Difference between collarbone and clavicle. Clavicle vs Collarbone: Understanding the Anatomy and Function of This Crucial Bone

03.07.197301.09.2021 by alexxlab

What is the difference between clavicle and collarbone. How does the clavicle contribute to shoulder function. What are the main anatomical features of the collarbone. Why is the clavicle prone to fractures. How does the clavicle connect to other bones in the body.

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The Clavicle: A Crucial Component of the Shoulder Girdle

The clavicle, commonly known as the collarbone, is a prominent bone located at the top of the chest, spanning between the shoulder and neck. This S-shaped bone plays a vital role in the human skeletal system, forming half of the shoulder girdle and connecting the upper limb to the trunk of the body.

Understanding the anatomy and function of the clavicle is essential for both medical professionals and individuals interested in human physiology. This article will delve into the intricacies of this unique bone, exploring its structure, function, and clinical relevance.

Anatomy of the Clavicle: A Closer Look at Its Structure

The clavicle is a slender, S-shaped bone with large double curves. It consists of three main parts:

Sternal (medial) end
Shaft
Acromial (lateral) end

The sternal end features a large facet that articulates with the manubrium of the sternum, forming the sternoclavicular joint (SC joint). On its inferior surface, there’s a rough oval depression for the attachment of the costoclavicular ligament.

The shaft serves as an origin point for several muscles, including:

Deltoid
Trapezius
Pectoralis major
Subclavius
Sternocleidomastoid
Sternohyoid

At the acromial end, a small facet articulates with the acromion of the scapula, forming the acromioclavicular joint. This end also provides attachment points for the conoid and trapezoid ligaments, which are parts of the coracoclavicular ligament.

The Functional Significance of the Clavicle

The clavicle performs three primary functions:

Attaching the upper limb to the trunk as part of the shoulder girdle
Transmitting forces from the upper limb to the axial skeleton
Protecting underlying neurovascular structures that supply the upper limb

These functions highlight the clavicle’s importance in shoulder mechanics and overall upper body movement. How does the clavicle contribute to shoulder stability? The clavicle acts as a strut, keeping the shoulder joint away from the body and allowing for a greater range of motion in the arm.

Clinical Relevance: Clavicle Fractures and Their Implications

The clavicle’s relative size and position make it susceptible to fractures. Common mechanisms of clavicle injury include:

Falls onto the shoulder
Falls onto an outstretched hand

After a fracture, the lateral end of the bone is typically displaced inferiorly due to the weight of the upper limb. Simultaneously, the medial end may be pulled superiorly by the sternocleidomastoid muscle.

Why are clavicle fractures so common? The clavicle’s horizontal orientation and its role in transmitting forces from the arm to the trunk make it particularly vulnerable to impact injuries. Additionally, its S-shaped curve creates natural weak points along its length.

Clavicle vs. Collarbone: Dispelling the Misconception

A common question that arises is: “What is the difference between clavicle and collarbone?” The answer is simple: there is no difference. “Clavicle” is the technical, anatomical term for the bone, while “collarbone” is the common, everyday name used to describe the same structure.

Both terms refer to the prominent bone on each side of the top of the chest, connecting the shoulder blade (scapula) to the breastbone (sternum). This understanding is crucial for clear communication between medical professionals and patients.

The Clavicle’s Role in the Shoulder Girdle

The clavicle is a key component of the shoulder girdle, also known as the pectoral girdle. This structure consists of:

Two clavicles (collarbones)
Two scapulae (shoulder blades)

Together, these bones form a ring-like structure that encircles the upper chest, providing attachment points for muscles and facilitating arm movement. How does the shoulder girdle enhance upper limb mobility? By creating a flexible connection between the arm and the trunk, the shoulder girdle allows for a wide range of motion in multiple planes.

Developmental Aspects of the Clavicle

The clavicle has unique developmental characteristics that set it apart from other long bones in the body:

It is the first bone to begin the ossification process during fetal development
It is one of the last bones to complete ossification, typically around age 25
It is the only long bone in the body that lies horizontally

These developmental features contribute to the clavicle’s distinct properties and its importance in skeletal maturation studies. Why does the clavicle ossify earlier than other bones? This early ossification is thought to be related to the bone’s critical role in supporting early arm movements in infants.

Evolutionary Significance of the Clavicle

From an evolutionary perspective, the clavicle plays a crucial role in primate locomotion and manipulation. Its presence allows for:

Greater range of motion in the shoulder joint
Enhanced ability to perform overhead arm movements
Improved capacity for tool use and manipulation

In humans, the clavicle’s shape and position have evolved to support our upright posture and the increased demands placed on our upper limbs for complex tasks. How has the human clavicle adapted compared to other primates? The human clavicle is generally longer and more S-shaped than in other primates, allowing for greater shoulder mobility and arm dexterity.

This evolutionary adaptation has played a significant role in human technological development and our ability to perform precise manipulations with our hands and arms.

Comparative Anatomy: Human Clavicle vs. Other Species

While the clavicle is present in many mammals, its form and function vary across species:

In quadrupedal mammals like dogs and cats, the clavicle is often reduced or absent
Bats and birds have highly specialized clavicles adapted for flight
Marsupials like kangaroos have well-developed clavicles to support their unique locomotion

These variations highlight the clavicle’s adaptability to different locomotor and functional demands across species. Why do some mammals lack a clavicle? In animals that primarily use their forelimbs for weight-bearing and forward motion, like horses, the clavicle has been lost through evolution as it’s not necessary for their mode of locomotion.

Imaging Techniques for Clavicle Assessment

Various imaging modalities are used to assess the clavicle in clinical settings:

X-rays: Standard for initial evaluation of suspected fractures
CT scans: Provide detailed 3D images, useful for complex fractures or surgical planning
MRI: Can reveal soft tissue injuries associated with clavicle trauma
Ultrasound: Used for pediatric patients to avoid radiation exposure

Each imaging technique offers unique advantages in diagnosing and managing clavicle-related conditions. How do clinicians choose the appropriate imaging method? The choice depends on factors such as the suspected injury type, patient age, and the need for detailed visualization of surrounding structures.

Innovative Approaches in Clavicle Fracture Treatment

While many clavicle fractures heal well with conservative management, some cases require surgical intervention. Recent advances in treatment include:

Minimally invasive plate osteosynthesis (MIPO)
3D-printed patient-specific implants
Biological augmentation techniques using stem cells or growth factors

These innovative approaches aim to improve outcomes and reduce recovery time for patients with complex clavicle fractures. How do these new treatments compare to traditional methods? Studies suggest that minimally invasive techniques may offer faster recovery and lower complication rates in certain patient populations, though long-term data is still being gathered.

The Clavicle’s Role in Upper Body Biomechanics

Understanding the clavicle’s role in upper body biomechanics is crucial for athletes, physical therapists, and anyone interested in optimizing upper body function. The clavicle contributes to:

Shoulder joint stability
Arm elevation and rotation
Force transmission between the arm and torso
Protection of underlying neurovascular structures

These functions highlight the clavicle’s importance in activities ranging from everyday tasks to high-performance athletics. How does clavicle function affect athletic performance? In sports requiring overhead arm movements, like swimming or tennis, proper clavicular mechanics are essential for maximizing power and preventing injury.

Clavicular Dysfunction and Its Impact on Movement

Dysfunction of the clavicle can lead to various movement impairments:

Reduced shoulder range of motion
Altered scapular kinematics
Impaired arm strength and control
Increased risk of shoulder impingement syndromes

Recognizing these potential issues is crucial for early intervention and prevention of chronic shoulder problems. How can clavicular dysfunction be addressed? Treatment often involves a combination of manual therapy, corrective exercises, and addressing any underlying postural or movement pattern issues.

The Clavicle in Art and Cultural Significance

Beyond its anatomical importance, the clavicle has cultural and artistic significance:

In many cultures, prominent collarbones are considered a sign of beauty
Artists often emphasize the clavicle in figurative works to convey elegance or frailty
Some cultures have traditions or beliefs specifically related to the collarbone

This cultural significance underscores the clavicle’s visibility and its role in human aesthetics. Why is the clavicle often associated with beauty? Its prominence and visibility make it a defining feature of the upper body, and its appearance can be influenced by factors like body composition and posture.

The Clavicle in Fashion and Body Modification

The visibility of the clavicle has made it a focus in fashion and body modification:

Necklines are often designed to highlight or conceal the collarbone
Some body modification practices involve decorating or altering the skin over the clavicle
Fitness trends sometimes focus on exercises to enhance the appearance of the collarbone area

These practices reflect the clavicle’s role in human aesthetics and self-expression. How do cultural perceptions of the clavicle vary globally? While some cultures celebrate prominent collarbones, others may have different aesthetic ideals, highlighting the diversity of human beauty standards.

In conclusion, the clavicle, or collarbone, is a fascinating and crucial component of human anatomy. Its unique structure, developmental characteristics, and functional significance make it an important subject of study in fields ranging from medicine to anthropology. Understanding the clavicle’s role in shoulder function, its vulnerability to injury, and its cultural significance provides valuable insights into human physiology, evolution, and aesthetics.

What is the Difference Between Clavicle and Collarbone

The clavicle is the bone which joins the shoulder blade and the breast bone. It is a horizontally located long bone, and collarbone refers to the same bone. Therefore, there is no difference between clavicle and collarbone.

There are two clavicles in the body: one in the left and the other on the right. They make up the shoulder girdle or pectoral girdle along with the shoulder blade, connecting to the arm or the upper limb on each side. Also, the location of the collarbone is touchable in people with less fat in their bodies.

Key Areas Covered

1. What is Clavicle
– Definition, Characteristics
2. What is Collarbone
– Definition, Anatomy, Function
3. What are the Similarities Between Clavicle and Collarbone
– Outline of Common Features
4. What is the Difference Between Clavicle and Collarbone
– Comparison of Key Differences

Key Terms

Clavicle, Collarbone, Scapula, Shoulder Girdle, Sternum

What is Clavicle

The clavicle is the technical term for the collarbone, which is the prominent bone at the top of the chest between the shoulder and the neck. The two clavicles form half of the shoulder girdle, encircling the upper chest like a collar. Therefore, they are also known as collarbones.

Figure 1: Clavicle – Superior View

What is Collarbone

Collarbone refers to either of the pairs of bones joining the breast bone to the shoulder blades.

Anatomy

The collarbone is a slender bone with the shape of an ‘S’. It consists of large double curves. The three parts of the collarbone are the sternal (medial) end, shaft, and the acromial (lateral) end. Moreover, there is a large facet in the sternal end of the bone. It articulates with the manubrium of the sternum or the breast bone, forming the sternoclavicular joint (SC joint). Also, another rough oval depression occurs in the inferior surface of the sternal end for the costoclavicular ligament, a ligament of the SC joint. The main function of the shaft of the collarbone is to serve as a point of origin for several muscles including deltoid, trapezius, pectoralis major, subclavius, sternocleidomastoid, and sternohyoid muscles.

