Clavicle Fracture

The collarbone is also called the clavicle. A fracture to this bone is a common injury that occurs in people of all ages. Most breaks to the clavicle occur in the middle portion. The clavicle is located between the ribcage and the shoulder blade. This structure connects the arm to the trunk of the body and lies above several important blood vessels and nerves. These vital body components do not usually become injured with a clavicle fracture.

What causes clavicle fractures?

The collarbone gets broken when there is a direct blow to the shoulder. This can occur during a fall onto the shoulder or during a motor vehicle accident. A fall onto an outstretched arm can also lead to a fracture of the clavicle. Many infants are born with a fracture to the collarbone – an injury that occurs during a traumatic birth.

What are the symptoms of a clavicle fracture?

If you sustain a clavicle fracture, it will most likely be very painful and hard to move your arm. Other symptoms include:

• Shoulder sagging downward and forward
• A deformity or “bump” over the area of the break
• Inability to lift the arm without pain
• Bruising, swelling, or tenderness over the clavicle
• A grinding sensation when the arm is raised up

How is a clavicle fracture treated?

With some breaks, the ends of the bone have not shifted out of place and line up correctly. These types of fractures do not require surgery, and the orthopedic specialist can treat them with conservative measures.

These include the use of an arm support or sling (worn to keep the arm in proper position while the bone heals), mild pain medication, and physical therapy. Therapy is done to increase muscle strength in your shoulder and to prevent stiffness and weakness of the muscles.

The orthopedic specialist will recommend surgery if the bones are displaced (out of place) and do not line up correctly. During the procedure, the bone fragments are situated into their normal alignment and held that way with special screws and plates that are attached to the outer surface of the bone.

These structures are not removed until after the bone has healed. Some surgeons use pins to hold the fracture in proper position once the bone ends are put back in alignment.

AC Separation

The acromioclavicular joint (also called the AC joint) is the area where the clavicle meets the highest point of the shoulder blade. An injury to this structure that is common is an AC separation, where a force causes the ligaments that attach to the underside of the clavicle to tear.

What causes an AC separation?

The most common reason for a person to suffer an AC separation is a fall directly onto the shoulder. The force causes the ligaments to be injured and the collarbone separates from the wingbone (shoulder blade). This type of injury will cause the wingbone to move downward with the weight of the arm, creating a bulge above the shoulder.

How is an AC separation treated?

If the shoulder is not seriously deformed, and the AC separation is mild, the orthopedic specialist will recommend nonsurgical treatment modalities. These include the use of a sling, cold packs, and pain medications. Most people will return to full activity once the injury has healed without permanent, significant deformity.

If the pain of AC separation persists with conservative treatment, or the tears to the ligaments are severe, the orthopedic specialist will recommend surgery. This is done to trim back the end of the clavicle so that it will not rub against the shoulder blade. This procedure can be done long after the injury has occurred, too.

Joint Dislocations

A dislocation is an injury to a joint in which the ends of the bones are forced out of their normal positions. Joints are the areas of the body where two or more bones come together. This particular kind of injury temporarily immobilizes and deforms the joint and results in severe, sudden pain.

Dislocations can happen to your shoulder, hip, knee, elbow, ankle, finger, thumb, or toe. If you suspect you have a dislocated joint, seek prompt medical attention. The orthopedic specialist will have to return the joint to its normal alignment.

What do I do if I think I have a dislocated joint?

It is difficult to distinguish a dislocated bone from a broken bone. If you suspect you have a dislocation or a broken bone, there are things you can do while you are waiting to see the doctor. While you are waiting for medical attention:

• Don’t move the joint. Sling or splint the affected area in its current position. Do not try to force the joint back into place. This could damage the bones, muscles, ligaments, nerves, and blood vessels.
• Ice the injured area. Apply ice to the injured joint to reduce swelling, control pain, decrease the buildup of fluid, and stop internal bleeding.

