Pain in the collarbone is a specific discomfort in the shoulder girdle, caused by the pathology of the collarbone itself, the surrounding soft tissues, and distant organs. It can be sharp, dull, constant, periodic, aching, breaking, stabbing, pressing, tearing. In some cases, there is a connection with weather conditions, exacerbation of chronic diseases, and other factors. To determine the cause of pain, radiography, CT, MRI, and other studies are prescribed. Until the diagnosis is established, rest is recommended, sometimes we can take painkillers, apply gels, ointments.
Bruising of the clavicle area usually occurs with a direct blow to the shoulder girdle, manifested by moderate, gradually subsiding pain. The shoulder girdle is slightly or moderately edematous, bruising is possible. Palpation is painful. The function of the limb may be somewhat limited due to increased pain during movement.
Fracture of the clavicle in adults develops when hitting the shoulder girdle area, falling on the shoulder, elbow, outstretched arm. Accompanied by a very sharp explosive pain, sometimes - a crunch. Subsequently, at rest, the pain subsides somewhat, with the slightest movement it intensifies, which forces the patient to keep the diseased arm healthy. The shoulder girdle is edematous, deformed. In some patients, the protruding end of the fragment is visible under the skin or protrudes from the wound. The shoulder is lowered, shifted forward and inward.
In children, the clavicle breaks like a "green branch", the fragments are interconnected by the periosteum, the pain is usually mild, reminiscent of a pain syndrome with a bruise. There is a slight or moderate limitation of movement. The presence of a fracture is evidenced by the deformation of the shoulder girdle, the bulging of the middle part of the clavicle in the form of an obtuse angle.
Dislocation of the collarbone is formed due to a fall on the arm, a direct blow. There is a sharp pain at the time of injury, sometimes in combination with a click. With dislocation of the acromial end of the clavicle, the maximum pain is determined just above the shoulder joint. The shoulder girdle is deformed, the end of the clavicle stands up and backwards, easily returns to its place when pressed, but again shifts when the pressure stops.
With a dislocation of the sternal end of the clavicle, the patient complains of pain in the lower part of the neck on the left or right. The end of the bone is displaced upward, anteriorly or behind the sternum. In the first two cases, its protrusion is noted, in the last - retraction. The movements of patients with all types of dislocations of the clavicle are limited, but possible.
Pain in the distal part of the clavicle may be due to arthrosis of the acromioclavicular joint. At stage 1, the pain is weak, dull appears only when the arm is raised up, sometimes accompanied by a click. At stage 2, the pain becomes more intense, aching, disturbing with habitual movements. At stage 3, movements are significantly limited, pain is constant, work capacity is reduced.
Pain in the proximal part of the clavicle is caused by arthrosis of the sternoclavicular joint. At first, they are noted only with sudden movements. Then they are provoked by daily activity, intensify with deep breaths, but the clinical picture remains less pronounced than with the involvement of the acromioclavicular joint.
The clavicle is often affected with deforming osteitis. Pathology is manifested by continuous dull aching pain, which intensifies at rest, after rest. The clavicle increases in volume, the shoulder girdle is deformed. Breaks are possible. Nerve compression is accompanied by neurological symptoms, with the involvement of a nearby joint, a clinic of arthrosis is revealed.
The most common inflammatory cause of pain in the collarbone is myositis. Occurs with viral and parasitic infections, after injuries, with some systemic diseases. It is characterized by moderate aching pain on palpation and movement, muscle weakness. The affected muscle is hardened. Minor local hyperemia, subfebrile condition are possible.
Purulent periostitis of the clavicle is diagnosed quite rarely, manifested by severe pain, which increases over several days, becomes twitching, pulsating, bursting, deprives a night's sleep. The shoulder girdle is edematous, hyperemic, palpation is painful, fluctuation can be determined during the formation of a purulent focus. Body temperature is elevated. Subsequently, pus breaks through the skin or spreads to the underlying bone with the development of osteomyelitis.
Hematogenous osteomyelitis is also rare. It is characterized by unbearable acute pain of a drilling, pulsating, twitching nature. The pain is so intense that the patient freezes in bed, avoiding any movement. There are local signs of inflammation. Chills, fever, severe weakness are observed. Less commonly, the pain is moderate, the condition remains close to satisfactory.
Post-traumatic and postoperative osteomyelitis of the clavicle occur with similar symptoms, but the purulent process does not develop so quickly, the pain syndrome is less pronounced, and progresses more slowly. Pathology occurs after open fractures, operations on the collarbone, accompanied by the appearance of purulent discharge from the wound, deterioration of the general condition.
Arthritis of the acromioclavicular and sternoclavicular joints are more often purulent, formed during the spread of infection from nearby osteomyelitic foci. Manifested by sharp jerking pains, aggravated by movement. The joint area is edematous, hyperemic, local temperature is increased. There is general hyperthermia.
Psoriatic arthritis of the sternoclavicular and acromioclavicular joints is rare, combined with damage to other joints (more often - knee, shoulder, small joints of the hands). Perhaps a gradual onset with increasing arthralgia, which reaches a maximum at night and in the morning, decreases with movement. The pains are dull, aching, pulling. Less commonly, there is an acute onset with intense pain.