Figure 2: Clavicle – Anatomy

Moreover, a small facet occurs at the end of the acromial end of the collarbone, articulating with the acromion of the scapula or the shoulder bone at the acromioclavicular joint. On the other hand, the acromial end provides attachment points for both conoid ligament and trapezoid line. The conoid tubercle is the attachment point for the conoid ligament while the trapezoid ligament is the attachment point for the trapezoid ligament. However, the conoid ligament is the medial part of the coracoclavicular ligament while the trapezoid ligament is the lateral part of the coracoclavicular ligament. Additionally, the coracoclavicular ligament is a strong structure responsible for the effective suspending of the weight of the upper limb through the collarbone.

Figure 3: Shoulder Girdle

Function

The collarbone performs three functions. They are the attachment of the upper limb to the trunk by being a part of the shoulder girdle; transmission of the forces from the upper limb to the axial skeleton, and protecting the underlying neurovascular structures supplying the upper limb.

Clinical Relevance

The relative size of the clavicle is responsible for its susceptibility to fracture. The fall onto the shoulder and onto an outstretched hand are the most common mechanisms of clavicle injury. Generally, after a fracture, the lateral end of the bone is displaced interiorly due to the weight of the upper limb. Also, the medial end of the bone can be pulled superiorly by the sternocleidomastoid muscle.

Similarities Between Clavicle and Collarbone

Clavicle and collarbone are two names used to describe the only horizontal long bone in the body.
Both occur in pairs.
Also, both join the shoulder blade and the breast bone.

Difference Between Clavicle and Collarbone

There is no difference between clavicle and collarbone. They are the prominent bones on each side of the top of the chest.

Conclusion

The clavicle is the bone joining the shoulder blade and the breast bone. A pair of clavicles occurs on each side of the chest. They are involved in the formation of the shoulder girdle, which connects the arms to the trunk of the body. However, collarbone is another term to the clavicle. Therefore, there is no significant difference between clavicle and collarbone.

References:

1. “The Clavicle.” TeachMeAnatomy, 7 Aug. 2018, Available Here.

Image Courtesy:

1. “Clavicle – superior view” By Anatomography – en:Anatomography (CC BY-SA 2.1 jp) via Commons Wikimedia
2. “Gray201” By Henry Vandyke Carter – Henry Gray (1918) Anatomy of the Human Body, Bartleby.com: Gray’s Anatomy, Plate 201 (Public Domain) via Commons Wikimedia
3. “Pectoral girdles-en” By Original by National Cancer Institute; SVG by Mysid – Vectorized in Inkscape by User:Mysid (Public Domain) via Commons Wikimedia

Guide to Shoulder Anatomy

The shoulder is a strong and flexible ball-and-socket joint that connects the arm to the torso, and it is considered one of the most mobile parts of body. It is responsible for:

Moving and rotating the upper arm
Overhead weight-bearing
Reaching behind the back

The shoulder is composed of a network of bones, joints, and soft tissues that make this large range of motion possible.

The most common shoulder injuries involve the muscles, ligaments, cartilage, and tendons, rather than the bones. Common shoulder injuries include rotator cuff tears, shoulder impingement, and dislocation. Athletes, such as tennis or football players, and people who work in occupations that require frequent, heavy, over-head lifting are most susceptible to shoulder injuries.

See Shoulder Dislocation Injury (Dislocated Shoulder)

Shoulder Bones

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The shoulder bones include the scapula (shoulder blade), humerus (upper arm bone), and clavicle (collarbone). The joints between these bones are flexible and allow for a wide range of motion.

The shoulder is made up of 3 bones:

The scapula (shoulder blade). The scapula is a large, flat, and somewhat triangular bone that sits between the humerus (upper arm bone) and collarbone. It is responsible for stabilizing the upper arm bone, which sits in a shallow socket on the outer edge of the shoulder blade.
See A Broken Shoulder: Scapula Fracture
The humerus. This is the bone of the upper arm. The top of the humerus is rounded and fits into the shallow socket of the scapula, called the glenoid cavity, creating the shoulder’s ball-and-socket joint. This ball-and-socket construction allows for the arm’s large range of motion.
See Proximal Humerus Fractures of the Shoulder
The clavicle (collarbone). The collarbone is a long and thin bone located between the shoulder and top of the ribcage. The collarbones help support and keep the arms in place when away from the body.
See Clavicle Fractures: Types and Symptoms

All 3 bones are susceptible to injury and trauma, including fractures and dislocations.

See The 3 Types of Shoulder Fractures

Joints of the Shoulder

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Four major shoulder joints help to achieve a complex range of motion: the glenohumeral joint, the acromioclavicular joint, the scapulothoracic joint, and the sternoclavicular joint.

Joints are where 2 or more bones meet. While the shoulder is often referred to as a singular joint, it is technically made up of 4 joints.

Two of these joints are more susceptible to injuries:

Glenohumeral joint. This joint is considered the main joint in the shoulder and is where the rounded top, or head, of the humerus (arm bone) nestles into the shallow, rounded socket of the scapula (shoulder blade) like a golf ball on a tee. The medical term for the shoulder socket is glenoid cavity. This ball-and-socket construction allows for circular movement of the arm.
Acromioclavicular joint (AC joint). The acromioclavicular joint is located where the clavicle (collarbone) glides along the acromion, located at the top of the shoulder blade. The AC joint is considered a gliding synovial joint, which means it allows the bones to move side-to-side, up and down, and diagonally. The acromioclavicular joint mainly helps facilitate raising the arm over the head.

The other 2 shoulder joints are less well-known and less likely to be injured:

Sternoclavicular joint. The sternoclavicular joint is where the clavicle (collarbone) meets the sternum (breastbone). It connects the upper arm to the rest of the body. The sternoclavicular joint is considered a gliding synovial joint and helps facilitate a number of shoulder movements, including shrugging, extending the arm behind the body, and moving the shoulders forward and backward.
Scapulothoracic joint. This joint is located where the scapula glides against the rib cage at the back of the body. Not everyone considers this area a joint because the bones are not attached by ligaments.

The shoulder is essential to arm movement and therefore critical to most everyday activities, such as driving and cooking. A healthy shoulder allows the arms to move up and down, side-to-side, forward and backward, and to perform reaching movements.

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Articular Cartilage in the Shoulder

Like all joints in the body, the shoulder joints’ bony surfaces are covered in articular cartilage. Articular cartilage is a slippery, strong, and flexible material. It has 2 functions:

Allows two bones to move or glide against one another. This means that, in a healthy shoulder, movement is smooth and pain free.
Cushions bones from impacting one another. Articular cartilage acts as a shock absorber during high impact activities, such as tennis or gymnastics.

Articular cartilage is often thinner in the shoulder than it is in weight-bearing joints, such as the knees and hips. When articular cartilage in the shoulder is damaged, it can significantly affect the shoulder’s ability to withstand friction and impact.

The damage and loss of articular cartilage is called osteoarthritis. The glenohumeral joint and acromioclavicular joint are susceptible to this and other types of arthritis.

See Acromioclavicular Joint Anatomy and Osteoarthritis and What Is Shoulder Osteoarthritis (Glenohumeral Arthritis)? on Arthritis-health

Nearby soft tissues, such as the rotator cuff, support the shoulder joints and are also susceptible to damage.

See How Do Rotator Cuff Injuries Occur?

Anatomy, Shoulder and Upper Limb, Clavicle – StatPearls

Introduction

The clavicle is a sigmoid-shaped long bone with a convex surface along its medial end when observed from cephalad position. It serves as a connection between the axial and appendicular skeleton in conjunction with the scapula, and each of these structures forms the pectoral girdle. [1] Though not as large as other supporting structures in the body, clavicular attachments allow for significant function and range of motion of the upper extremity as well as protection of neurovascular structures posteriorly. Each part of this long bone has a purpose in regards to its attachments that affects the overall physiology of the pectoral girdle.

Medially, the clavicle articulates with the manubrial portion of the sternum, forming the sternoclavicular joint (SC joint). This joint, surrounded by a fibrous capsule, contains an intra-articular disc in between the clavicle and the sternum. Superiorly, the interclavicular ligament connects the ipsilateral and contralateral clavicle, together providing further stability.[2]

Laterally, the clavicle articulates with the acromion, forming the acromioclavicular ligament (AC joint). The surrounding area provides an attachment for the joint capsule of the shoulder. This joint, like the SC joint, is also lined by fibrocartilage and contains an intra-articular disc. The three main ligaments to support this joint are the AC ligament, the coracoclavicular ligament (CC), and the coracoacromial ligament (CA).[3]

The actual shaft of the clavicle is clinically divided into two parts clinically: medial two-thirds and lateral third. These locations are used to properly identify where muscles are attached. The medial two-thirds has an attachment site for the sternocleidomastoid (SCM) muscle and subclavius muscle along the subclavian groove superiorly and inferiorly, respectively. The anterior surface is an attachment for the pectoralis major and the posterior for the sternohyoid muscle. The costal tuberosity, which is where the costoclavicular ligament inserts and supports the SC joint, is also found on the inferior surface.[4] The lateral third of the clavicle serves as attachments for the deltoid and trapezius muscles anteriorly and posteriorly, respectively. Inferiorly the conoid and trapezoid components of the CC ligament provide stability between the clavicle and the coracoid process of the scapula.

The clavicle happens to be one of the most commonly fractured bones in the human body; fracture can be as a result of direct contact or force transmission from falling onto an outstretched hand. Depending on the level of displacement of the fracture, surgery may be indicated, and proper management is determined on an individual basis due to differentiating factors surrounding such injury.

Structure and Function

Although small, the clavicle allows for optimal function of the upper extremity as well as protects the upper extremity by dispersing the amount of force transmitted from direct contact. The positioning of the clavicle also keeps the extremity far enough away from the thorax, allowing for the range of motion (ROM) of the shoulder to be unimpeded. Its strut-like mechanics allow the scapula to glide smoothly along the posterior wall which is critical for full upper extremity motion.[5] The anatomical location also protects neurovascular structures, including the brachial plexus, subclavian artery, and subclavian vein which, if disrupted, would greatly increase morbidity. [6]

Embryology

The clavicle, interestingly, is the first bone to begin ossification during embryologic development and is a derivative of the lateral mesoderm. The medial and lateral ends of the clavicle undergo different processes of ossification. The medial end undergoes formation via endochondral ossification. Endochondral ossification of a bony structure is preceded by a cartilaginous model constructed by chondrocytes before mineralization and ossification. The lateral end, on the contrary, forms via intramembranous ossification which constitutes woven bone formed directly without cartilage. In both cases, the structure is remodeled in a way that the result is lamellar bone. Despite being one of the first bones to begin ossification, it is one of the last to complete this process, and growth plates may not close until between the twentieth to twenty-fifth year of life.[7][8]

Blood Supply and Lymphatics

Although classified as a long bone, the clavicle (in most cases) does not have a medullary cavity like its long bone counterparts. Previous studies have shown periosteal arterial blood supply to the bony structure but no central nutrient artery (a.). The suprascapular a., thoracoacromial a., and the internal thoracic a. (mammalian a.) have all been found to provide arterial supply to the clavicle.[9]

Nerves

Controversy surrounds the primary sensory innervation of the clavicle. Anesthetizing studies following clavicular fracture have suggested there may be involvement individually or in a combination of the supraclavicular nerve (n.), subclavian n., and long thoracic/suprascapular n.[10] A common anatomical variation is a perforating branch of the supraclavicular n. that passes in the superior surface of the clavicle. Post-mortem studies have revealed insertion of the nerve in bony tunnels or grooves that would prove susceptible to injury and may explain entrapment neuropathy following clavicular fracture.[11]

Muscles

The clavicle has multiple attachments for musculature that should be considered anatomically.