What causes a dislocation?

The most common cause among young people is sports injuries. Dislocations can occur during contact sporting activities, such as hockey or football. They can also occur with falls during sports, such as gymnastics, volleyball, downhill skiing, or snowboarding. Basketball and football players frequently dislocated the joints of the fingers or hands when striking the ball or during a fall. Also, any fall or hard blow to a joint can result in a dislocation, such as a motor vehicle accident.

What are the complications of a joint dislocation?

There are many serious complications with a dislocated joint. These include:

• Nerve or blood vessel damage
• Tearing of ligaments, tendons, and muscles
• Development of arthritis
• Susceptibility to re-injury

How is a dislocated joint treated?

Besides ordering X-rays and MRIs, the treatment of your dislocation may include:

Reduction – This is the process where the orthopedic specialist gently maneuvers the joint to put the bones back into proper position. You will be given an anesthetic or pain reliever prior to this procedure.
Immobilization – Once the doctor has your bones back in the right place, he will immobilize your joint with a sling or split for several weeks. This is done to allow the area to heal and protect it from further injury. How long you will wear the device will depend on the severity of your injury.
Pain Medication – After the doctor does the reduction, your pain will subside. However, if your pain continues, you may be prescribed a mild pain reliever or muscle relaxant.
Surgery – If there is damage to the nerves or blood vessels or if the doctor cannot move your dislocated bones back into position, surgery may be necessary. The orthopedic specialist often recommends surgery if you have recurring dislocations.
Rehabilitation – Once your sling or splint is removed, you will begin a rehabilitation program to help restore your joint’s strength and range of motion. Most dislocations take several months to heal.

What can I do to help heal my dislocated joint?

There are several things you can do to help encourage healing and ease discomfort. These include:

Use ice and heat. Applying ice to your injured joint helps reduce pain and inflammation. You can use a cold pack or a towel filled with ice cubes for 20 minutes at a time. Do this every couple of hours while you are awake. Also, hot packs or a heating pad helps relax sore, tight muscles. Limit heat applications to 15 minutes at a time and do these every couple of hours.

Rest the joint. You don’t want to repeat the activity that caused the injury in the first place. Also, avoid painful movements of the injured joint.

Take a pain reliever. Use your pain medication as prescribed. The orthopedic specialist will suggest an anti-inflammatory agent, such as naproxen (Aleve) or ibuprofen (Motrin). Follow the label directions and stop using the drug when the pain improves.

Maintain the range of motion in your joint. After a few days, do some gently range of motion exercises approved by your doctor or physical therapist. This helps to restore strength to the joint and maintain range of motion.

What can I do to prevent future dislocations?

To prevent further or future dislocations:

Take precautions to avoid falls. Make sure your vision is good by getting your eyes checked. If you take medications that make you dizzy, avoid standing up too fast. Also, keep your home well-lit and remove tripping hazards from walkways.

Wear protective gear. If you play contact sports, wear devices that protect your joints.

Follow doctor’s orders. While you are recovering, follow your doctor’s orders. To avoid recurrence, do the recommended stability and strengthening exercises.

Arthroscopy FAQs

Arthroscopy is a detailed surgical procedure that allows your orthopedic specialist to look at the inside of a particular joint through a viewing instrument called an arthroscope. During this procedure, the doctor looks at the joint surfaces, as well as the other structures within the joint, such as the cartilage and ligaments. An arthroscopic examination allows the doctor to make a tiny incision in your skin and insert a pencil-sized instrument. The arthroscope has a small lens and lighting system used to illuminate and magnify the joint structures. The doctor can then visualize your joint on a TV monitor.

What does the word ‘arthroscopy’ mean?

The word ‘arthroscopy’ is derived from two separate Greek words, ‘arthro’ meaning joint, and ‘skopein’ meaning to look in. The term literally means “to look in the joint”.

Why is arthroscopy necessary?

