Pain in the collarbone
Pain in the collarbone is a specific unpleasant sensation in the area of the upper arm caused by the pathology of the collarbone itself, surrounding soft tissues, distant organs. It can be acute, dull, constant, periodic, aching, aching, 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. Before the diagnosis is made, rest is recommended, sometimes taking painkillers, applying gels, ointments is acceptable.
Causes of pain in the collarbone
Traumatic injuries
Degenerative processes
Inflammatory diseases
Oncological lesions
Neurological pathologies
Other reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of pain in the collarbone
Traumatic injuries
Bruising of the clavicle area usually occurs with a direct blow to the upper arm, manifested by moderate, gradually subsiding pain. The upper arm 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.
A fracture of the collarbone in adults develops when hitting the area of the upper arm, 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 movements it increases, which forces the patient to support the sick hand with a healthy one. The upper arm is edematous, deformed. In some patients, the protruding end of the fragment is visible under the skin or will stand out of the wound. The shoulder is lowered, shifted forward and inward.
In children, the collarbone breaks like a “green branch”, the fragments are interconnected by the periosteum, the pain is usually indistinct, reminiscent of a pain syndrome with a bruise. There is a slight or moderate restriction of movements. The presence of a fracture is indicated by the deformation of the upper arm, 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 moment of injury, sometimes in combination with a click. With dislocation of the acromial end of the clavicle, the maximum soreness is determined just above the shoulder joint. The upper arm is deformed, the end of the clavicle stands up and back, easily returns to place when pressed, but shifts again when the pressure stops.
When the sternal end of the clavicle is dislocated, the patient complains of pain in the lower part of the neck on the left or right. The end of the bone is shifted upwards, anteriorly or behind the sternum. In the first two cases, its persistence is noted, in the last – a trap. The movements of patients with all types of dislocations of the collarbone are limited, but possible.
Degenerative processes
Pain syndrome in the distal part of the clavicle may be caused by arthrosis of the acromioclavicular joint. At stage 1, the pain is weak, dull appears only when lifting the hand up, sometimes accompanied by a click. At stage 2, the pain becomes more intense, aching, disturbing with habitual movements. At stage 3, movement is significantly limited, the pain is constant, the ability to work is reduced.
Pain in the proximal part of the clavicle is caused by osteoarthritis of the sternoclavicular joint. At first, they are noted only with sudden movements. Then they are provoked by daily activity, they increase with deep breaths, but the clinical picture remains less pronounced than with the involvement of the acromioclavicular joint.
The clavicle is often affected by deforming osteitis. Pathology is manifested by continuous dull aching pain, which increases at rest, after rest. The collarbone increases in volume, the upper arm is deformed. Fractures are possible. Nerve compression is accompanied by neurological symptoms, with the involvement of a nearby joint, an arthrosis clinic is revealed.
Inflammatory diseases
The most common inflammatory cause of pain in the collarbone is myositis. It occurs with viral and parasitic infections, after injuries, and with some systemic diseases. It is characterized by moderate aching pain during palpation and movements, muscle weakness. The affected muscle is compacted. Minor local hyperemia, subfebrility are possible.
Purulent periostitis of the clavicle is diagnosed quite rarely, manifested by severe pain, which increases for several days, becomes twitching, pulsating, bursting, deprives of night sleep. The upper arm 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 movements. Local signs of inflammation are detected. There are chills, fever, sharp weakness. Less often, 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 as quickly, the pain syndrome is less pronounced, 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 in nature, formed when infection spreads from nearby osteomyelitic foci. They are manifested by acute twitching pains, which increase with movements. The joint area is swollen, hyperemic, and the local temperature is elevated. There is a general hyperthermia.
Psoriatic arthritis of the sternoclavicular and acromioclavicular joints occurs infrequently, combined with damage to other joints (more often – knee, shoulder, small joints of the hands). Perhaps a gradual onset with increasing arthralgias, which reach a maximum in the night and morning hours, decrease with movements. The pain is dull, aching, pulling. Less often there is an acute onset with intense pain syndrome.
Oncological lesions
Among the benign neoplasms of the clavicle, chondromes, osteochondromes are more often detected, rarely – chondroblastomas. Neoplasia can be asymptomatic for a long time. With an increase in the tumor, the patient is concerned about short-term indefinite pain in the collarbone, which increases with the growth of the formation. When the tumor squeezes nearby nerves and vessels, neurological symptoms may appear, the development of trophic disorders.
Primary malignant neoplasia, metastatic lesions of the clavicle are rarely diagnosed. They are manifested by rapidly increasing pains, which increase after physical exertion, during the night period. Over time, the pain syndrome becomes excruciating, unbearable, eliminated only by taking narcotic analgesics. Weakness, weight loss, fatigue, anemia, hyperthermia are noted.
Neurological pathologies
Pain in the projection of the clavicle is quite typical for cervical osteochondrosis, disc herniation, spondyloarthrosis, and other neurological pathologies accompanied by compression of nerve roots. The pain is pulling, shooting, burning, spreads from the neck to the shoulder, often radiates into the arm. It increases with head turns, hand movements. It can be combined with dizziness, impaired limb sensitivity.
Ladder muscle syndrome occurs with osteochondrosis, posture disorders, injuries, intensive strength sports, constant stay in an uncomfortable static position. Usually manifests acutely intense pain in the neck and upper arm, radiating into the shoulder. The pain increases with movements of the head and limb, deep breathing. The strength of the limb muscles is reduced, circulatory disorders are detected.