Superior surface: The anterior deltoid originates on the anterior aspect and assists in flexion of the shoulder while one of the insertion sites for the trapezius muscle is located at the posterior aspect. The trapezius predominantly is responsible for stabilizing the scapula.[12]
inferior surface: The subclavius muscle resides in the subclavian groove of the clavicle and functions to depress the shoulder as well as pull the clavicle anteroinferiorly. The coracoacromial ligament is located laterally and provides support from the coracoid residing below. The medial component of the CA ligament is the conoid ligament which inserts onto the conoid tubercle, and the lateral component is the trapezoid ligament which inserts onto the trapezoid line.
Anterior surface: The clavicular part of the pectoralis major muscle originates from the medial clavicle anteriorly. The clavicular head contributes to flexion, horizontal adduction, and inward rotation of the humerus.
Posterior surface: As mentioned, the trapezius inserts posterosuperior on the clavicle. The clavicular head of the sternocleidomastoid (SCM) also has a similar location but is found along the medial third of the clavicle. The SCM, when contracting alone, causes the head to rotate to the opposite side and laterally side bend ipsilaterally. When both SCM contract, this causes head flexion.

The sternohyoid muscle has fibers originating inferomedially along the posterior surface of the clavicle in addition to the manubrium and posterior sternoclavicular ligament. Contraction of the sternohyoid causes hyoid bone depression.

Physiologic Variants

Compared to other long bones, the clavicle has shown to exhibit varying features. Thickness and length can both vary depending on the sex, with males having longer and thicker bone morphology than females. Males also have a greater degree of curvature in the bone compared to females. Cadaveric studies also revealed left clavicles were substantially longer than the contralateral. [13] A rare, but clinically relevant genetic disease, cleidocranial dysplasia, can present with absent or partially absent clavicles bilaterally. Dental abnormalities, delayed fontanel closure, and cranial sutures that have failed to fuse are other features that can be present in this disease.[14]

Surgical Considerations

One of the most common fractures to occur is a clavicular fracture, more typically in the middle third of the bone. While most medial and lateral fractures can be managed non-operatively if they remain stable, mid-shaft fractures can potentially have a higher degree of displacement with an increased incidence of malunion or non-union. Depending on the displacement and possible shortening of the involved fragments, surgery may be warranted. Additionally, neurovascular compromise may also be an indication for operative management. Pediatric injury typically occurs in physeal regions of the clavicle, and due to the healing potential of these regions, non-operative treatment can be pursued. [15]

Operative management has shown to improve short-term functional outcomes; however, long-term shoulder function difference compared to non-operative management has proven unremarkable. Open reduction with internal fixation using plate and screws as well as intramedullary nails have been used to reduce these fractures.[16] Increased patient satisfaction and earlier return to physical activity have been seen with surgical management when compared to the non-operative approach. Cost-effectiveness was also surprisingly advantageous for operative patients. Current recommendations suggest a patient-tailored approach when considering surgery which may involve multiple parameters.[17]

Clinical Significance

The mid-clavicular line is a landmark on the clavicle that is used for multiple reasons. This landmark provides a general location for cardiac apex beat as well as appreciating the liver size. It also can be used to locate the gallbladder which is located between the mid-clavicular line and transpyloric plane. Accurate location assessment can vary, however, depending on the user.[18]

Clavicle fractures are responsible for 10% of all fractures and are the most acute of issues when dealing with injuries of the clavicle.[19] Depending on comminution, displacement, and shortening, surgery may be warranted. The level of superior displacement of the medial fragment seen in midshaft fractures may be due to SCM tension leading to further instability. The injury typically occurs due to trauma, such as falling directly on the shoulder laterally in 87% of cases. The injury also may be a result of falling outward onto an outstretched hand or due to contact directed medially onto the clavicle.[19]
AC joint (ACJ) dislocation is common in contact sports and represents 9% of all traumatic shoulder girdle injuries [20]. The joint injury can be appreciated via X-ray imaging and is classified into six types. The injury severity increases with injury type and is dependent on the amount of gapping between acromioclavicular articulation. [21]
Type I and II injuries are managed nonoperatively. The former manifest solely as ACJ tenderness but no instability. Type II injuries exhibit horizontal instability only, as the ACJ is disrupted and coracoclavicular distance is increased by less than 25% compared to the contralateral extremity.
Type III injuries are often managed nonoperatively as well, albeit slightly more controversial. For example, as surgical techniques have improved over the years, a survey of 28 Major League Baseball team orthopedic surgeons resulted in 72% (20/28) reporting nonoperative treatment as the preferred management modality [22]. Interestingly enough, the aforementioned study from 2018 closely echoed the previous classic report 20 years earlier from McFarland and colleagues, when 69% of team physicians reported favoring nonoperative management of type III AC separations [23]. Thirty years earlier, however, there was an overwhelming preference for treating acute, complete ACJ separation with surgical repair. A study from the 1970s by Powers and Bach consisted of a163 chairmen-survey of United States orthopedic programs, with 92% advocated for surgical treatment [24].
Type IV injuries through VI are typically managed with surgery. [25] Type IV consists of lateral clavicular posterior displacement through the trapezial fascia. Type V is an increase in CC distance greater than 100% compared to the contralateral. Type VI consists of inferior dislocation of the lateral clavicle (in the subacromial or subcoracoid positions)[25].
AC joint osteoarthritis has multiple etiologies including degenerative, posttraumatic, septic, and inflammatory arthritis. Being the most common disorder of the AC joint, it can be quite debilitating for patients in their daily activities, especially with overhead activity. Clinical management can consist of the use of anti-inflammatory medication, intra-articular injections, and physical therapy. If symptoms persist, some patients may be candidates for AC joint resection. [26]
SC joint injuries can also occur; however, they are less common. Anterior dislocations can occur with an anterolateral loading of the distal clavicle; posterior dislocations occur with posterolateral loading. An even less common mechanism of posterior SC joint dislocation can be due to significant posteriorly directed force to the medial head of the clavicle. Females with ligamentous laxity have a higher incidence of SC joint injuries and can also be associated with trapezius nerve palsy.[27]

Figure

Clavicle, Anterior surface. Articular capsule, Costal tuberosity, Subclavian groove, Articulating cartilage of First Rib, Articulation with Sternum, Deltoid, Tuberosity for Conoid Ligament, Acromion of Scapula, Trapezoid Ligament. Contributed by Gray’s (more…)

References

1.: Javed O, Maldonado KA, Ashmyan R. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 31, 2020. Anatomy, Shoulder and Upper Limb, Muscles. [PubMed: 29494017]
2.: Tubbs RS, Loukas M, Slappey JB, McEvoy WC, Linganna S, Shoja MM, Oakes WJ. Surgical and clinical anatomy of the interclavicular ligament. Surg Radiol Anat. 2007 Jul;29(5):357-60. [PubMed: 17563831]
3.: Wong M, Kiel J. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 15, 2020. Anatomy, Shoulder and Upper Limb, Acromioclavicular Joint. [PubMed: 29763033]
4.: Tubbs RS, Shah NA, Sullivan BP, Marchase ND, Cömert A, Acar HI, Tekdemir I, Loukas M, Shoja MM. The costoclavicular ligament revisited: a functional and anatomical study. Rom J Morphol Embryol. 2009;50(3):475-9. [PubMed: 19690777]
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8.: Schmidt S, Ottow C, Pfeiffer H, Heindel W, Vieth V, Schmeling A, Schulz R. Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment. Int J Legal Med. 2017 Nov;131(6):1665-1673. [PubMed: 28889331]
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10.: Tran DQ, Tiyaprasertkul W, González AP. Analgesia for clavicular fracture and surgery: a call for evidence. Reg Anesth Pain Med. 2013 Nov-Dec;38(6):539-43. [PubMed: 24121609]
11.: Natsis K, Totlis T, Chorti A, Karanassos M, Didagelos M, Lazaridis N. Tunnels and grooves for supraclavicular nerves within the clavicle: review of the literature and clinical impact. Surg Radiol Anat. 2016 Aug;38(6):687-91. [PubMed: 26702936]
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14.: Modgil R, Arora KS, Sharma A, Mohapatra S, Pareek S. Cleidocranial Dysplasia: Presentation of Clinical and Radiological Features of a Rare Syndromic Entity. Mymensingh Med J. 2018 Apr;27(2):424-428. [PubMed: 29769514]
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Broken collarbone – NHS

A broken collarbone, or fractured clavicle, is a common injury. It usually happens after a fall or a blow to the shoulder.

It takes about 6 to 8 weeks to heal in adults, and 3 to 6 weeks in children.

The collarbone is a long, slender bone that runs from the breastbone to each shoulder.

You can feel it at the top of your chest, just below your neck. Tough bands of tissue (ligaments) connect the collarbone to the breastbone and shoulder blades.

When to get medical help

If you think you have injured your collarbone go to your nearest urgent treatment centre or call NHS 111 for advice.

If the the injury is severe – for example, the bone is poking through the skin or the pain is unbearable – immediately call 999 or go straight to your nearest A&E department.

What you should do

While waiting to see a doctor, stabilise your arm using a towel as a sling – this goes under the forearm and then around the neck. Try to move your arm as little as possible.

Painkillers, such as paracetamol or ibuprofen, can help reduce the pain. Do not give aspirin to children under the age of 16.

Holding an ice pack to the injured area can also help reduce the pain and swelling. A bag of frozen peas wrapped in a tea towel works well. But do not put ice directly onto your skin because it can burn.

Symptoms of a broken collarbone

A cracked or broken collarbone will be very painful. There may also be:

swelling or tenderness around the injured area
bruising to the skin
bleeding if the bone has damaged the tissue and skin (this is rare)
numbness or pins and needles if nerves in the arm are injured

Your shoulder may be slumped downwards and forwards under the weight of the arm, as the broken collarbone is no longer providing support.