The orthopedic specialist uses arthroscopy for diagnosis and repair. Some injuries can be diagnosed with x-rays, magnetic resonance imaging (MRI), or computed tomography (CT). Other injuries, however, require further diagnostic techniques. The arthroscope allows the surgeon to make a more accurate final diagnosis and repair the injury at the same time. Some of the common conditions found during arthroscopy include:

• Inflammation: Swelling and redness of the lining of the shoulder, elbow, wrist, knee, or ankle
• Shoulder: Injury to the rotator cuff tendon, injury to the biceps tendon, impingement syndrome, and recurrent dislocations
• Knee: Meniscus tears, chondromalacia, and anterior cruciate ligament tears as well as evaluating damage to the joint surfaces
• Wrist: Torn cartilage or loose bodies
• Loose Bodies of Bone or Cartilage

What are some problems treated with arthroscopy?

The problems treated with arthroscopy include:

• Reconstruction of the anterior cruciate ligament of the knee
• Rotator cuff surgery
• Removal of lose bone or cartilage
• Repair of torn ligaments
• Removal of inflamed synovium lining of the shoulder, knee, elbow, ankle, or wrist
• Repair or removal of a torn meniscus of the knee

What joints are most frequently examined by arthroscopy?

There are six joints that are typically examined with the arthroscope. These include the knee, shoulder, elbow, ankle, hip, and wrist.

How is arthroscopy performed?

Arthroscopic surgery is less traumatic than traditional open surgery. The orthopedic specialist uses general or regional anesthesia, depending on which joint and the extent of the problem. A small, buttonhole sized incision is made on the skin to insert the arthroscope along with several other small incisions around the joint area.

The surgeon inserts the instruments through this incisions and uses the additional incisions to insert specially designed instruments used for repair. When indicated, the surgeon corrects the problem and repairs the damage as necessary.

After the procedure, the small incisions are closed with sutures or Steri-strips and covered with a dressing. You will be moved from the operating room to the recovery room. Most arthroscopic procedures are done on an outpatient basis.

Before you are discharged to home, you will be given instructions about how to care for your wounds, what activities to avoid, and which exercises to perform to aid your recovery. The sutures will be removed during your follow-up visit.

What are the possible complications of arthroscopy?

Although complications are rare, they do occasionally occur following arthroscopy. These include blood clots of a vein, infection, excessive swelling, bleeding, damage to blood vessels or nerves, and muscle damage.

What are the advantages of arthroscopy?

Arthroscopic surgery allows quicker recovery time and less pain because less muscle and tissue are disturbed during the procedure, as compared to traditional open surgery. Most patients are treated as outpatients and are home several hours after the operation.

What is recovery like after arthroscopy?

The small incisions take several days to heal. The orthopedic specialist will instruct you as to when the surgical dressing can be removed. The pain in the joint is minimal but may take several weeks to maximally recover. The orthopedic specialist will develop a tailored rehabilitation plan for you to follow. This will depend on the joint that was worked on, the degree and severity of your injury or condition, and your current health status. Most athletes are able to return to their usual athletic activities within a few weeks, and other patients return to normal activities in a short time.

How does arthroscopy feel?

If you are given a general anesthetic, you will be unconscious and not feel anything during your operation. If you receive regional anesthesia, your arm or leg will be numb for several hours. You will not feel anything during the procedure either.

Expect to have some mild soreness and pain following your arthroscopic procedure. The orthopedic specialist will prescribe some pain medicine for you to use, and advise you to apply ice to your joint. This helps reduce pain and swelling. Be sure to keep your bandages clean and dry while the joint heals.

The knee is the largest joint of the body, and it is also the one most easily injured. The knee is made up of the lower end of the femur (the thigh bone), the upper end of the tibia (the shin bone), and the patella (the knee cap). Large ligaments support the knee, provide stability, and connect the bones. Other important structures include the meniscus (a cushion of cartilage), muscles, nerves, and blood vessels.

