is just tearing through tissue with every movement of my arm causing chronic and constant inflammetion. I feel pain all the way up my neck. It grinds and crunches with every movement. What questions should I ask the new orthopedists? Is a prosthetic clavicle reasonable? My primary also wants another MRI and is finding me the second opinion. This shoulder is wrecking my life.
@Gerard Rinaldi,
I am sorry to hear that. I do not think there is prosthesis for clavicle.
The idea now is to look for what is causing the pain and what structure is being insulted.
A good clinical examination supported by MRI would be able to tell us that.
Are you using Arm Pouch sling or something similar.
A sling would take the weight off your limb and you would get temporary pain relief.
Dr Singh. My MRI showed supraspinatus tendinosis and tendinopathy. My AC joint has more arthropathy. And I have a ganglion cyst in the joint that measures 2.1 x 0.8 cm. I am having it drained again monday by a radiologist using ultrsaound. I already made my mind up. I'm having arthroscopis surgery by someone period. My current Dr. does not want to do anything if he can avoid it. He is talking about potential open incision and adding cadavre ligaments to stabilize the acromion and clavicle. I want the bursitis removed under arthroscopy. My bursa sac is bulging out as well. He never did a subacromial decompression and all that thick inflammatory tissue remains and is pushing on everything. The source of my pain. The ganglion cyst is a direct result of this and not the solution. And more bone spurs scraping the hell out of the inside of my joint capsule top, bottom and posteriorly. My prblem is chronic inflammation caused by???? He missed something doing a 25 minute open excision. My wife said he was out in liteally 25 minutes. That's enough time to make an incision, saw off the clavicle and leave the closure to residents.
@Gerard Rinaldi,
I am sorry for the delay in replying. Got extremely busy.
How are you now? has decompression brought any relief.
Did you take a second opinion as you mentioned before.
Instability per se can lead to chronic inflammation but the cause needs to be determined befoer we take any further step.
All the best.
Quite possibly the most rediculous clavicle situation ever? Please help!!!
Hi, I am writing to see if there is any help out there for what I have been going thru. To sum it up, I had a clavicle resection on my left shoulder in 1995. It took a while but I finally got to the point where i could work out and live my life. There would be occasional pain, particularly if I slept on it, but it was fine otherwise. about 15 years later I began to have more and more pain and I decided to see a doctor to see if anything could be done, as I was about to turn 40. The doc told me there was probably scar tissue and it just needed to be cleaned up. In surgery, instead, he resected my clavicle again!!! This was never discussed or even suggested by him. I should add that I did have an MRI before surgery (surgery was March 2010). The MRI showed a small partial tear, but he told me it was not the source of my pain and suggested I leave it for him to decide in surgery it the tear was worth repairing since in surgery he can see it better. Again, instead, despite noting, "extensive tearing" in his own op report, he took out another 1cm (on top of the 1.5 cm that was removed in 1995). He then prescribed me to physical therapy which, along with my new instability, tore the rest of my shoulder. I finally got away from him and saw a few other docs…All agreed that the shoulder was now unstable and the tear was now severe and in one docs words "hanging on by a thread". I had rotator cuff surgery in Jan 2011. The new surgeon told me after surgery that he could confirm that too much bone was removed and I would need another surgery ASAP. This would be the third in a year if you're counting….I had an ac joint stabilization surgery with allograft. a few months later. The doc attached my clavicle to the coracoid process with donor tissue from a cadaver. Just when I thought things couldn't get any worse, 6 weeks later as I was sleeping I was awakened with a "pop". I didn't know it then, but the coracoid had broken right in half! Curiously, the graft seemed to hold place, except for the area where the hole was drilled was now chipped and very movable, it just didn't rise as high as before. I went into surgery immediately, and they fixed a large screw in the coracoid. Now I still have major pain and instability in the clavicle, and now they tell me, the coracoid did not heal and they will need to operate again to take out the screw and affix the tendons on the end of the coracoid to what's left of the base of the bone, while discarding the previously fractured bone. What started out as a small tear and some inflammation from years of weightlifting has now rendered me disabled and a complete wreck. Naturally, I don't want to jump into any surgery again until I am absolutely sure this is it! The problem I am having now is, I do not have any bone density problems, I am wondering why the coracoid broke? Also, if there is a screw holding it together, will removing it leave it compromised as they intend to place the pectoral, bicep, and ac tendon all on this nub of a bone with a hole in it! Also, the clavicle is still highly painful and I can press on it and it moves around with ease. Also, what's left of the graft is also being supported by the base of the coracoid, which will lose the outer bone and have a hole in it where the screw was. They did a few follow up MRI's and it does confirm an incomplete union, as well as pain from the hardware pressing on surrounding tissue. This has absolutely been a nightmare…surgery after surgery, each one making it worse, and more painful, and now I have new broken bones. Yes I am seeking action against the surgeon that caused this. I do not believe in lawsuits, but I have paid an enormous amount out of pocket for these surgeries, not too mention I spent more time in 2011 in a sling than out. This has ruined my business. Not only the disability, but the pain and mental anguish of it all has made me often wonder how I did not kill myself already…I am just hoping to God that someone out there has some kind of an answer. I know this is a complicated situation, rarely, if ever seen, but there has to be a way to get this fixed. As of now I am on so many meds and waiting for the coracoid surgery they suggested, but again, the clavicle is still a problem, and they seem to think it is ok. If I have to have surgery AGAIN (that will be the 6th one total!!!) all for a problem that was caused by….SURGERY! I have never had an accident or injury, just pain from years of exercise.
