Causes of Collarbone Pain and Treatment Options

Everything you need to know about pain in the collarbone

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The collarbone (clavicle) is part of the shoulder girdle. Collarbone pain can be perceived as shoulder pain and sometimes neck pain. The most common causes of collarbone pain are caused by injuries. However, collarbone pain can come on with or without injury, gradually or suddenly. The most common descriptions for collarbone pain are tenderness, throbbing, aching, dull, or stabbing.

Causes

Collarbone pain can be true pain originating from the clavicle or it can be from surrounding tissues. Pain can also be referred from conditions in the abdomen to the area of the shoulder and the distal part of the collarbone.

Common Causes

The most common causes of almost any bone pain are from direct or indirect trauma. External forces are transferred to the bone through mechanisms of injury. Less common causes can be from infections or inflammations of the bone.

Traumatic causes are usually felt immediately with sudden, severe pain at the time of injury. Nontraumatic causes may come on gradually and do not always feel like severe pain. Sometimes, nontraumatic causes might not be painful unless the patient attempts to move his arm or shoulder.

Fractured Collarbone: The structure and location of the collarbone put it in a prime spot for direct injury. Because the ends of the clavicle are the only places where it is connected to other bony structures and because those bony structures are also strong, the collarbone is at risk for fracture and dislocation. Fracture or dislocation can occur together or separately. Broken collarbones account for about 5 percent of all adult fractures.

The most common mechanism of a collarbone injury is to fall and strike the shoulder or to fall onto an outstretched arm and transfer that energy to the shoulder. Another common mechanism is a car accident. A properly worn seat belt shoulder strap lays right on the collarbone, but the seat belt is not responsible for most broken collarbones in motor vehicle collisions. Energy transferred from the steering wheel through the arm is more likely to cause a fracture of the clavicle than the seat belt.

Acromioclavicular (AC) Joint Separation: The AC joint is a bit of cartilage that connects the collarbone to the scapula (triangular bone on the back of the shoulder). Direct impact to the shoulder or transferred to the shoulder through the arm can separate the collarbone from the scapula at the AC joint.

Arthritis: Joint inflammation from overuse can occur particularly in the AC joint. Just about any repetitive arm lifting or circling can lead to inflammation in the part of the shoulder structure called the rotator cuff. Usually, this sort of pain feels like it is coming from the lateral (outside) part of the shoulder rather than from the collarbone. However, arthritis can cause collarbone pain as well.

Rarer Causes

Less likely than trauma, these causes of collarbone pain can occur much less commonly.

Referred Pain (Kehr's Sign): Irritation in the abdomen can trigger pain in other parts of the body. One of the most common types of referred pain causes the patient to feel a constant aching pain in the top of the shoulder near the distal end of the collarbone.

Kehr's sign is pain in the left shoulder caused by bleeding from the spleen into the abdominal cavity. The pain might get worse with palpation of the upper left quadrant of the abdomen where the spleen is located. A similar referred pain can occur if there is bleeding on the other side of the abdomen, which will show up as pain in the right shoulder or collarbone.

Referred pain is an important consideration if the patient has had recent trauma to the abdomen followed by collarbone pain or shoulder pain, especially if there was not an injury to the shoulder or collarbone that hurts.

Thoracic Outlet Syndrome: Thoracic outlet syndrome refers to impingement of an area of the shoulder structure where blood vessels and nerves transition from the chest to the axillary area near the armpit. This is not a common cause of collarbone pain, but it can occur in rare cases, particularly when veins or arteries are blocked.

This cause shows up regularly on the internet as a cause of collarbone or shoulder pain, but the pain is much more likely to be felt distal to the blockage, such as in the arm or the hand. In most cases of thoracic outlet syndrome, the blockage is impending on the nerves. In extremely rare cases it happens to veins and, even more rarely yet, arteries.

Condensing Osteitis: This is the rarest condition that is specific to the clavicle and could lead to collarbone pain. Condensing osteitis is extremely painful but benign. It is an inflammation of the inside of the medial end of the clavicle, the part attached to the sternum (breast bone), and is usually treatable with anti-inflammatory drugs. In some cases, osteitis requires surgery to reduce the inflammation and possibly remove a portion of the collarbone.

When to See a Doctor

Treatment for collarbone pain depends on the cause, and in almost every case it is important to see a doctor. Whether or not you can wait to make an appointment depends on a few factors.

Traumatic Collarbone Pain

In the case of trauma, the most important factor is whether or not the pain is tolerable. If you were involved in a motor vehicle collision, for example, and you now have debilitating pain in the shoulder or specifically on the collarbone, call 911 or go to an emergency department. Sudden, severe pain as the result of an injury could mean the collarbone is broken or dislocated (separated) from the other bones around it.

