Not Your Ordinary Clavicle Pain

A 20-year-old male with no significant past medical history presents to the emergency department with pain over his right clavicle with activity. He was wrestling with friends four months ago when he was thrown down landing directly on his right shoulder. He notices pain, especially when he does push-ups, lifts his arm over his head, and while lying on his right side. He has no pain at rest. He has no numbness or tingling in his arm. He works in the trades industry and has continued to lift heavy objects while working since his injury. He has not tried immobilizing his arm. His pain has been improving over the past four months, but he notices his clavicle protrudes more compared to the left. Physical exam reveals, prominence of the right clavicle at the sternoclavicular (SC) joint. It is not tender to palpation. There is no overlying redness or fluctuance. He has full pain-free range of motion at the right shoulder. The clavicle at the SC joint is noted to become more prominent with lifting his arm over his head. Sensation is intact throughout the right upper extremity. He has 2+ radial pulses. Breath sounds clear in all lung fields. X-rays did not reveal a clavicle fracture, but were unable to visualize a potential SC dislocation. CT scan of the clavicle revealed an incomplete intra-articular fracture involving the medial aspect of the right clavicle without evidence of dislocation of SC joint. The patient was diagnosed with a closed non-displaced fracture of right medial clavicle. He was discharged from the ED with a sling and recommended to take ibuprofen as needed for pain. He was provided a referral to follow up in the sports medicine clinic.The patient left the state for work and did not have a chance to follow up with sports medicine. During a follow up phone discussion with the patient a few months after his ED visit, the patient stated his pain had completely resolved. He wore his sling for 3-4 weeks. He is back to work lifting heavy objects during trade jobs. He is slowly returning back to weight lifting and sports. This case reveals a rare presentation of an uncommon injury. The patient did not present for medical treatment until four months after his injury. The patient’s presentation may represent delayed healing due to the failure of initial immobilization.https://scholarlycommons.henryford.com/merf2019caserpt/1025/thumbnail.jp