@Charles Martin,
If the screw impingement is causing a problem, it should be removed.
When a hole is created in bone, that part gets weakned. An unusual stress on that part might result in fracture.
The coracoid in your case has probably broken because of that.
Your concern is rightly placed. When screw is removed, the bone would be rendered weak.
An answer to such situations is immobilizing the limb in neutral position.
You have put your facts well and things do point towards need for surgery and postoperative immobilization.
Please feel free to ask. Within limitation of this interface, I would try to answer every bit.
I can only answer specific questions. Because I cannot evaluate you physically, I am not a candidate for commenting on the plan of treatment you should follow.
If you feel doubtful, seek another opinion before you decide for surgery.
And most important! Please do not loose hope and bear negative thoughts.
What you are going through is painful but you need to keep yourself steady.
Let me know.
fyi, I have read of prosthetic clavicle devices in rare occasions, they do exist, but I am having a hard time finding someone that knows how to do them.
@Charles Martin,
First clavicle implant was done in 2003. The concept is thus very recent and needs long term studies to be published in literature to lay out the standards.
So they are not a standard practice yet.
One last thing….(sorry to drag this out). I am having alot of pain in the other (right) shoulder now as I use it to over compensate for everything, since my left shoulder is in so much pain. They see a tear in the MRI and a bone spur on my elbow they want to operate on, if and when I ever get the left side fixed, but of course now I don't want anyone messing with anything else, but I may have no choice
(right side is pretty painful). I just want to not feel like I wanna die everyday…Help!
@Charles Martin,
Treat your right shoulder with rest and medication. Concentrate on your left shoulder for now.
MRI is a very sensitive investigation and not all tears need surgery. Local heat, massage and rest should help.
You need to evaluate if you need surgery for your right shoulder, not MRI finding.
Dr. Singh. My primary found a second opinion and I gave him to much info. He refused to see me stating he doesn't do second opinions. I got my shoulder drained from the radiologist and he avoided my questions saying I need to ask my Dr. My pain is still constant and worse at night when I sleep. I'm back to NSAIDS and Vicodan until I decide what to do. Researching alternative medicines like prolotherapy and LED. I will either find a Dr. who will see me or just ask my current Dr. to scope me.
Today when I looked over at my 14 year old daughter, I noticed that her left clavicle was sticking out much farther than her right. When I felt it, I didn't feel anything that felt like a lump….it just felt like the bone. It is very noticeable but she says that she didn't notice it and that she doesn't feel any pain. Should I be worried? Any idea's of what could be going on?
@Teair Mullins,
It is always better to see a doctor if there is a concern. I would not be able to help you from a distance on the point whether there is something of concern or not.
An examination by a doctor whom you visit in person would reveal that easily. I suggest you to see a doctor please so that your doubts can be addressed.
All the best.
Really need advice here.
I find myself in a really particular situation regarding my collarbone pain.
First started last year, around April. I had a little clicking in my shoulder region during certain lifts like a bench pressing, however nothing too crazy, just a little discomfort at most. The only limiting action I had with my collar bone was when I would lean back on and incline bench and attempt to do a dumbbell press with my left arm. Once my bicep was inline with my collarbone, I was not able to push it upward without a ton of effort. Really odd.
Saw a doctor in May, he said "I have never seen that before." His guess was a fracture of my left collarbone, however he said most fractures occur distal on the collarbone, while mine was more medial. I got the X-ray taken, and it came back negative for any fracture.
I then saw an Orthopedic. He once again said "I have never seen that before." He did not offer any guess as to what my condition was, and said the next step would be to see if it went away, avoid anything that caused discomfort, and if it doesnt improve an MRI would be in order.
I stopped working out and started a different job that consumed my time. I did not notice any discomfort from that point on, and it seemed like the swelling subsided for the most part, although my left collarbone still protruded a little more than the right.