Among benign neoplasms of the clavicle, chondromas, osteochondromas are more often detected, rarely chondroblastomas. Neoplasia can be asymptomatic for a long time. With an increase in the tumor, the patient is disturbed by short-term, indefinite pain in the collarbone, which increases with the growth of the formation. When the tumor compresses nearby nerves and vessels, neurological symptoms may appear, and trophic disorders may develop.
Primary malignant neoplasia, metastatic lesions of the clavicle are rarely diagnosed. They are manifested by rapidly growing pains, aggravated after physical exertion, at night. Over time, the pain syndrome becomes painful, unbearable, it is eliminated only by taking narcotic analgesics. Weakness, weight loss, increased fatigue, anemia, hyperthermia are noted.
Pain in the projection of the clavicle is quite typical for cervical osteochondrosis, disc herniation, spondylarthrosis, and other neurological pathologies accompanied by compression of the nerve roots. The pain is drawing, shooting, burning, extending from the neck to the shoulder, often radiating to the arm. It is aggravated by turning the head, moving the hand. It can be combined with dizziness, impaired sensitivity of the limb.
Lane muscle syndrome occurs with osteochondrosis, posture disorders, injuries, intensive strength sports, constant stay in an uncomfortable static position. Usually manifests as acutely intense pain in the neck and shoulder girdle, radiating to the shoulder. The pain is aggravated by movements of the head and limb, a deep breath. The strength of the muscles of the limb is reduced, circulatory disorders are detected.
Shoulder plexitis, which develops against the background of injuries, infectious, dysmetabolic diseases, is characterized by bursting, boring, aching, shooting pain in the clavicle area, spreading throughout the limb. The pain syndrome intensifies at night, during periods of physical activity, is combined with limb weakness, sensory and trophic disorders.
With scapular-costal syndrome, aching pain appears in the scapula, then spreads to the collarbone, radiates to the neck, shoulder joint, and less often to the chest. Painful sensations are aggravated by changes in the weather, movements. Sometimes the pain syndrome reaches a high intensity, limits the ability to work, the ability to self-service.
Pain in the shoulder girdle is observed with the cervical rib, accompanied by compression of the nerve trunks. They have a shooting, stabbing character, they arise or intensify with physical exertion, sudden movements in the shoulder joint and neck, turning the head, raising the arm. Soreness in the collarbone is combined with pain in the forearm, sometimes in the shoulder, neck, and head. There are violations of the sensitivity of the limb.
Pain in the collarbone in diseases of the internal organs due to irritation of the phrenic nerve. Taking into account the location of the pathological focus, there are:
Pain in the collarbone, nearby tissues can be observed with mental disorders, depression. Sometimes a quickly transient pain syndrome is provoked by excessively intense training, carrying weights in the arm or in a bag slung over the shoulder.
The diagnosis is established by an orthopedic traumatologist. With neurological causes of pain, the diagnosis is carried out by a neurologist, with somatic pathology, the examination is carried out by doctors of the relevant specialties. The following diagnostic procedures are prescribed:
The list of studies for damage to internal organs is determined individually. In case of pathological processes in the chest area, an ECG, chest X-ray, and CT of the chest organs are prescribed. In diseases of the hepatobiliary zone, ultrasound, MRI and CT of the liver and gallbladder are performed, as well as tests to determine the level of bilirubin. With symptoms of other diseases of OBP, ultrasound of the abdominal organs is performed. With signs of intra-abdominal bleeding, diagnostic laparoscopy is performed.
Radiography. Clavicle fracture
In case of clavicle injuries, the hand is hung on a scarf bandage, cold is applied, and an analgesic is given. In case of non-traumatic pathologies without signs of pronounced inflammation, the hand is provided with rest, painkillers and warming agents are applied to the diseased area. The progression of pain, an increase in body temperature, the appearance of significant edema and hyperemia is a reason for an immediate visit to a specialist.
In case of fractures of the clavicle, reposition is carried out, in children the limb is fixed with Delbe rings, in adults with a Deso bandage. Patients with bruises and non-traumatic diseases are advised to reduce the load on the limb. The variant of the protective regimen is chosen taking into account the type of pathology, complete rest is recommended only during periods of exacerbations, the rest of the time it is advised to maintain sufficient motor activity to avoid atrophy and the development of contractures.
In the treatment of diseases of the clavicle, non-drug methods are widely used - massage, physiotherapy exercises. Shock wave therapy is considered a promising method. The following types of physiotherapy are used:
The plan of drug therapy is drawn up taking into account the characteristics of the disease. In infectious processes, antibiotic therapy is required. In chronic inflammatory and degenerative diseases, NSAIDs of general and local action are prescribed, blockades with corticosteroid drugs are performed.
Most often, operations on the collarbone are performed during the treatment of injuries and their consequences. Depending on the type of damage carried out:
With compression of blood vessels and nerves due to a congenital anomaly, resection of the cervical rib may be required. For other neurological causes of pain, in some cases, neurosurgical interventions are performed. Tumors are excised or the bone is resected.