Knee injuries cause knee pain, especially for athletes. There are four major ligaments of the knee: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL). Also, the meniscus is commonly injured, resulting in knee pain. Other causes of knee pain include Osgood-Schlatter Disease and Adolescent Anterior Knee Pain.

ACL Injury

The ACL extends from the front of the tibia and inserts on the back of the femur. This structure prevents excessive posterior movement of the femur on the tibia. The ACL is often torn when an athlete changes direction rapidly, slows down from running, or lands wrong from a jump. These types of injuries are common for athletes who ski, play basketball, or play football. The pain associated with a torn ACL is rated as moderate to severe and is typically described as sharp at first, and then throbbing or achy as the knee begins to swell. Most people report increased pain with bending or straightening of the knee.

PCL injury

PCL injuries are much less common compared to ACL injuries.  The PCL is often injured when an athlete receives a blow to the front of the lower leg, just below the knee or makes a simple misstep on the playing field. The PCL prevents the tibia from sliding backwards and works with the ACL to prevent pivoting of the knee. The symptoms of a PCL tear include knee pain, decreased motion, and swelling.

MCL Injury

Most injuries to the MCL are the result of a direct blow to the outside of the knee. Athletes who play soccer or football are at increased risk for this type of injury. The MCL spans the distance from the top of the tibia to the end of the femur on the inside of the knee. This structure prevents widening of the inside of the joint. A torn MCL causes swelling over the ligament, bruising, and feeling that the knee will give out or buckle.

LCL Injury

The LCL connects the end of the femur to the top of the fibula (the smaller shin bone). It is located on the outer aspect of the knee. The LCL helps to prevent unnecessary side-to-side movement of the knee joint. The LCL is usually torn from traumatic falls, motor vehicle accidents, or during sporting activities. Symptoms of a torn LCL depend on the severity of the tear and include pain, swelling, difficulty bending the knee, and instability of the joint.

Torn Meniscus

The meniscus is the rubbery, tough cartilage that sits between the femur and the tibia. This structure works as a shock absorber. Athletes are at risk for tears in this cartilage with cutting, pivoting, twisting, decelerating, or being tackled. There are two menisci of the knee and they lie between the femur and tibia, one on the inside and one on the outside of the joint. The symptoms of a meniscus tear include knee pain, swelling, popping sound within the knee, and limited motion of the joint.

Osgood-Schlatter Disease

Osgood-Schlatter disease is an overuse injury common among growing adolescents. This syndrome is caused by inflammation of the tendon below the patella. Athletes who participate in gymnastics, basketball, running, and soccer are at increased risk for this disease. The symptoms of Osgood-Schlatter disease include swelling, knee pain, and tenderness below the knee cap.

Adolescent Anterior Knee Pain

Young, active adolescents often complain of pain in the front and center region of the knee. This is called Adolescent Anterior Knee Pain, and it is not associated with any injury or damage to the knee structures. The cause of this syndrome is not clear, but experts believe that the complex anatomy of the knee joint contributes to the problem. The knee is extremely sensitive to problems of alignment and overuse. For teens, a number of factors are thought to be involved. These include poor flexibility, imbalance of the thigh muscles, problems with alignment, improper sports training techniques, improper use of equipment, and overdoing sports activities.

Symptoms of Adolescent Anterior Knee Pain include pain that begins gradually and is worse at night, popping sounds of the knee when climbing stairs or walking after prolonged sitting, pain during activities that repeatedly bend the knee, pain that causes the knee to buckle, and pain related to change in activity level or playing surface.

When to Seek Treatment

Seek medical attention immediately if you:

• Have severe knee pain
• Begin limping
• Notice swelling at the site of injury
• Hear a popping or clicking noise
• Feel that your knee is going to give out
• Cannot move your knee
• Cannot bear weight on your knee
• Have tenderness along any aspect of the knee or tibia
• Have pain with climbing stairs, walking, or running