A clavicle fracture is a break in the collarbone, the slightly S-shaped bone that runs horizontally between your breastbone and shoulder blade. It accounts for roughly 2.6 to 4% of all fractures in adults and is one of the most common broken bones, especially in young, active people. The largest group affected is males between 15 and 24 years old, who make up about 21% of all clavicle fractures.
What the Clavicle Actually Does
The collarbone is small compared to other load-bearing bones, but it plays a surprisingly important role. It acts as a strut connecting your arm skeleton to your torso, holding your shoulder far enough away from your chest to allow a full range of motion. Without it functioning properly, the scapula (shoulder blade) can’t glide smoothly along the back wall of your ribcage, and overhead movements become limited or painful.
The clavicle also serves as a shield. Running just behind it are the brachial plexus (the nerve bundle controlling your arm), the subclavian artery, and the subclavian vein. A healthy collarbone absorbs and disperses force from impacts, protecting those critical structures underneath.
Where the Bone Typically Breaks
Clavicle fractures are classified by location along the bone into three groups. The middle third, or midshaft, is by far the most common site. This makes anatomical sense: the middle of the clavicle is the thinnest part and lacks the reinforcing ligament attachments found at either end. Fractures of the outer (lateral) third, near the shoulder, are the next most common. Fractures of the inner (medial) third, near the breastbone, are the rarest.
Each location behaves differently. Midshaft fractures tend to displace more visibly because the muscles pulling on each fragment pull in opposite directions. Lateral fractures can be tricky because they sometimes involve the ligaments that stabilize the shoulder joint. Medial fractures are uncommon and can be harder to see on standard X-rays.
Causes and How It Happens
Most clavicle fractures result from a direct blow to the shoulder or a fall onto an outstretched hand. Cycling crashes, contact sports like football and rugby, and falls from height are the most frequent causes. In newborns, the collarbone can fracture during delivery as the baby passes through the birth canal, though these heal remarkably fast, typically within about two weeks.
Symptoms You’ll Notice
The pain is usually immediate and sharp, centered over the collarbone. You’ll likely feel it worsen when you try to lift your arm or move your shoulder. Most people instinctively cradle the injured arm against their body because any movement of the shoulder transmits force through the break.
Visible signs often include swelling and bruising over the fracture site. With a displaced midshaft fracture, you may see or feel a bump where the broken ends overlap or angle upward. In some cases, the sharp edge of a bone fragment pushes against the skin from underneath, creating a tented appearance. The shoulder on the injured side may droop forward and downward compared to the other side.
How It’s Diagnosed
A standard front-to-back (AP) X-ray that captures the full length of the collarbone, from the breastbone to the shoulder, is usually enough to confirm the fracture. If the degree of displacement isn’t clear on a standard view, a second X-ray taken at a 45-degree upward angle helps reveal how far apart the bone fragments have shifted. For fractures near the outer end, stress views, taken while gently pulling down on the arm, can show whether the ligaments are also damaged. Imaging of the shoulder blade and upper arm bone is typically included to check for associated injuries.
Nonsurgical Treatment
Most clavicle fractures heal without surgery. The standard approach is immobilization with a simple arm sling, pain management, and gradual return to movement. You may have heard of figure-of-eight bandages, which wrap around both shoulders to pull them back. A clinical trial comparing the two approaches found that a standard arm sling produced significantly less pain in the first four weeks, better early function scores, and a lower rate of malunion (the bone healing in a suboptimal position). At two-year follow-up, patients treated with a sling still had slightly better functional outcomes. The sling is also easier to put on and take off, which matters when you’re doing it one-handed.
Healing time depends on age. Children’s collarbones typically knit back together in 3 to 6 weeks. Adults usually need 6 to 12 weeks before the bone is solidly united. During that time, you’ll likely transition from full-time sling use to part-time use as pain allows.
When Surgery Is Needed
Surgery is considered when the fracture fragments are significantly displaced, meaning the broken ends have shifted far apart or are no longer aligned. Other situations that push toward surgical repair include bone fragments threatening to break through the skin (called “open” or near-open fractures), fractures with significant shortening of the collarbone, and injuries where the nerves or blood vessels behind the bone are compromised. Fractures at the outer end of the clavicle that involve torn stabilizing ligaments also tend to do better with surgical fixation.
The procedure typically involves realigning the bone and securing it with a plate and screws along the top or front of the clavicle. Some surgeons use a rod placed inside the bone’s canal instead. The hardware usually stays in permanently, though it can be removed later if it causes irritation under the skin.
Rehabilitation After a Clavicle Fracture
Recovery follows a predictable progression that balances bone healing with preventing shoulder stiffness. In the first two weeks, the focus is on rest and very gentle movement. Pendulum exercises, where you lean forward and let the arm swing in small circles using gravity, begin almost immediately. Assisted bicep curls are also introduced, but no overhead motion is allowed in the first week.
From weeks two through six, the range of motion window opens gradually. Gentle passive movement above shoulder level starts, then progresses to you actively moving your own arm through increasing ranges. Around week four, light isometric exercises (contracting muscles without moving the joint) begin. By week five, gentle resistance band work is added.
From weeks six through twelve, actual strengthening begins in earnest, progressing to higher weights as the bone solidifies. Most people return to desk work within a few weeks, light physical activity by six to eight weeks, and full contact sports or heavy labor by three to four months, depending on how the bone is healing on follow-up X-rays.
Complications to Watch For
The most significant complication is nonunion, where the bone fails to heal. In displaced midshaft fractures treated without surgery, roughly 19% develop nonunion. Two factors independently raise that risk: smoking and increasing age. Smokers have about 2.5 times the odds of nonunion compared to nonsmokers, making this one of the clearest situations where quitting or pausing tobacco use directly affects bone healing.
Malunion, where the bone heals but in a shortened or angled position, is more common and usually less problematic. Many people with mild malunion have no functional limitations, though some notice a persistent bump or mild weakness with overhead activities. Other potential complications include hardware irritation after surgery, stiffness from prolonged immobilization, and, rarely, injury to the nerves or blood vessels running beneath the bone.