# The Collar Bone Thread.



## Globalti (14 Mar 2019)

So you're sitting at home with a broken collar bone, depressed, in pain, anxious to learn as much as possible about it. Here are some links to recent posts. Feel free to add your own.

Glasgow Cyclist's accident of 27 Feb 2019: https://www.cyclechat.net/threads/just-back-from-a-e.246242/

DJR's thread of 1 May 2017: https://www.cyclechat.net/threads/broken-collarbone-real-world-recovery.217725/ 

My own thread about non-union: https://www.cyclechat.net/threads/anybody-had-a-broken-collar-bone-that-wouldnt-knit.241484/


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## Levo-Lon (14 Mar 2019)

What amazes me is a moto gp rider does one and after a week or less there racing again. 

So what is happening to average Joe?
Is it purely money?
I've not done a clavicle but had a good few fractured bones. 
My brother did his and was in agony for a fortnight.. And had a big horrible lump where it rehealed


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## Globalti (14 Mar 2019)

The first consultant I saw said exactly the same thing; motorcyclists and especially racers come in demanding to be plated and are back on their bikes in a ridiculously short time. I was relieved to get my non-union plated but I certainly didn't feel like riding a bike for at least three months afterwards!


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## Sharky (14 Mar 2019)

As a double collar bone breaker (both sides on separate occasions), recovery can't be rushed, but in 2 or 3 months back on the bike. But it doesn't come close to fracturing a pelvis in terms of pain and recovery.


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## Mo1959 (14 Mar 2019)

Globalti said:


> The first consultant I saw said exactly the same thing; motorcyclists and especially racers come in demanding to be plated and are back on their bikes in a ridiculously short time. I was relieved to get my non-union plated but I certainly didn't feel like riding a bike for at least three months afterwards!


Surgeon wouldn’t let me anyway. No point risking it. I wore my sling for his recommended time and did my exercises and it eventually started to improve after several weeks. Never give it much thought now apart from being slightly apprehensive about ever landing on it again.


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## Chappy (14 Mar 2019)

I had a clean break (no bulging) so they didn't operate. However it has been over 4 months now and it still hasn't healed fully. Had a further x-ray they confirm its healing just slowly, however they did consider a CT scan in 4 months if this still ongoing.


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## ColinJ (14 Mar 2019)

I _think _that I broke a collar bone when I was 13 years old but I didn't go to hospital (despite being in severe pain) so I can't be sure. I made a DIY sling to immobilise the arm and it stopped hurting after a couple of months or so.


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## Globalti (14 Mar 2019)

Chappy said:


> I had a clean break (no bulging) so they didn't operate. However it has been over 4 months now and it still hasn't healed fully. Had a further x-ray they confirm its healing just slowly, however they did consider a CT scan in 4 months if this still ongoing.



If it never heals fully and just forms a gristly pseudo-joint they will consider it sorted because the prevailing attitude is that surgery must be avoided if possible. My first consultant kept talking about an amateur racer he knows who has this and manages to ride and compete just fine. 

Not for me though, having a non-union was uncomfortable and distressing.


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## DCBassman (14 Mar 2019)

Chappy said:


> I had a clean break (no bulging) so they didn't operate. However it has been over 4 months now and it still hasn't healed fully. Had a further x-ray they confirm its healing just slowly, however they did consider a CT scan in 4 months if this still ongoing.


Time to lean on someone. With the other arm, natch...

Seriously though, that's not the way it should be left.


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## Chappy (15 Mar 2019)

DCBassman said:


> Time to lean on someone. With the other arm, natch...
> 
> Seriously though, that's not the way it should be left.



Luckily I have been seeing a really good Physio. She told me to go back see the doc again after a further x-ray. There is no pain anymore and I am riding fine, its just now and again I get for lack of a better word a crunchy feeling on the bone if I roll over in the night. Apparently its where the bone is taking its time to knit together properly.


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## Globalti (15 Mar 2019)

If it's crunching, the bone isn't knitting. The ends have given up trying and you have non-union. This was mine after three months, you can see that the bone ends had rounded off:







Non-union is not necessarily bad, plenty of people live with it. The other structures of your shoulder are holding the shoulder blade and hence the humerus more or less in its proper place.


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## HLaB (17 Mar 2019)

I've never broke a bone as far as I know. However a friend of mine (a London based doctor) thinks I might have done so in the past


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## Chappy (18 Mar 2019)

Globalti said:


> If it's crunching, the bone isn't knitting. The ends have given up trying and you have non-union. This was mine after three months, you can see that the bone ends had rounded off:
> 
> View attachment 457543
> 
> ...



What did your doctor say the solution was with this.


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## fossyant (18 Mar 2019)

Chappy said:


> What did your doctor say the solution was with this.



Metalwork !!

To be frank, where possible, you are best not having additional surgery, unless needed, that's why they prefer not to operate. I don't regret not having metalwork in my back - risks were too high.