Also, I went to the emergency room for an unrelated issue. While I was there, I asked the doctor about my collarbone. He replied with he didnt see an issue, its just the way I was created, and my posture is not ideal.
Now I have began working out again as of December. I still have mild discomfort, but only when I do pushing exercises for my chest workouts. I decided to get an MRI, as I am sick of this being an issue.
My MRI came back completely normal according to my doctor. He said it was just the way it formed. This baffles my mother and I, as we both know my collarbone has not always been larger than the other.
So now I have no clue where to go. I have seen 3 different doctors. They have all felt the collarbone and examined it. X-Ray came back normal. MRI came back normal.
I would really appreciate any medical advice. It only causes comfort during certain workouts, and I can live with that. However, I do not want this to turn into a chronic or more serious issue.
Do MRI's show everything when it comes to what kind of problem it could be? I also thought MRI's were extremely in depth, and if there was a diagnosis, an MRI could easily find it. If I had a sternioclavical dislocation, it should be easy to detect and definitely show up on an MRI right?
Any advice would be greatly appreciated. I am starting to think maybe there is nothing wrong, but I have a muscle imbalance in my deltoids or rhomboids or something that is putting too much weight and pressure on my collarbone while working out.
@Bob Endrai,
MRI is quite sensitive to miss any pathology in the tissues, so do not worry on that aspect.
Your problem arises when you load your shoulder girdle and there must be some kind of instabiilty that is manifested when you lift the weight.
I am just speculating here and I think most prudent approach is to prevent the loading. Keep a watch over your conditiona dn take an advice if it worsens further.
All the best.
Dr. Singh, I had two right scm releases for severe torticollis that didn't respond to anything else,after the second release I immedialtely have had severe right clavicle,pectoral,shoulder problems,pt failed I'm at aloss.
@susan,
How old are you. Would you please elaborate about your condition and treatment taken so far.
I am a breast cancer survivor. Lumpectomy 1.3 cm. Invasive, stage 1. (spring 2010)
Followed by 33 rounds of radiation.
A month ago, I noticed swelling on the right side collarbone. I visited my Oncologist and he ordered CT and Bone Scans, full body. They returned negative. He said that it was some sort of inflammation and sent me home with celebrex to return in 3 months. Meanwhile, the problematic collarbone has become more prominent pushing upward. Slight pain. I am scheduled to see my family doctor Tuesday to get more information about “some sort of inflammation”. I did continue to carry a lot of weight on that side after the surgery. I carry lots of books and a laptop home daily. It is also the side that I sleep on.
@Lydia White,
Too little info to comment on. Has a diagnosis been made?
Hiya, I broke my collarbone in two places last year. One fracture was stable and located in the middle of my left clavicle, the other was unstable and basically snapped off the distal end. This was left to heal, which it did so, to the rear of my collarbone. The ortho decided that the best way to deal with this, three months later, was a distal clavicle excision. What I would like to know, is how much should be taken off with a dce, and what are the possible complications if over 1 inch is removed?
thanks
October 2001 a male teacher grabbed my wrists and pull both arms above my head. He is considerably taller than me. He did this with great force causing WBA jest looked like a sub laxation of the sternoclacivular joint except chronic pain inner arm at elbow and a tingling of the fingers. First CT scan showed little as did MRI pain has been unbearable as I am left handed and a school teacher I had an MRI with contrast and was as back with 4 hours for a dooplar which showed no steal but they did find a lesion of the subclavanian artery causing on occlusion I then had an iodine CT which the radiographer thought needed a stent. Meanwhile I can write on the board I wake 6 or 7 times a night with a numb had and blue fingers. When I walk for exercise my fingers feel so fat and swollen I think thru are going to split.I am currently waiting for my surgeon to get clearance to work at the hospital then only cardiovascular surgeon who agrees with the plan. Hid plan from what I eardrum was to react the medial end of the clavicle thus taking press off the brachial plexus nerve and relieve the pressure on the subclavanian artery. I just want the pain to stop the tablets to stop I hardly take a panadol and now I am on antidepressants antisycotic tramal 250 mg a day it's driving me crazy I have to physically stop and tape each finger to Mack they are still there I I can not feel them move unless I tap them. Then at night I have to reposition myself continuously so I don't fall asleep on that arm
@Stephanie,
I think this falls into specialty other than orthopedics.
How are things now?
@Corina,
What are your limitations in present situation?
I am in a reasonable amount of pain everyday. I am only able to do light tasks, and have had to quit my job recently due to pain and activity limitations. My surgery was just over a year ago. My shoulder blades sit at different heights and you cannot put pressure on the shoulder area. I cannot hang washing. I have had to cut my hair short due to pain while washing it. My range of movement is quite good, but i cannot over exert the shoulder.