There may have been a snapping or grinding noise when your collarbone broke. In severe cases, one end of the bone may poke through the skin.

Treating a broken collarbone

Most broken collarbones are left to heal naturally using a simple triangular sling to support the arm and hold the bones together in their normal position.

The sling is usually fitted in hospital after an X-ray has confirmed the collarbone is broken. You’ll be given painkillers to relieve the pain.

Surgery under a general anaesthetic is only needed if the injury is severe – for example, where the bone has broken through the skin – or if the bones have failed to line up and are overlapping significantly.

Several techniques can be used to repair the collarbone. Fixing the break with a plate and screws is the most common method. Your surgeon will explain the technique they’re going to use and its advantages and disadvantages.

Being discharged

You may need to stay in hospital overnight, depending on the extent of the injury.

Before you’re discharged, you may see a physiotherapist, who can show you some gentle arm and shoulder exercises to do at home with your arm out of its sling. These will help reduce stiffness, relieve some of the pain, and strengthen your shoulder muscles.

Follow-up

You’ll probably need to go back to the hospital outpatient department about a week after being discharged to check your collarbone is healing properly. See your GP if you have any concerns before this appointment.

Go back to the A&E department if you notice any weakness developing in your arm or hand, or the pain suddenly gets worse.

How long does it take to heal?

In adults, it usually takes about 6 to 8 weeks for a broken collarbone to heal, although it can take longer. In children, it usually takes about 3 to 6 weeks to heal.

However, it will take at least the same period again to restore full strength to your shoulder.

While the fracture heals, a lump may develop along your collarbone. This is normal, and often improves over the following months.

Occasionally, the fracture does not heal and you may need surgery. This should be discussed with your surgeon.

Recovery advice

While recovering from a broken collarbone you may find it helpful to:

use extra pillows at night to keep yourself more upright if you find sleeping uncomfortable
use ice packs and painkillers if pain and swelling continues while your arm is in a sling
move your elbow, hand and fingers regularly as soon as it’s comfortable to do so
remove the sling for short periods of time if it is not too painful (when you think the fracture has started to heal)
do not play contact sports for at least 10 to 12 weeks after the injury – your doctor will tell you when you can go back to work and resume normal activities

Page last reviewed: 20 March 2020
Next review due: 20 March 2023

Shoulder Injuries: Understanding the Difference Between a Dislocation and a Separation

Although the terms dislocation and separation are used often interchangeably, they do not refer to the same shoulder injury. The shoulder is made up of three bones: the humerus (arm bone), clavicle (collar bone) and scapula (shoulder blade). The bones are connected by soft tissues to form two important joints: the glenohumeral and acromioclavicular. In orthopedic terms, a dislocation refers to the glenohumeral joint and a separation refers to the acromioclavicular joint. Let’s learn more about both joints and how they’re injured:

Glenohumeral Dislocations

Illustration 1- A shoulder dislocation

Understanding the injury. The glenohumeral joint is the body’s most mobile joint and the joint that’s most likely to become unstable. When a dislocation occurs, the head of the humerus partially or completely slips out of the circular glenoid that helps hold it in place. The injury can be painful, especially if the shoulder is completely dislocated and/or if supporting soft tissues are damaged.

Treating the injury. Whether they be partial or complete, shoulder dislocations need to be treated by an Orthopedic Specialist. Treatment depends on the severity of the dislocation and associated soft tissue damage.

Conservative, non-surgical options are always tried first. Immobilization, usually in a sling, is used to decrease pain and give the shoulder time to heal. Physical therapy is used to strengthen the shoulder and prevent future dislocations.

Surgery is recommended when shoulder dislocations are recurrent. Recurrent dislocations leads to shoulder osteoarthritis so patients with recurrence typically undergo surgery to prevent further damage. During a 1-2-hour arthroscopic procedure, an orthopedic surgeon locates and then fixes damaged soft tissues so the shoulder can be held properly in place.

Shoulder Separations

Illustration 2- Shoulder seperations classified based on severity

Understanding the injury. The acromioclavicular joint is formed by the clavicle and the acromion of the scapula. A separation can occur when the joint experiences forceful impact during incidents such as falls, blows, and collisions. The injury is easy to identify, as a bump (the separated clavicle) sticking up as the shoulder itself is droops. Pain, limited mobility and pain with mobility are common symptoms.

Treating the injury. Immediately following a separation, a sling, ice, and medications can be used to immobilize the shoulder and decrease inflammation and pain. In most cases, this type of treatment can be continued for a few weeks and the damaged soft tissues that caused the separation will heal. However, in cases where severe pain and/or a severe deformity is present, surgical intervention might be necessary.

What to Do If You’ Have a Shoulder Injury

You now know the difference between a shoulder dislocation and separation. If you sustained either, please don’t hesitate to contact one of our 5 Long Island offices to arrange an appointment. Your injury can and will be treated in a manner that ensures a full recovery.

The physicians at Total Orthopedics and Sports Medicine focus on both the surgical and non-surgical treatment of shoulder injuries and are one of the most innovative orthopedic practices in the area. Dr. Charles Ruotolo, President of Total Orthopedics and Sports Medicine, has published several peer-reviewed studies on orthopedic care and orthopedic surgery of the shoulder.

Fortunately, many patients can be treated non-surgically with a combination of conservative modalities coordinated by the Total Orthopedics and Sports Medicine Team. If surgery is necessary, the practice uses a multidisciplinary approach to create a treatment plan that focuses on the patient’s lifestyle and activities and helps them get back to those activities quickly and effectively. Expect a full recovery when in the hands of our trusted physicians

Anatomy of the Shoulder | UT Health San Antonio

The shoulder is extremely mobile and made up of several joints that work together. The scapula, clavicle and humerus are the bones of the shoulder. The glenohumeral joint is the main joint and is more like a golf ball sitting on a tee. It works to allow a lot of range of motion in forward flexion (arms in front), abduction (arms to the sides), adduction (arms across the body) and extension (arms reaching back). The acromioclavicular joint connects the clavicle to the acromion, which is part of the shoulder blade or scapula. There is not a lot of movement in this joint, but when there is an injury here it can be very painful.

The scapular thoracic joint is the space between the back of the chest wall and the front of the shoulder blade or scapula and there is a lot of movement in this joint. There is forward and back tilt, gliding movement across the back and rotation across the back.

Ligaments

Ligaments are a dense connective tissue that connects bone to bone. They are fairly short in comparison to tendons, but very similar in what they are made of. Ligaments are tough and flexible and look like a white band or cable-like structure. To withstand forces that it takes from different directions a ligament is made of a weaving matrix of fibers.

The ligaments in the shoulder are all named after the bones they connect. The clavicle has two ligaments involving the shoulder that help with stabilizing it to nearby bony structures: The acromioclavicular ligament and the coracoclavicular ligament both stabilize the clavicle to the shoulder blade. There is also the costoclavicular ligament that stabilizes the clavicle to the sternum of the chest. Injuries to these ligaments can cause clavicle instability.

There are ligaments that connect the shoulder blade (scapula) to the Humerus which include: coracohumeral ligament and the glenohumeral ligaments (superior, middle and inferior).

Finally, there is a ligament connecting the coracoid process to the acromion called the (you guessed it!) coracoacromial ligament. This ligament plays a role in stopping the head of the humerus from shifting too high upward into the shoulder as well as a tension band in

helping absorb forces transmitted into the acromion by large muscles like the deltoid and trapezius.

Muscles and Tendons

Tendons are thick bands of connective tissue that connect muscle to bone. Similar to ligaments, they are made of collagen and can withstand increased tension. Tendons are the reason a muscle can move the bones in our body when muscles contract.

The tendons involved in the shoulder mainly include the long head of the biceps tendon and the tendons of the rotator cuff: supraspinatus, infraspinatus, teres minor and subscapularis. Other supporting tendons include the pectoralis minor, coracobrachialis and the short head of the biceps. These tendons and muscles of the shoulder provide stability to the shoulder joint in different ranges of motion. While one muscle is tightening the opposite is true for an opposing muscle.

Cartilage and Labrum of the Shoulder

There is cartilage at the end of all bones in the body. It serves as a gliding surface for when the shoulder joint moves into different positions. It is made of a thick, smooth tissue that acts as a protective covering over the ends of the longs bones at the joint space. Injuries to the cartilage occur either with trauma or over long periods of time where these surfaces slowly deteriorate due to wear and tear or a disease process. When the process is slow and gradual the damage is often worse. Eventually the cartilage is worn off and the surface of the two ends of bone are no longer gliding on a smooth surface with movement, but instead grinding together.

The labrum of the shoulder is found on the glenoid rim. Like the meniscus of the knee, the labrum of the shoulder helps deepen the contour of the glenoid so that humeral head fits better in the joint. Injuries to the labrum occur with shoulder dislocations and repeated anterior subluxations. These can also be seen in throwers due to the long head of the biceps tendon pulling on the labrum during the acceleration phase of a pitch or throw. There is also incidence of labrum tears in someone who falls on an outstretched arm or when a golfer grounds the club on their swing.

Physical Therapy Guide to Collarbone Fracture (Clavicle Fracture)

ChoosePT Guide

The collarbone, or clavicle, connects the arm to the body. It helps stabilize the shoulder and arm as they move. A collarbone fracture is a common shoulder injury. It makes up 4% of all fracture types and 35% of all shoulder injuries. The injury is most often caused by trauma, such as a direct blow to the shoulder or a fall. It occurs most often in young men under age 20, often as a result of a sports injury. Collarbone fractures also often result from a fall in older adults. Men typically fracture their collarbones in their younger years. Collarbone fractures in women are more common with older age.

Most collarbone fractures are treated without surgery. However, more severe fractures may require surgery. Physical therapists treat collarbone fractures before and after surgery. They provide pain management, guided exercise, and functional training during the healing process.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To locate a physical therapist in your area, visit Find a PT.

Find a PT Near You!

What Is a Clavical Fracture?

The collarbone (clavicle) is located on the front of the chest and shoulder. It connects the arm to the body by two joints:

Sternoclavicular joint. This is where the clavicle connects to the sternum (breast bone).

Acromioclavicular joint. This is where the clavicle connects to the scapula (shoulder blade).

The collarbone helps stabilize the shoulder during movement. It also helps protect nerves and blood vessels that extend from the neck and connect into the upper extremity.

Clavicle fractures are classified according to the place where the bone is broken. They are:

Midshaft (middle of the bone). This type usually occurs in younger people and makes up 75% to 80% of all collarbone fractures.

Lateral-end (near the acromioclavicular joint). About 15% to 25% of all collarbone fractures are lateral-end fractures.

Medial-end (near the sternoclavicular joint). This type is rare, making up just 5% of all collarbone fractures.

Health care providers also describe fractures as:

Nondisplaced. The pieces of the fractured bone remain lined up.

Displaced. The two parts of the fractured bone do not line up.