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## Globalti (18 Mar 2019)

Chappy said:


> What did your doctor say the solution was with this.



The surgeon has to persuade the bone to re-start the healing process, which, as far as I understand, means getting it to bleed again and form a clot, which slowly transforms into a callus and thence to new bone. This means roughing up the bone ends, chopping up some of the inside of the bone and packing that and synthetic bone chips into and around the repair. My experience of three months of non-union says that if I ever break a collar bone again I will insist on plating while everything is fresh and while I'm recovering from the original crash.

So far I've had 3 months of recovery with non-union, 4 months of recovery with a plate and from 8 April I'm facing another 3 months of recovery from the capsule release for the frozen shoulder. This might have been reduced to just 3 months if it had been plated immediately.


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## Mo1959 (18 Mar 2019)

Globalti said:


> My experience of three months of non-union says that if I ever break a collar bone again I will insist on plating while everything is fresh and while I'm recovering from the original crash.


My surgeon left it up to me, but his assistant who I also spoke to said if it was his collar bone he would definitely want it plated. Glad I did now.


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## Chappy (18 Mar 2019)

Globalti said:


> The surgeon has to persuade the bone to re-start the healing process, which, as far as I understand, means getting it to bleed again and form a clot, which slowly transforms into a callus and thence to new bone. This means roughing up the bone ends, chopping up some of the inside of the bone and packing that and synthetic bone chips into and around the repair. My experience of three months of non-union says that if I ever break a collar bone again I will insist on plating while everything is fresh and while I'm recovering from the original crash.
> 
> So far I've had 3 months recovery with non-union, 4 months of recovery with a plate and from 8 April I'm facing another 3 months of recovery from the capsule release for the frozen shoulder. This might have been reduced to just 3 months if it had been plated immediately.




Cheers for the info, the specialist does not want to operate at all. If it continues for longer he did talk about a CT scan which may lead to surgery. And if happens again and the bone breaks I will insist on a plate.

I am worried that it will be weaker because it may not have knitted.


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## Globalti (18 Mar 2019)

As I've explained, surgeons are rightfully reluctant to operate as there's a good chance it will heal naturally but I think an assessment needs to be made within a month:

1 - Will this heal at all without plating?

2 - If it heals overlapping, will the patient be left with a narrower shoulder and permanent squashed armpit and muscle pain and imbalance?


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## Colin_P (20 Mar 2019)

1986, day *one *of what was the last six week summer school holiday, the next summer I left school.

Came off the bike, a twelve speed Peugeot racer, at speed. Thankfully knocked out but skinned parts of my head, shoulder and snapped my collar bone clean in half.

Back then, they seemingly had no interest in re-setting it into a straight line or as near to what it should look like. Instead I was packed off home and spent a miserable few weeks of the school summer hols whilst it was really raw. After a few weeks it had started to stabilise / knit so I could do a few things but it was horrible. I vividly recall the bones jarring and grinding against each other even with something as benign as gentle breathing.

It mended with the step in it and as a result my right shoulder is about 15mm closer to my neck than the left, but is apparently stronger than a bog standard collar bone.

Do they set or wire them these days?


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## Colin_P (20 Mar 2019)

I've liked a lot of post on this thread.

I don't actually like them but feel the pain!


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## Sharky (20 Mar 2019)

Colin_P said:


> I've liked a lot of post on this thread.
> 
> I don't actually like them but feel the pain!


snap


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## Globalti (20 Mar 2019)

Colin_P said:


> 1986, day *one *of what was the last six week summer school holiday, the next summer I left school.
> 
> Came off the bike, a twelve speed Peugeot racer, at speed. Thankfully knocked out but skinned parts of my head, shoulder and snapped my collar bone clean in half.
> 
> ...



They use plates and sometimes internal pins and sometimes wire, from what I've seen on YouTube. Because the bone is under compression it has to be stabilised.


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## Mo1959 (20 Mar 2019)

Colin_P said:


> Do they set or wire them these days?


I've got a plate and 8 screws in mine. Was a bad break and was actually in 3 bits with a jagged bit in the middle.


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## Globalti (20 Mar 2019)

The collar bone fulfils a role very similar to that of a suspension strut on a car, it holds the shoulder blade in the correct position and the humerus hangs off the end of the shoulder blade. Normally the shoulder joint allows a very wide range of movement but beyond a certain point and for whole-shoulder movements the shoulder blade actually floats around between layers of muscle on the back. It's a much more complex and interesting joint than the hip. If the collar bone breaks muscle tension pulls the shoulder inwards causing the ends to overlap, but they can't be plastered like a limb so you have to wear a sling and hope the ends will find each other and stick together.


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## Globalti (28 Mar 2019)

Well I saw the physio this morning and he measured my grip strength with a dial gauge. The average for a bloke aged 50 is 73 lbs pressure and I'm almost 63 so I'm pleased to see that I'm squeezing 102 lbs with the uninjured side (left) and my right has doubled from 32 lbs a month ago to 64 lbs today, so there's progress. 