Shoulder plexitis, which develops against the background of injuries, infectious, dysmetabolic diseases, is characterized by aching, drilling, aching, shooting pain in the clavicle area, spreading throughout the limb. Pain syndrome increases at night, during periods of motor activity, combined with limb weakness, sensory and trophic disorders.
With scapular-rib syndrome, a cerebral aching pain appears in the scapula area, then spreads to the collarbone, radiates into the neck, shoulder joint, less often – the chest. Painful sensations increase with changes in the weather, movements. Sometimes the pain syndrome reaches a high intensity, limits the ability to work, the ability to self-care.
Pain in the upper arm is observed with a cervical rib, accompanied by compression of nerve trunks. They have a shooting, stabbing character, occur or increase with physical exertion, sudden movements in the shoulder joint and neck, head turns, lifting of the arm. Soreness in the collarbone is combined with pain in the forearm, sometimes in the shoulder, neck, head. There are violations of the sensitivity of the limb.
Other reasons
Pain in the collarbone in diseases of the internal organs is caused by irritation of the diaphragmatic nerve. Taking into account the location of the pathological focus , there are:
Pain on the right or left: focal or croup pneumonia, pleurisy, subdiaphragmatic abscess, bleeding into the abdominal cavity, tumors of the diaphragm.
Pain in the left upper arm: angina pectoris, myocardial infarction, pancreatitis.
Pain in the right upper arm: biliary dyskinesia, cholecystitis, hepatic colic, biliary peritonitis, viral hepatitis.
Painful sensations in the collarbone, nearby tissues can be observed in mental disorders, depression. Sometimes a rapidly transient pain syndrome is provoked by excessively intense training, carrying weights in your hand or in a bag slung over your shoulder.
Diagnostics
The diagnosis is made by an orthopedic traumatologist. In case of neurological causes of pain, diagnosis is carried out by a neurologist, in case of somatic pathology, the examination is carried out by doctors of the relevant specialties. The following diagnostic procedures are prescribed:
Radiography of the clavicle. A basic study in the pathology of bones and joints. The images visualize fracture lines, displacement of articular surfaces in dislocations, violations of the structure and shape of bones in tumors, osteomyelitis, deforming osteitis, deformities, changes in the configuration of joints in arthrosis and psoriatic arthritis.
Ultrasound of soft tissues. It is performed to assess the condition of soft tissue structures surrounding the collarbone. It reveals signs of inflammation and degeneration, foci of calcification. When vessels are compressed, special ultrasound examinations may be performed.
CT and MRI of the clavicle. They are carried out to detail the nature, location and prevalence of pathological changes, to clarify the data obtained during other diagnostic manipulations, to choose the tactics of conservative or surgical treatment.
Neurological EFI. If the neurological etiology of the pain syndrome is suspected, patients are shown electromyography or electroneurography.
Laboratory tests. General and biochemical blood tests are prescribed to assess the general condition, identify signs of anemia, and the inflammatory process.
The list of studies for internal organ damage is determined individually. In case of pathological processes in the chest area, an ECG, radiography of the OGC, CT of the chest cavity organs are prescribed. In diseases of the hepatobiliary zone, ultrasound, MRI and CT of the liver and gallbladder are performed, tests to determine the level of bilirubin. With symptoms of other diseases of the OBP, ultrasound of the abdominal cavity is performed. If there are signs of intra-abdominal bleeding, diagnostic laparoscopy is performed.
Radiography. Fracture of the collarbone
Radiography. Fracture of the collarbone
Treatment
Help before diagnosis
In case of injuries to the collarbone, the arm is suspended on a kerchief bandage, cold is applied, an analgesic is given. With non-traumatic pathologies without signs of pronounced inflammation, the arm is provided with rest, painkillers and warming agents are applied to the affected area. The progression of pain, an increase in body temperature, the appearance of significant edema and hyperemia is a reason for immediate treatment to a specialist.
Conservative therapy
In case of fractures of the clavicle, reposition is carried out, in children the limb is fixed with Delbe rings, in adults – with a Dezo bandage. Patients with bruises and non-traumatic diseases are recommended to reduce the load on the limb. The variant of the protective regime 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 clavicle diseases, non–drug methods are widely used – massage, physical therapy. Shock wave therapy is considered a promising method. The following types of physiotherapy are used:
medicinal electrophoresis;
UHF;
magnetic therapy;
laser therapy;
ultrasound;
electrical stimulation.
The plan of drug therapy is made 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.
Surgical treatment
Most often, operations on the collarbone are performed during the treatment of injuries and their consequences. Depending on the type of damage carried out:
Osteosynthesis of the clavicle. In an emergency, it is indicated in case of damage or threat of damage to the neurovascular bundle by a bone fragment. It is planned when the reposition is ineffective, it is impossible to conservatively hold the fragments in the correct position.
Open reduction of dislocation. Dislocations of the collarbone are easily corrected, but they are poorly held, therefore they require surgical treatment. Taking into account the localization of dislocation, plastic surgery of the acromioclavicular or sternoclavicular articulation is performed.
Plastic surgery for a false clavicle joint. It is recommended in the absence of fusion of fragments. Fragments are fixed using a bone autograft.
In case of compression of vessels and nerves due to a congenital anomaly, resection of the cervical rib may be required. For other neurological causes of pain, neurosurgical interventions are performed in some cases. Tumors are excised or resected bone.