Comminuted. Splinters or small pieces of bone are found at the fracture site.

Compound. When the bone pierces (goes through) the skin.

How Does It Feel?

If you break your collarbone, you will experience pain in the immediate area of the break. Other signs and symptoms may include:

Pain in the general area of the collarbone. Arm pain or discomfort (in more severe cases).

Bruising, which may spread to the shoulder and arm.

Swelling that occurs at the injury site and in the arm.

Lack of ability to lift the arm. Most people will hold their arm close to their body or support their arm with the other hand.

A grinding or shifting feeling of the bone when moving the arm.

A bump at the injured area. The skin may lift in the location of the fracture, like a tent.

How Is It Diagnosed?

Your physical therapist will perform a full evaluation whether or not you have surgery. The goals of the exam are to assess the degree of your condition or injury. It also helps to determine the cause and any factors that may have contributed to it. Collarbone fractures often result from a single injury.

Your physical therapist will interview you about your health history, injury, condition, and activities.

Forms you fill out before your first session help your physical therapist gather needed information. The interview will become more specific to the symptoms of a collarbone fracture. Your physical therapist may ask you questions such as:

How did your injury occur?

How have you taken care of the condition, such as seeing other health care providers? Have you had imaging or other tests and received their results?

What are your current symptoms, and how have they changed your typical day and activities?

Do you have pain, and if so, what is the location and intensity of your pain? Does pain vary during the day?

Do you have trouble doing any activities? What activities are you unable to do since your injury? What activities make your symptoms worse? How do you reduce your symptoms?

This information allows the physical therapist to better understand what you are experiencing. It also helps determine the course of your physical exam.

The physical exam will vary depending on your interview. Most often it will begin with observing the movements discussed in the interview or any positions that cause you pain. The exam will include the area of your symptoms. It also may include other areas of the body that may have changed because of the injury.

Your physical therapist may watch you raise and lower your shoulder and arm. They will assess the mobility and strength of your shoulder, and other areas as needed. This will help them find what areas need treatment to improve your condition. Your physical therapist will gently, but skillfully, press around your upper arm and shoulder to find exactly where it is most painful.

Your physical therapist will discuss their findings with you. They will work with you to develop a program specific to you to help you recover.

How Can a Physical Therapist Help?

Most collarbone fractures are treated without surgery. The involved arm will be secured in a sling or a figure-eight brace for support and comfort. Physical therapy usually begins early to help reduce pain and swelling.

Healing times vary from person to person due to differences in age, health, and the extent of the injury. Many patients return to light daily activity after about six weeks. Generally, people can return to more strenuous job duties after nine to 12 weeks.

Your physical therapy treatment program may include some or all of the following:

Patient education. Your physical therapist will teach you about your injury. They will work with you to find any external factors that may have contributed to your injury. Your physical therapist also will recommend ways to change these factors and modify your daily activities.

Pain management. Your physical therapist will design a program to address your pain. This may include treatments such as applying ice to the affected area. They also may recommend changing some activities that cause pain. Physical therapists are experts in helping people manage pain. They can help you reduce or avoid the need for medicines, including opioids.

Range-of-motion exercises. With a collarbone injury, your movement may be limited. This can cause increased stress on your neck or other areas of the arm. In addition, a restriction in the area may force other parts of your neck or arm to work harder. Your physical therapist may teach you self-stretching methods. These will help to decrease tension and restore normal motion of the joints in your upper arm and shoulder.

Manual therapy. Your physical therapist may use hands-on (manual) therapy to gently move your muscles and joints to help improve motion. They also may provide hands-on therapy to guide your joints into a less stressful movement pattern. Your physical therapist also may use their hands to apply resistance while you do exercises to improve strength in the affected muscles.

Muscle strengthening. Muscle weaknesses or imbalances can contribute to ongoing symptoms. Your physical therapist will design a safe strengthening program for you. It likely will include your core (midsection) and the upper arm and shoulder area. Your program may include doing exercises in different positions, including standing or lying on your back. They may have you use elastic bands, tubing, or other equipment to provide resistance. Your physical therapist will choose exercises that are right for you based on your restrictions, pain level, and fitness.

Functional training. Once your pain, strength, and motion improve, you will need to safely transition back to more demanding activities. To minimize the stress on your collarbone and shoulder, it is important to learn safe, controlled movements. Your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely.

Braces and other assistive devices. Your physical therapist will work with you and other health care providers to determine if bracing will help you. Braces may be used for a short time, to rest the area.

Treatment After Surgery

Physical therapy after surgery is similar to that provided for people who do not need surgery. However after surgery, your program will progress by following a strict schedule set by your surgeon. It is typical for physical therapy to begin immediately following the operation. Eight to 12 weeks of physical therapy is common after surgery.

During the first week after surgery, your physical therapist will help you control pain and swelling. They may begin some gentle motion exercises. You will wear a sling or brace for support and comfort.

Over the next few weeks, your physical therapist will help you gradually increase your exercise program.

After about four weeks. If X-rays show good collarbone position and stability, your physical therapist will guide you to achieve full shoulder range of motion.

At six to eight weeks. If X-rays show enough healing, treatment will progress to include strengthening and resistance exercises.

These time frames will vary based on your age, health, the extent of your injury, and any surgery you had.

Can This Injury or Condition Be Prevented?

Not all collarbone fractures can be prevented. However, you can reduce your risk of injury by wearing appropriate protective gear when playing sports, such as properly fitted shoulder pads for football. Physical therapists work with athletes to improve their strength and movement. They help to ensure that you can safely perform at your best.

You also can reduce your risk by avoiding falls. To reduce your fall risk, it is important to keep strength and fitness throughout your life. It also is important to remove any tripping hazards (such as throw rugs, slippery floors).

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat collarbone fractures. However, you may want to consider:

A physical therapist who has experience treating sports or orthopedic injuries or pediatric conditions. Some physical therapists have a practice with a focus on sports medicine or orthopedics.

A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedics or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists in your area with these credentials and clinical expertise on Find a PT, a tool built by the American Physical Therapy Association.

General tips when you’re looking for a physical therapist (or any other health care provider):

Get recommendations from family, friends, or other health care providers.

When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people who have fractured a clavicle/collarbone.

Be prepared to describe your symptoms in as much detail as possible during your first visit. Make a note of what makes your symptoms better or worse.

X-ray of the clavicle – X-ray of the clavicle in the clinical diagnostic center Alpha Health Center

The clavicle is a small S-shaped bone that connects the scapula to the sternum. Due to the peculiarities of its anatomical location, inflammatory and degenerative diseases of bone structures are difficult to diagnose. Clavicle X-ray is a non-invasive research method that allows visualizing deformities and pathological processes and obtaining information for making a diagnosis.

The Alfa Health Center clinic in Murmansk works seven days a week. In our medical center, you can make an X-ray of the clavicle, get the results in digital form, consult with a traumatologist, orthopedist, surgeon.

Indications for research

The condition of the clavicle affects the functioning of the shoulder joint. It is regularly exposed to high stress, so injuries to this bone are widespread. Clavicle X-rays are taken if there is a suspicion of fracture, dislocation, or cracking.

The indications for the procedure are pain, swelling and discomfort resulting from:

a sharp jerk of the shoulder;
strong direct blow;
mechanical pressure in the area of the forearm and shoulder.

Sometimes collarbone injuries occur due to regular intense exertion, combined with poor bone condition. In this case, it is also advisable to take an x-ray.

X-rays are used to diagnose:

tumors and cysts;
false joints;
fibrous dysplasia;
occlusion of the subclavian artery;
osteomyelitis and osteosclerosis;
periostitis.

X-rays are also taken to monitor the effectiveness of the prescribed therapy. The pictures show whether the bones heal properly after a fracture.In case of incomplete dislocation of the acromial end of the clavicle, an X-ray of the healthy bone is needed to compare the difference between the joints.

Procedure

To diagnose injuries, an X-ray of the clavicle is most often performed in two projections: it allows you to determine the location and nature of the damage. What kind of image is needed is decided by a traumatologist or a radiologist. An X-ray of the clavicle in the anterior direct projection is considered standard, an additional one in the posterior direct projection.

A special lead apron is used to protect non-examined areas of the body.It takes a few minutes to take pictures.

Get an X-ray of the clavicle in Murmansk

Alfa Health Center in Murmansk offers digital radiography at a convenient time for you. You can sign up for a study, as well as a consultation with a traumatologist, surgeon, rheumatologist by phone or through your personal account on the website. To save up to 20%, we recommend signing up for the “Deposit Agreement” program.

Ischemic heart disease. Angina pectoris / Diseases / Clinic EXPERT

The term “Ischemic heart disease” includes a group of diseases:

myocardial infarction
atherosclerotic cardiosclerosis
angina pectoris.

Angina pectoris (synonym angina pectoris) is characterized by attacks of sharp chest pain and discomfort in the chest area due to a lack of blood supply to a specific area of the heart. The severity of the attacks is different, in rare cases it ends in death. The main cause of the disease is atherosclerosis of the coronary arteries of the heart.

For an accurate diagnosis, a number of other diseases should be excluded that can manifest themselves as pain in the heart: osteochondrosis of the spine, herpes zoster, diseases of the esophagus and stomach, lung diseases, cardioneurosis, pericarditis.

Types of angina pectoris

There are the following types of disease, which depend on the clinical picture:

Exertional angina pectoris

One of the main manifestations of ischemic heart disease. As a result of the discrepancy between the myocardial demand for oxygen and its delivery through the arteries narrowed due to atherosclerosis, myocardial ischemia occurs, which is manifested by pain behind the sternum or shortness of breath and severe fatigue during exertion.

Stable exertional angina is divided into four functional classes.Angina functional classes are designed for accurate diagnosis and include a wide variety of clinical information (for example, walking without much physical effort on level ground and climbing stairs at a fast pace).

Variant (spontaneous) angina pectoris

Characterized by an unpredictable appearance, i.e. pain can appear at rest. It does not arise as a response of the heart to emotional and physical stress and differs from angina pectoris in that it is, as a rule, based on spasm of the coronary arteries of the heart, and not only their atherosclerotic lesion.

Unstable angina

Requires urgent hospitalization, there is a high likelihood of myocardial infarction.

Symptoms

The main symptoms include:

acute chest pain radiating from the left (or right) side to the lower jaw, arm, scapula
shortness of breath
feeling of suffocation and lack of air
feeling of fear, anxiety
increased pain in the left retrosternal region when trying to take a deep breath
increased sweating
tachycardia
deviation of blood pressure from the norm (low or high).

The main factors in the development of the disease, in which symptoms of angina pectoris occur, include

age (more often after 40 years)
gender (men develop coronary heart disease on average 10 years earlier than women)
hereditary factor.

Overweight, a history of such diseases as diabetes mellitus, arterial hypertension, increased blood clotting, metabolic cider, emotional lability, lack of physical activity, smoking and alcoholism play an important role in the formation of the disease.