My shoulder feels better but arm lift is still limited to shoulder height. I'm not looking forward to the capsule release op on 8 April.


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## glasgowcyclist (28 Mar 2019)

Colin_P said:


> Do they set or wire them these days?



In my case they have used a clavicular hook plate like the one in this diagram, because the break was so close to the end of the shaft. (Mine is for my left side, diagram shows right)







In x-ray it loks like this. This isn't my own x-ray but is close enough.





They'll be removing it in just over two months.


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## ColinJ (28 Mar 2019)

Globalti said:


> Well I saw the physio this morning and he measured my grip strength with a dial gauge. The average for a bloke aged 50 is 73 lbs pressure and I'm almost 63 so I'm pleased to see that I'm squeezing 102 lbs with the uninjured side (left) and my right has doubled from 32 lbs a month ago to 64 lbs today, so there's progress.
> 
> My shoulder feels better but arm lift is still limited to shoulder height. I'm not looking forward to the capsule release op on 8 April.


That sounds impressive! Is that a hangover from your rock climbing days?

My upper body is pretty weedy for a man of my size. I don't want to bulk up but I think I need to do more upper body exercise. My upper body gets more tired on long rides than my legs do ...


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## Globalti (28 Mar 2019)

GC, that's pretty cool, cooler than my plate and six screws. I can see how it has the potential to hurt a lot more because the outboard end is just floating, bearing on the underneath of the acromium.


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## benborp (29 Mar 2019)

glasgowcyclist said:


> In my case they have used a clavicular hook plate like the one in this diagram, because the break was so close to the end of the shaft. (Mine is for my left side, diagram shows right)
> 
> View attachment 459617
> 
> ...



Ah, that's what I should have had. Apparently it severely limits movement while it's in place and takes quite a while to rehabilitate afterwards. I can't recommend the eventual alternative of having the acromion and broken collarbone removed. Although with new materials that are now used, the rehabilitation should be complete before the artificial ligaments are due for replacement unlike in my case.


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## Globalti (7 Apr 2019)

25 sunny miles yesterday and the biggest annoyance was the weakness of the muscles that support me on the bike: the shoulders and the triceps were feeling pretty tired by the time I'd done 15 miles.

Got the shoulder capsule release op tomorrow, following which rehabilitation has to start properly.


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## philk56 (7 Apr 2019)

I did mine almost exactly five years ago. I didn't have any surgery, just a sling. It took me almost two months to get back on the bike and another couple of months before I had anything like full movement. It didn't knit completely so I still have a lump but it doesn't bother me most of the time.


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## Katherine (7 Apr 2019)

Globalti said:


> 25 sunny miles yesterday and the biggest annoyance was the weakness of the muscles that support me on the bike: the shoulders and the triceps were feeling pretty tired by the time I'd done 15 miles.
> 
> Got the shoulder capsule release op tomorrow, following which rehabilitation has to start properly.


Well for getting a ride in and best of luck for tomorrow.


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## Globalti (10 May 2019)

Just seen the sawbones and he was surprised at how well I've recovered. He'd been anticipating having to do a steroid injection but has discharged me instead. He said: "You don't look like the sort who sits around on the sofa all day"!

Back to driving, cycling tomorrow. Woohoo!


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## DCBassman (10 May 2019)

Globalti said:


> Just seen the sawbones and he was surprised at how well I've recovered. He'd been anticipating having to do a steroid injection but has discharged me instead. He said: "You don't look like the sort who sits around on the sofa all day"!
> 
> Back to driving, cycling tomorrow. Woohoo!


Excellent news!
Have been driving two weeks, cycling for one. Feels like the end of a punishment!


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## ColinJ (10 May 2019)

Globalti said:


> Just seen the sawbones and he was surprised at how well I've recovered. He'd been anticipating having to do a steroid injection but has discharged me instead. He said: "You don't look like the sort who sits around on the sofa all day"!
> 
> Back to driving,* cycling tomorrow*. Woohoo!


That's good news!

If you don't have other plans, you would be welcome to meet up with us at Spring Wood, Whalley around 10:00 for my Conder Green forum ride? We will be riding slowly and heading out via Cow Ark to the Trough of Bowland. Do as much or as little as you like!


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## Globalti (10 May 2019)

T'would be good, thanks, but Mrs Gti and I are planning to walk in Buttermere tomorrow. Hope the ride goes well, the weather will be fine.


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## ColinJ (10 May 2019)

Globalti said:


> T'would be good, thanks, but Mrs Gti and I are planning to walk in Buttermere tomorrow. Hope the ride goes well, the weather will be fine.


Sounds nice - have fun!

PS Don't forget to feed @potsy's dog - I think he left the poor animal tied to a lake shore tree!


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