Differentials
Clavicle contusion
SIGNS / SYMPTOMS
May be very tender but pain is usually more diffuse than with clavicle fracture. No step-off or bony crepitus. May occur from a direct strike to the clavicle but with lower force than required to cause fracture. No deformity. Function of the shoulder is usually maintained.
INVESTIGATIONS
X-rays negative for clavicle fracture.
CT, MRI, ultrasound (if performed) negative for clavicle fracture.
Haematoma
SIGNS / SYMPTOMS
May occur along with a clavicle fracture but could occur without fracture, especially if direct trauma in an anticoagulated patient. No deformity. Function of the shoulder is usually maintained.
INVESTIGATIONS
X-rays negative for clavicle fracture but may show localised soft tissue swelling overlying clavicle.
Ultrasound, CT, and MRI can directly show the haematoma.
Sprain of acromioclavicular joint
SIGNS / SYMPTOMS
May mimic and/or accompany lateral clavicle fracture. Injury site is usually painful and tender directly over the acromioclavicular joint. May be painful and tender over the distal clavicle. Elevation of the distal clavicle seen at the acromioclavicular joint if higher grade injury.
INVESTIGATIONS
X-rays should show acromioclavicular separation in grade II or grade III sprain.
MRI can more accurately show the degree of acromioclavicular joint injury.
Sprain/dislocation of sternoclavicular joint
SIGNS / SYMPTOMS
May mimic and/or accompany medial clavicle fracture. Injury site is usually painful and directly tender at the sternoclavicular joint. May be painful and tender at the medial clavicle. May have laxity at the sternoclavicular joint if higher grade injury. If clavicle posteriorly dislocated, may cause acute compression of or injury to underlying neurovascular structures, airway, or oesophagus.
INVESTIGATIONS
X-rays may not always clearly delineate sternoclavicular joint injury. CT or MRI are first choices to reveal extent of injury.
Rotator cuff injury
SIGNS / SYMPTOMS
Mainly in older patients. Pain is usually more vague with diffuse tenderness.
Pain is usually minimal with passive range of motion, but pain and weakness occurs with attempted active range of motion.
INVESTIGATIONS
X-rays negative for clavicle fracture.
Anterior glenohumeral dislocation
SIGNS / SYMPTOMS
In an isolated glenohumeral dislocation, there is a characteristic deformity, and the humeral head can be palpated anterior and inferior to its usual location. If no concomitant clavicle fracture is present, bony point tenderness is absent.
INVESTIGATIONS
Anteroposterior and lateral x-ray views show no sign of clavicle fracture, but scapular 'Y' and axillary lateral views show dislocated humeral head.
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