Diagnostics

In the diagnosis of angina pectoris, a balanced and competent approach is required, because with unstable angina pectoris, the patient’s condition may worsen up to the development of myocardial infarction. Every research must be substantiated.

ECG
24-hour ECG monitoring
bicycle ergometry or treadmill (exercise test with simultaneous ECG registration)
EchoCG
stress echocardiography
coronary angiography
myocardial scintigraphy
4

Clinic EP is also a doctor cardiologist. functional diagnostics.They will weigh all the risks before conducting a survey.

Treatment

The goals of treatment are to improve the prognosis (prevention of heart attack) and eliminate the symptoms of the disease. They use non-drug (sports, diet), medication (tablets and drip infusions) and surgical methods of treatment.

At the EXPERT Clinic, patients have the opportunity to receive a full consultation with a cardiologist on lifestyle changes and modification of risk factors. If necessary, treatment in a day hospital under the supervision of experienced medical personnel is possible.

Forecast

To draw up an accurate picture, it is necessary to take into account many indicators that will enable the doctor to assess the degree of myocardial damage.

Don’t risk your life. Help with angina pectoris may include only temporary measures to alleviate the patient’s condition before contacting a qualified cardiologist.
Seeing a doctor for signs of coronary heart disease should be immediate!

Recommendations

To prevent angina attacks, you must:

Quit smoking
Control cholesterol levels, if necessary, a low-fat diet
Perform a dosed and physician-selected set of physical exercises
Avoid stress
Lead a healthy lifestyle

Rational nutrition, measured physical activity and regular observation by a qualified doctor can save a patient with angina pectoris from heart surgery.

Frequently asked questions

How to avoid angina pectoris?

To avoid angina pectoris, it is necessary, if possible, to prevent the development of atherosclerosis, because in the overwhelming majority of cases, it is he who is the cause of angina pectoris. As you know, many factors directly affect the formation of atherosclerotic plaques. Gender, age, heredity are predisposing factors that cannot be changed, but other factors can be controlled and even prevented:

high blood pressure
smoking
high cholesterol
overweight
diabetes
low physical activity
stress

Change these factors in your hands!

Is it possible to completely recover from angina pectoris?

Angina pectoris, as a rule, occurs as a result of damage to the coronary arteries supplying the myocardium, atherosclerosis, and this is a chronic, incurable process. However, with a properly selected treatment regimen, it is possible to achieve that long-term remission occurs and angina attacks will not bother. Also, at the present time, if necessary, it is possible to install a stent into the narrowed lumen of the vessel to restore blood circulation, or the operation of MSCB / CABG is a surgical intervention, as a result of which the blood flow of the heart is restored below the site of vasoconstriction. This surgical manipulation creates another pathway for blood flow to the part of the heart that was not supplied with blood around the site of constriction.

Where does it hurt during an attack of angina pectoris?

Typical for angina pectoris is paroxysmal pain in the chest, in the center of the chest. The pain of a compressive, pressing nature is more often associated with physical or psycho-emotional stress and disappears when it stops. Pain may radiate to the left arm, scapula, lower jaw, and collarbone. If nitrates are used, then the effect for angina pectoris is not delayed, it develops immediately, within 1-2 minutes.

Are there ways to cope with an angina attack without medication?

Since many people experience angina attacks during physical exertion, sometimes it is simply the cessation of the load (walking, etc.)and rest can cause the pain to stop. However, people with angina pectoris should always carry nitroglycerin or nitrospray with them in order to stop the pain attack within one to two minutes. You should not delay the time before taking nitroglycerin, since pain is a manifestation of myocardial ischemia (insufficient blood supply), and if it persists, foci of necrosis in the myocardium may occur (myocardial cells may die). If the attacks of angina pectoris become more frequent, an urgent need to consult a cardiologist.

What drugs will help with an attack of angina pectoris?

An attack of angina pectoris must be stopped as early as possible from the moment of its onset. prolonged ischemia will lead to the development of necrosis, i.e. myocardial infarction. If this is the first time in your life, call an ambulance. You can take a nitroglycerin tablet on your own or use nitrospray under the tongue. The effect will come within 1-2 minutes and does not last long, 10-15 minutes. It is better to take the drug while sitting or lying down, as there may be a short-term decrease in blood pressure, dizziness, headache, tinnitus – these symptoms are safe and are a consequence of the action of nitroglycerin.If pain recurs, you can take nitroglycerin again, because it does not accumulate in the body, multiple administration of the drug is possible during the day (up to 6 tablets per day). With increased pressure, it is necessary to reduce it to normal values.

All patients who have had an attack of angina pectoris need to perform an ECG and resolve the issue of hospitalization by a cardiologist.

Why quit smoking? How does smoking worsen angina pectoris?

If you smoke and have angina, the best thing you can do to help your heart is to quit smoking!

Studies have shown that the mortality rate in those patients with angina pectoris who quit smoking decreased by 2 times compared with those who continue to smoke. Why? Angina pectoris is based on a lack of oxygen in the heart muscle, and smoking increases the level of carbon dioxide in the blood, and it displaces oxygen in the blood. This leads to oxygen starvation of the heart muscle. Smoking also increases blood viscosity. Smoking increases and aggravates the attacks of angina pectoris, greatly increases the risk of myocardial infarction. Smoking cessation eliminates the adverse effects of nicotine on coronary arteries, angina attacks disappear or become less frequent.

Important: replacing cigarettes with cigars and pipe tobacco, switching to cigarettes with a lower tar and nicotine content does not reduce cardiovascular risk!

Contrary to popular belief, a sharp cessation of smoking is not harmful, overcoming this bad habit gives an indisputable positive effect, regardless of smoking experience.

You need to be prepared for the fact that sometimes when quitting smoking occurs depression, irritability, in this case, you can seek help from a psychotherapist.

I suffer from angina pectoris, but I dream of getting rid of excess weight. What physical activity is acceptable for people with such problems?

For people with angina pectoris, exercise is recommended for 30–45 minutes a day. The best choice is walking (preferably with a brisk pace) or Nordic walking with ski poles, cycling, swimming. It is important that exercise does not cause pain, palpitations, or shortness of breath. When swimming or water aerobics, remember that cold water can provoke angina attacks, so the water temperature in the pool should be comfortable for you.It is better to do water aerobics under the supervision of a trainer and according to a program specially adapted for people with cardiac problems. In this case, the loads should increase very gradually.
However, to reduce body weight, not only physical activity is necessary, but also proper nutrition; a nutritionist will help you to choose the right menu for consultation.

Can angina be present if there is no pain?

Unfortunately, yes. For example, with diabetes mellitus, diabetic polyneuropathy develops, and the patient may not feel pain, this is the so-called painless ischemia.This condition is dangerous because the patient does not take action on time, and myocardial infarction will develop. In some cases, the equivalent of pain can be considered shortness of breath during physical exertion, so you can suspect the presence of angina pectoris and come to a cardiologist for examination.

History of treatment

Case No. 1

Kirill, 57 years old. Experienced smoker, hypertensive (“working” pressure 150/95 mm Hg). Five years ago, according to the patient, there were problems with the heart and blood pressure, he was examined, he took the prescribed drugs for six months, then he stopped taking them on his own.During the visit to the clinic, attacks of chest pain during physical exertion appeared, which disappear when the load ceases. At the doctor’s appointment, blood pressure is 170/100 mm Hg, rapid pulse is 90 beats per minute. The patient was examined – an increase in the level of “bad” cholesterol, ECG and ultrasound of the heart without signs of ischemia was revealed, and ischemia was recorded on the 24-hour ECG monitor at the time of significant physical exertion, i.e. there is exertional angina.

A treatment regimen for angina pectoris was selected for the patient, against the background of which blood pressure and cholesterol levels normalized over 3 months, exercise tolerance increased significantly.With the help of a psychotherapist, the patient decided to quit smoking, took up Scandinavian walking with a gradual increase in loads under the supervision of a cardiologist. During the last year attacks of angina pectoris do not bother. It was recommended to continue taking medications and regularly undergo preventive examinations.

Thanks to cooperation with doctors and the desire to feel better, the patient was able to change his lifestyle, prevent complications of the disease and prolong his life for many years.

soloist of VIA “Volga-Volga” about the trip on a scooter

I took an electric scooter for the first time – found myself on the operating table

The soloist of VIA “Volga-Volga” Anton Salakaev ended up in the hospital after an unsuccessful attempt to master an electric scooter. Together with the group, he was on tour in Nizhny Novgorod, where he was offered to ride.

“We were walking around a wonderful, beautiful city, along the embankment, and saw a parking lot for scooters. The guys from the group took a scooter and decided to ride.Before that I categorically did not approach these devices, ”he said.

Anton admits that he always advised his children to be careful and, if possible, not to ride scooters. From his windows, he often watched how, despite the presence of a special path for bicycles, the drivers of two-wheeled vehicles rode in a stream of pedestrians.

“But for some reason that day I decided to try: once you can do it, feel how great it is, because many said that the wind is in your hair, romance and everything is great,” Salakaev said.

But the musician did not have time to drive even a hundred meters, as he found himself on the asphalt. He does not remember the moment of the fall, but he felt the difference between a bicycle and a scooter clearly. According to him, the scooter is more unstable and not adapted to maneuvering – it has small wheels and a thin handlebar.

The 100-meter trip ended for the musician with torn ligaments of the right collarbone, three broken ribs and an open wound on his back.

But the group did not cancel the concert in Nizhny Novgorod.They performed in front of the Nizhny Novgorod footballers, the team’s sports doctor provided first aid to the soloist and applied tapes.

“During the operation, I talked with the surgeon about creativity”

Already in Kazan, Anton fell into the hands of the doctors of the Republican Clinical Hospital, they took pictures and made a diagnosis. After that Anton, together with VIA “Volga-Volga”, played two more concerts in Kazan and Moscow. The soloist was on painkillers and refused to play the button accordion with which he usually performs.Five days later, he was lying on the operating table at the traumatologists of the RCH.

“During the operation, I talked with the surgeon, talked about my work. The process of approaching the operation was a little more complicated, the moment of anesthesia, if we talk about the nuances, the doctors were looking for nerve endings to turn them off. I didn’t feel the operation, ”Anton said.

A titanium plate was placed on the collarbone with five holes drilled in it.

Anton Salakaev admits that he has now shown his children by his own example how a trip on an electric scooter can end.

Ahead of the soloist of the Kazan group, another operation to remove the titanium plate awaits.

Anton Salakaev admits that he loves extreme sports, but he has not yet encountered such serious injuries.

“There have never been such serious injuries. Although the group and I, for example, jumped with a parachute, ”he said.

You will have to forget about playing the button accordion for at least three months, the head of the trauma department №1 of the RCH Hamil Garifullov told the musician.