If the pain is tolerable after an injury, you could choose to make an appointment with your primary physician or with an orthopedic doctor if you have that option available through your insurance. Either way, your doctor is going to need an X-ray and sometimes it is easier to go to the emergency department and let the staff guide you.

Anytime after a significant injury, if you are feeling light-headed, confused, or short of breath, call 911 immediately. The amount of force necessary to cause a fracture of the collarbone is also enough to cause significant bleeding or puncture a lung.

Nontraumatic Collarbone Pain

Pain that develops gradually over time can usually wait for you to make an appointment with your primary care physician. In the event that your pain develops suddenly, it is perfectly acceptable to go to the emergency department for treatment.

If nontraumatic collarbone pain is associated with abdominal pain or if it gets worse when you lie flat and bend your knees, call 911. Kehr's sign is pain in the shoulder that worsens when the patient lies flat on her back and bends her knees. Kehr's sign may mean that there is bleeding in the abdomen and that is a true medical emergency.

Besides worsening while lying down, if there is any bruising on the abdomen or pain in the abdomen along with shoulder or collarbone pain, call 911. If you feel faint or confused, call 911.

Cardiac Chest Pain

While it rarely is described as collarbone pain, chest pain originating from the heart can often feel like neck or shoulder discomfort. Depending on where it is located, it could feel as if the pain is centered on the collarbone. Usually, cardiac chest pain does not increase with pressing on it or with movement of the arm and shoulder. If there is any concern that pain in the collarbone might actually be from the heart, call 911 immediately.

Diagnosis

Collarbone pain is a symptom of another condition. Diagnosing the cause of the collarbone pain will always start with a detailed medical history and focused physical examination. The history and physical will drive the doctor's decision on which tests to perform after that.

Imaging

The most common diagnostic test will all be imaging studies, especially if there is any possibility of trauma. The doctor will almost always start by ruling out whether the cause of the pain is the collarbone itself or where the collarbone connects on either end. The doctor will follow the most common causes first and work toward more rare causes. Imaging study options include:

  • X-rays: The simplest and most cost-effective way to see if the collarbone is the cause of the pain is to look at it. X-rays provide the easiest, quickest, and cheapest option. Expect to get an X-ray if you go to the doctor for collarbone pain. The X-ray is at least going to be a direct frontal view of the side of the chest that hurts.
  • Computerized tomography (CT) scan: In some cases, especially if the cause of the collarbone pain is non-traumatic and not obvious, the doctor will order a CT scan. It will almost always follow a simple X-ray and might not be necessary if the doctor gets a good view of an obvious injury or abnormality on the X-ray.
  • Magnetic resonance imaging (MRI): A CT scanner uses X-ray technology to create images. The MRI uses a magnetic field. The CT is able to see the difference between hard and soft tissue very clearly. An MRI, on the other hand, can differentiate between different soft tissues. In the case of a potentially broken collarbone, the use of an MRI will be rare.
  • Bone scan: If there is any question about the integrity of the collarbone or other structures in the shoulder, your doctor might order a bone scan to check for weak spots.

Treatment

Treatment for collarbone pain is specific to the cause. In the most common cases of traumatic injuries, treatment will be some form of immobilization, either surgical or nonsurgical.

At-Home Treatment and First Aid

Immediate treatment can be done before going to the physician or before the ambulance arrives if 911 was called. In traumatic cases of collarbone pain, especially if a broken collarbone is suspected, the affected arm should be immobilized as well as possible by placing the arm in a sling.

A sling can be made out of a towel or a triangular bandage, also known as a cravat. If the patient is wearing a button up shirt, the tail of the shirt can be unbuttoned and folded up to hold the weight of the arm. Either pin the shirt or button a top button to one of the bottom buttonholes to keep it in place.

Treating Swelling

Ice the collarbone to reduce swelling. Do not place ice directly on the skin and don't leave ice in place for more than 20 minutes at a time. After 20 minutes, remove the ice for at least 20 more minutes. Keep repeating the cycle of 20 minutes with ice and 20 minutes without. Do not let the patient move his affected arm.

Physician Treatment

Depending on the type and severity of the injury, the physician will order either an external sling or brace to keep the arm immobilized, or the physician will consult with an orthopedic surgeon to operate on the injury and repair it from the inside. Either way, the actual treatment is the same: immobilization.

Nontraumatic treatments will be very specific to the cause of the collarbone pain.

Medications

The patient will usually be offered pain medications, either an opioid or a non-steroidal anti-inflammatory drug (NSAID). In the event of an infection, the doctor might also order an antibiotic.

A Word From Verywell

Collarbone pain is overwhelmingly caused by trauma and the treatment is very straightforward. Even if the pain came on seemingly without injury, many patients learn that the original injury was simply old. The good news is that even in the rarest cases, collarbone pain is usually non-life-threatening.

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