• Sagging shoulder (down and forward)
• Inability to lift the arm because of pain
• A grinding sensation if an attempt is made to raise the arm
• A deformity or "bump" over the fracture site

An x-ray can diagnose the severity of the break and will also be used as a monitoring tool to see if its healing.

Most broken collar bone injuries will heal without surgery, and many result in a lump at the break site as extra bone lays down to reconnect the bone. To start a sling will be provided as pain will limit all movements but as this subsides gentle movement can start to be achieved. Once healed shoulder function will restore back to normal unless there was also soft tissue damage which needs to be treated.

For those wanting to get back into sport or manual jobs then you can expect a full recovery time of approx 12 weeks, bone healing will be quicker but strengthening the shoulder back to full will take a few weeks more.

Guideline we follow with a collarbone break

• No arm raising. Don't raise the injured arm above 70 degrees in any direction for four weeks post injury.
• No lifting. Do not lift more than 5 pounds with the fractured arm for six weeks post injury. (strength will be done actively and isometrically)
• Use ice. Ice the injured shoulder for 15 minutes three times per day as needed to help reduce pain, swelling and inflammation.
• Use a sling. Keep your injured arm in a sling for 3 to 4 weeks post injury to help support the clavicle as it heals.
• Watch your body mechanics. While using a sling, it's important to maintain proper bone and muscle alignment to avoid future problems. Try to focus on good shoulder position. Don't shrug, slouch or let your shoulders round while in the sling.
• See your doctor. Keep your doctor's appointments, and see your physical therapist during your rehab usually starts 2-4 weeks post injury. It usually takes a few weeks for the injury to settle and allow the therapist to touch and to assess the area for soft tissue damage. You can however try week 1 and 2 exercises below but only if pain free and you understand the exercise if not, don't try it.

The following can be started when pain allows,

Week 1 - You will be using a sling for most of the time but 3 times daily you can bring it out to try this exercise. Only do this if there is no pain.

• Pendulum exercise. In this exercise, you bend forward at the waist and let your injured arm hang down toward the ground. Make small circles with your hand and let momentum move your arm around effortlessly. Try to make clockwise and counter clockwise circles. Try writing the alphabet in capitals.

• Grip Strength Exercise. Squeeze a small ball (a tennis ball works well or try rolled up towel) 30 times with gentle but even pressure several times per day.

After week 1 you may feel you can do a bit more. You can try

• Isometric or Static Exercises. During isometric exercises, you contract your muscles without movement. There are several forms of isometrics you may do during your rehab, including the following:
  1. Isometric Triceps Exercises. The triceps brachii is the muscle on the back of the upper arm primarily responsible for extending the elbow.
     1. Rest your injured arm on a table or counter top with your elbow at 90 degrees.
     2. Make a fist and press in to the tabletop with your entire forearm, from fist to elbow.
     3. Your arm will not move, but your triceps muscle will contract.
  2. Rotator Cuff Exercises. The muscles that make up the rotator cuff are often damaged or torn during shoulder injuries. Isometric internal and external rotation exercises are often prescribed to rebuild strength in the rotator cuff.

• Isometric Shoulder Exercises. You may also be instructed to do isometric shoulder exercises that include abduction, adduction, extension and flexion, with your arm at your side.

Fitness can be maintained by using a stationary bike, walking but again only do if it feels comfortable there should be no pain in the shoulder area. No running should be done until the x-ray shows full healing of the break.

From week 2 the rehabilitation can progress slowly from static and passive to active range of motion, by weeks 8 you should have achieved full range and be working on strength through the range, this will include rotator cuff  and scapula exercises. The weights will start off light with high reps and progress to heavier reps around week 10. At week 12 full range of motion and strength should be achieved and sports specific strength work can begin, it may take another few weeks before you get back into your sport/s fully. This is only a guide to rehabilitation anybody with this injury should be following a program suited their specific injury and later specific sport. Time frames may also be different with the severity of injury and whether there is also soft tissue damage as well.

Treatments in the clinic will include ultrasound and manual skills to aid healing and speed recovery as well as assisted exercises. The rehabilitation is mainly home based.