The result of unsuccessful braking on a scooter – fractures of the femoral neck or clavicle

Hamil Garifullov said that out of 35 people who applied to the RCH after falling from electric scooters, traumatologists operated on ten. Several more victims ended up in the clinic’s neurosurgeons – these were craniocerebral injuries.

“Two patients were with fractures of the femoral neck, they were from 35 to 50 years old, the rest of the patients received minor injuries: fractures of the clavicle, dislocation of the acromial end of the clavicle,” said the head of the trauma department No. 1 of the RCH.

The nature of the injuries suggests that more often people fall during sudden braking, they lose balance, fly over the steering wheel and fall either head down or with their hands or feet.

Half of the victims are 35–40 years old, the rest of the patients are 18–19 years old.

“There were three or four patients in a state of alcoholic intoxication, we operated on them,” said Garifullov.

This year, according to doctors, compared to previous years, there were no injuries after skateboarding, there were isolated cases of falling from bicycles, but there were much more people with injuries after riding scooters.

The press service of the Children’s Republican Clinical Hospital of the Tatar-inform news agency said that 35 children with injuries after falling from scooters turned to them.

The traumatologist advised those who still really want to ride an electric scooter, put on elbow pads, a helmet and knee pads, be instructed and ride strictly on bike paths. This will help prevent serious injury and disability.

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Osteochondroma (osteochondral exostosis) – is a benign defect in bone development, usually in the area of the epiphyseal growth plate.It is mainly localized initially in the metaphyses of the long bones of the limbs, however, as the skeleton grows, it shifts towards the diaphysis, but it can also be located in the pelvic bones, ribs, vertebrae, scapula, articular ends of the clavicle. The most common benign skeletal disease accounts for about 20% of all primary skeletal tumors. It is mainly found in children and adolescents (most often in the second decade of life), the growth of osteochondroma stops by the time of maturation of the skeleton, but sometimes it continues after the closure of the growth zone.In 70% of cases, solitary osteochondromas are detected in patients under the age of 30 years. Osteochondroma develops from the metaphyseal cortical plate and its axis is directed away from the nearest joint. Osteochondromatosis (multiple exostotic chondrodysplasia) is a hereditary disease, inherited in an autosomal dominant manner, more often in patients younger than 20 years old.

Clinical picture. Symptoms depend on the location and size of the exostosis.

Radiographically – the contours of the underlying cortical and cancellous bone pass directly into the contours of the osteochondroma; the cartilaginous cap is usually radiolucent, but sometimes contains foci of calcification; the border of calcification in the cartilaginous covering and in the body of the osteochondroma is clearly distinguishable.

Pathomorphology.
Macroscopy. Osteochondroma is a cancellous bone with a thin cortical layer, the surface of which is covered with cartilage (usually less than 1 cm thick) resembling an articular one; the size of the formation is from 2 to 12 cm or more; can be on a leg or with a wide attachment base; the cartilaginous covering is not separated from the underlying bone by the subchondral endplate.

Microscopy. Cartilage covering in the form of hyaline cartilage with randomly located chondrocytes of irregular size, but without nuclear atypism and binucleated cells.The cartilaginous cap is bounded by a well-defined perichondrium separating it from the adjacent soft tissues. In mature osteochondroma of elderly patients, the cartilaginous cap may be absent. In most osteochondromas, the thickness of the cap is 0.5–1.5 cm; if the thickness of the cartilaginous covering is more than 2 cm, the presence of a secondary chondrosarcoma can be suspected.

Differential diagnostics. Parosteal osteochondral proliferation, parostal osteosarcoma, chondrosarcoma due to malignancy of osteochondroma.

Treatment. In most cases, the pathological focus is monitored. If a pain syndrome appears or severe deformities of the skeleton develop, exostosis is excised at its base with the complete removal of the cartilaginous cap.

The outcome is favorable; during surgical treatment, the perichondrium covering the exostosis must be removed, otherwise a relapse is possible. Malignancy: solitary forms – in less than 1% of cases, it turns into chondrosarcoma, fibrosarcoma.The risk of malignancy is especially increased in patients with multiple osteochondromas. Malignancy is likely with a sudden increase in the growth of exostosis, an increase in its diameter by more than 5 cm, the thickness of the cartilaginous covering more than 1 cm.

90,000 Bone marrow is the place where hematopoiesis begins

All blood cells grow in the bone marrow.

Bone marrow (not to be confused with the spinal cord [spinal cord], which is part of the central nervous system [CNS]) is a spongy tissue with a very active blood supply.It fills cavities inside many bones (for example, inside the vertebrae, pelvis, thighs, ribs, shoulder blades, and collarbones).

All blood cells, that is, erythrocytes and leukocytes, as well as platelets grow there from single progenitor cells. These are the so-called hematopoietic stem cells, or more clearly blood stem cells. Already at the earliest stage of development, blood cells divide into cells of the myeloid series and cells of the lymphoid series:

From stem cells of the myeloid series , after several intermediate stages of development, erythrocytes, platelets, as well as a part of white blood cells (granulocytes, monocytes) grow.
From stem cells lymphoid g About series lymphocytes grow, that is, another subgroup of white blood cells.

Each stem cell is capable of producing several million offspring cells. Various blood cells mature in the bone marrow. And as soon as they fully ripen, that is, they become fully working cells, they go into the circulatory system. The only exception is lymphocytes. Some of them mature in the tissues of the body’s lymphatic system (lymph nodes, spleen, tonsils, thymus and intestinal mucosa), where they become fully working cells.

Mature blood cells have a relatively short lifespan. Platelets and white blood cells only live for eight to twelve days, although red blood cells live for up to 120 days. Therefore, blood cells are consumed in the body in huge quantities. More than two million cells die every second, and several middiards per day.

Therefore, the bone marrow must constantly produce new cells to replace the destroyed ones, so that the blood can really perform its vital functions.This system works so perfectly in a healthy body that only as many new cells are produced as they are destroyed. Certain blocking factors interfere with the “overproduction” of cells.

If the work of hematopoiesis is disrupted, for example, when a person is ill with leukemia, then this becomes evident from the results of bone marrow examination.

90,000 Clavicle surgery is becoming more and more popular among patients seeking to change the length and convexity of the bone, improve their décolleté and overall body proportion.

Clavicle surgery is becoming more and more popular among
patients seeking to change the length and convexity of the bone, improve their area
neckline and overall body proportion.

From
breast implants prior to liposuction and even body contouring, breasts are often
is the focus of aesthetic medicine. Recently popularity
clavicle surgery is increasing among patients seeking to change the length and
bulge bones, improve their décolleté area and overall body proportion.

Operation
the clavicle can be performed to shorten or lengthen the bone. Often at
patients who have undergone gender reassignment surgery or are looking for a more masculine appearance,
collarbones are lengthened, and those looking for a more feminine look have bones
are shortened to improve shoulder-to-waist balance. Here, we explain the subtleties
procedures.

Shortening of the clavicle

IF
surgery is performed for cosmetic reasons, surgery to reduce the clavicle
can lead to a general narrowing of the shoulder area.Although this method is often
used to treat patients who are undergoing additional
feminization procedures (this is a solution to soften square shoulders and
alignment of the ratio of shoulders and hips), some prefer to pass
procedure solely because they are unhappy with their natural width
shoulders.

“Shoulders
tilt slightly forward, creating a slightly rounded appearance, which my patients do not
object, ”says Leif Rogers, MD, board certified
plastic and reconstructive surgeon from Beverly Hills, on the results
procedures.“Many of these patients have very prominent, visible collarbones,
which can be made less visible if desired by adjusting the tilt angle
bones. A rounder appearance tends to look a little more
feminine. ”

Surgeons
can achieve contractions to just over an inch with a procedure that
can have a huge impact on overall body balance and measurements.

Yes
two main methods that can be used to achieve the desired
results – both are performed under general anesthesia.As the doctor explains
Rogers, shortening the clavicle is done by making a 1.5-inch incision
in the skin above the collarbone on each side. Part of the bone is removed up to two
centimeters (or about 10% of the total length of the clavicle). In the first commit method
the two ends are connected and fixed with a metal plate and screws.
“The resulting scar was very thin in all patients to date.”
he says.

VO
the second method uses an intramedullary screw instead of a plate.”It may
be done through a smaller incision, but this requires additional puncture about
the end of the collarbone, ”says Dr. Rogers. “The advantage is that the hardware
funds are never felt through the skin. ”

When
it comes to lengthening the clavicle, the results are essentially complete
the opposite of contraction. “As a result of the procedure, the shoulders become more
square or less rounded, and the chest appears to be wider, ”explains
Dr. Rogers.”The collarbones can also be made more visible.”

Clavicle
can be lengthened by an inch (give up or give up), and as a result of the operation
the shoulder area expands. People often choose the procedure as part of their overall effort.
by virilization (such as breast implants or fat transplants), but
the procedure is also performed on patients who are simply unhappy with the natural
the appearance of this area.

Similar
shortening of the clavicle, lengthening surgery is performed under general anesthesia and
leads to minimal scarring.During the procedure, the bone is cut
obliquely (read: diagonally) and the two ends slide over each other, creating
about 15-18 centimeters extra long. Dr. Rogers notes that
plate and screws are used to fix the bone, since the method
the intramedullary screw does not work for lengthening.

Recovery
after

Partially
due to the orthopedic nature of the operation, recovery is long
process.However, there is relatively little pain and complete
range of motion returns almost immediately after surgery. “It takes about
one to three weeks before the soreness disappears, and only about three
months for the bone to reach full strength, ”says Dr. Rogers.

W
time as a full return to physical exercise (including sports and
weightlifting) takes about three months, normal activity takes
with the exception of heavy load and weightlifting – it is possible only after a few
days after the procedure.It is important not to fall into a false sense of security. “Patients
tend to return to full activity too early because
the area is almost always painless after three weeks, ”he warns.
“At the moment, the bone is not healing, and problems may arise if the bone
too tense. Patients must recover for a full three months before
return to full-fledged activity. ”

Scarring
from the procedure is also minimal.The incisions are located just above the collarbone on both
sides, in the depression between the collarbone and the neck. “The skin in this area has
a tendency to form very good scars, ”explains Dr. Rogers. “But
some patients may have genetically thicker scars.
If this happens, there are treatments to lessen the appearance of the scars.
“.

Also
it is important to remember that the plate used to stabilize the bone can
felt under the skin.“To date, no patient has complained about
plates, ”he says. “But if you want to remove the plates, you can take them off.
in about a year. ”

90,000 CT scan of the lungs for coronavirus: when, why, how is it done?

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CT of the lungs for coronavirus: when, why, how is it done?

An outbreak of the new coronavirus COVID-19, first recorded in the Chinese province of Hubei, quickly spread across the world and in just 9 months killed about 1 million. human.

Coronavirus is an acute respiratory illness associated with the SARS-CoV-2 virus.

A new type of coronavirus infection spreads rapidly and is easily transmitted from person to person by airborne droplets or by household contact. If we look at the coronavirus under a microscope, we will notice that protein spikes are located on the surface of the virion – with their help, the virus is firmly attached to receptor proteins on the surface of human cells, in particular the lungs.

Coronavirus leads to serious complications – inflammation and fibrosis of the lungs, fever, acute respiratory and heart failure. Computed tomography (CT) of the lungs is currently recognized as the main method for diagnosing coronavirus. This research method reliably and in the early stages shows a pattern of lung damage, that is, pneumonia, in which the alveoli are filled with a pathological substrate (fluid, fibrous tissue), and not air.

Pattern (“model, scheme, pattern”) in medicine is understood as a set of signs and symptoms typical for a particular clinical condition. For example, the combination of “frosted glasses” and their consolidation in certain areas of the lungs is visualized on tomograms and interpreted as a pattern of COVID-19 viral pneumonia.

More than 50% lung damage is considered dangerous and requires hospitalization, especially if the pulse oximeter shows saturation (oxygen saturation) of less than 92-93%.

Is CT of the lungs necessary for coronavirus?

During the first wave of the COVID-19 epidemic in April 2020Russian doctors noted that 45.5% of the infected did not show clinical manifestations of the disease – in such patients, the coronavirus infection developed asymptomatically. Today, CT of the lungs is considered the main method for diagnosing viral pneumonia, the main consequence of which is partial damage to the lungs.

Alveoli are small air cells in the lung. When their volume shrinks due to fibrosis or fluid accumulation, a critical impairment of respiratory function occurs. A person has shortness of breath, cough with phlegm (sometimes with blood), body temperature rises.

In case of pneumonia caused by COVID-19, most often worried about:

Chest pain and discomfort;
Shortness of breath and shortness of breath;
Dry cough;
Loss of smell;
High temperature.

Laboratory blood tests aimed at identifying and determining the viral pathogen sometimes give a false negative result.In this regard, doctors made a conventional decision, according to which the presence of signs of lung damage on tomograms, despite a negative PCR, should be regarded as a probable coronavirus infection until an alternative diagnosis is made.

Another method of radiological diagnosis of pneumonia in coronavirus is a standard chest x-ray. X-ray is a more affordable and widespread examination method. However, it is significantly inferior to computed tomography in terms of information content. The fact is that X-rays do not show damage to the lungs of I and II degrees. This method has other drawbacks, for example, when shadows from large organs are superimposed on each other, artifacts appear that can be misinterpreted.

According to current clinical guidelines, in a pandemic, any compaction (infiltration) of lung tissue and signs of inflammatory changes on radiographs should be considered suspicious for COVID-19. This means that after the X-ray, the patient is directed to have a CT scan.To avoid unnecessary radiation exposure if a coronavirus is suspected, it is advisable for a patient to immediately do a CT scan of the lungs.

Lung lesion in coronavirus on CT

When a coronavirus infection is suspected, patients are most often concerned about the questions: how is the degree of lung damage determined, when is hospitalization necessary, and is it possible to restore the lungs after pneumonia? Let’s take a closer look at this topic and see how computed tomography of the lungs will be useful.

Manifestations of coronavirus

According to the observations of Chinese scientists and doctors, summarized in the “Handbook for the prevention and treatment of COVID-19”, chest pain with coronavirus already indicates a progressive (about 10 days) disease.With a mild course of pneumonia at an early stage, discomfort does not bother. Therefore, it is very important to listen to your body (especially breathing), to measure the temperature. And if you have come into contact with a sick person or people from epidemiologically unfavorable countries, you need to do a test for COVID-19 and CT of the lungs. Only tomography reveals the initial stages of lung damage in coronavirus, when it is easiest to cure pneumonia and preserve the function of the respiratory organ.

The lung tissue cannot be very painful, since there are very few nerve receptors in it.Discomfort in the lungs with coronavirus is a consequence of inflammatory edema. When the alveoli of the lungs are filled with fluid or fibrous tissue, the pleural membrane expands. This causes dull pain. Along with this, with coronavirus, the patient can feel:

Chest pressure, great distension;
Unpleasant sensations during a deep breath, with a sharp breath, a strong, prolonged cough is noted;
Discomfort in the neck, collarbone, between the ribs.

However, similar symptoms are common in other respiratory diseases. However, in order to exclude coronavirus or detect it in time and prevent the development of distress syndrome.

ARDS (acute respiratory distress syndrome or “shock lung”) is an acute and severe condition characterized by bilateral infiltration and pulmonary edema with severe hypoxemia. An extensive inflammatory process sharply causes respiratory failure in the patient, heart problems, pulmonary vasospasm.In some patients, it progresses to fibrosis, after which complete recovery of the affected lungs is sometimes impossible. ARDS is the leading cause of death in coronavirus.

What does lung lesion look like on CT scan

Lung damage caused by a new type of coronavirus is indicated by the so-called “frosted glasses” – relatively light areas resembling plaque, which indicate tissue compaction. Normally, there should be no “frosted glass”. The peculiarity of computed tomography is that such signs of coronavirus pneumonia are clearly visible, even if the lungs are affected by 5% or less.Traditional radiography and other hardware diagnostic methods have a lower resolution, therefore, they can give an ambiguous result.

In pneumonia associated with COVID-19, areas of “ground glass” are located in both lungs: in the lower and lateral regions, around the bronchi or closer to the pleura. CT scan can determine the extent of lung damage in coronavirus. Less than three “frosted glasses” correspond to a mild degree of the disease, more than three indicate moderate lung damage.If their consolidation is observed, the patient’s condition is assessed as moderate, with widespread compaction – severe.

To estimate the degree of damage as a percentage, the lungs are divided into 5 lobes: three in the right and two in the left. A radiologist examines each lobe and assesses how damaged each of them is on a five-point scale, where 1 point corresponds to 5% obstruction or less, and 5 points to more than 75%. Further, all points are added and multiplied by 4. The resulting number will express the degree of lung damage in coronavirus in percentage.If the respiratory organ functions by 50% or less, this is already the basis for hospitalization.

In addition to “frosted glasses” on CT of the lungs in patients with coronavirus, the doctor will see other clinically significant signs of pneumonia:

Cobblestone or Quilt Syndrome – when the lump spreads to the septa between the lobules of the lungs (about the third day of pneumonia), the texture of the lung tissue on CT scans becomes similar to paving stones.
Consolidation of “frosted glasses” – as the disease progresses (usually on days 5-8), the lung tissue becomes denser and less transmits X-rays, while there are fewer functional areas involved in gas exchange.
Symptom of a reverse halo or rim syndrome – Areas of thickening around the focus of infection (“ground glass”), similar to rings. It occurs in more than 50% of patients with coronavirus.
A symptom of an air bronchogram is the presence of air in the lumen of the bronchi along with a pronounced consolidation of “frosted glasses”.

When should a CT scan of the lungs be done for coronavirus?

According to the accepted classification of the revealed pathological changes, the “CT1” standard corresponds to less than 25% of lung damage, “CT2” – 35-50%, “CT3” – 50-75%, “CT4” – 75% or more. The peculiarity of pneumonia caused by the new coronavirus COVID-19 is that the transition of a complication to a more severe form occurs quickly.

Unlike X-ray, CT will show lung damage of 5% or less – the radiologist sees even single areas of infiltration with a diameter of 4-5 mm.X-ray does not detect pneumonia corresponding to CT1, and sometimes CT2. In the presence of characteristic symptoms, even mild ones, and a positive test for COVID-19, there is no need to wait until the infection spreads more intensively and causes damage to large areas of the lungs.

CT of lungs shown at:

Temperature 38 degrees;
Respiration rate> 22 per minute;
Shortness of breath / cough / chest pain;
Blood saturation

CT scan for coronavirus is done even if the test for COVID-19 shows a negative result, and no significant changes in the lung tissue are detected on the X-ray (the foci may still be small, there may be artifacts and shadows in the image) – while the patient disturbed by the above symptoms, contact with patients in the past is not excluded.

What CT scan of the lungs is done for coronavirus?

Today, the “gold standard” CT scan for coronavirus is a 1-2 mm slice scan on a multispiral tomograph or MSCT of the lungs. Diagnostics on such modern devices takes only a minute and allows you to get images in the highest possible resolution. The procedure takes place in the most comfortable conditions for the patient, therefore it is suitable even for patients in serious health conditions (with mechanical ventilation).CT of the lungs with coronavirus is performed without contrast, while the diagnostic value is superior to X-ray, MRI, ultrasound.

In a specialized CT center “Ami”, patients undergo lung CT scans on a new generation Siemens Somatom go.Now multispiral tomograph with reduced radiation exposure and immediately receive a recording of the study (CT scans) on a DVD.

How is CT of the lungs done in coronavirus

No special preliminary preparation for the study is required.Before the procedure, the patient should remove all metal objects and jewelry as they weaken the X-rays. Then the patient is invited to the treatment room, he lays down on the diagnostic table. The nurse turns on the tomograph, and the table gradually moves towards the gantry frame of the tomograph, equipped with sensitive sensors. The gantry of the scanner rotates around the chest and takes many scans (pictures). All this time, the feedback of the radiologist with the patient is maintained. CT of the lungs is done while inhaling, the patient holds his breath for a few seconds.Then the images are processed on a computer – the program makes a volumetric 3D reconstruction of internal organs. The radiologist examines the data obtained, writes the tomogram on a disk and prepares a conclusion.

What else does CT of the lungs show?

In addition to pneumonia, chest CT shows tuberculosis, tumors of the lungs and mediastinum, diseases (lymphadenopathy) of the mediastinum, thymomas and other neoplasms of the mediastinum. In this case, the diagnosis of soft tissues using computed tomography is even preferable to MRI of the lungs.Chest CT is also done after injuries, rib fractures, and thoracic spine fractures to assess damage. CT of the chest with contrast allows additional visualization of blood vessels. As part of a study with contrast enhancement, the doctor can see and evaluate in detail pulmonary embolism, lung tumors, and thoracic aorta.

CT of lungs after coronavirus

CT scan of the lungs with coronavirus is done not only to assess lung damage, but also to monitor the recovery process as part of therapy.The first is done three days after the start of treatment, if it does not work and the patient is not recovering. The next CT scan can be repeated a week later if the patient’s condition does not improve.

With favorable treatment in the rehabilitation period, CT of the lungs can be passed twice (interval – 2-3 weeks) in order to monitor the dynamics of lung recovery after coronavirus. In total, it is recommended to do no more than 5 CT scans per year.

Lung tissue is elastic and capable of regeneration.If the pathology is detected on time and treatment measures are taken, then the patient’s body can cope with the infection in 1 month, and after rehabilitation, the functionality of the lungs will be fully restored.

If a patient is admitted to a medical institution with lung damage of more than 50%, has suffered severe pneumonia or acute respiratory distress syndrome, then fibrosis may form.