Ask Doctor Hockey – Clavicle Fractures

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Question

I was recently checked hard into the boards (from behind) and was unable to continue playing because of sharp pain in my shoulder. I went to the Emergency Department and got x-rays. I was told I have a broken clavicle on my left side. I shoot left-handed.  How long will I be out with this injury?

 

Answer

The clavicle is a “S” shaped bone in your shoulder that helps connect your arm to your torso. It acts as a strut between the shoulder blade and the sternum and is the only long bone in the body that lies horizontally! It is unfortunately a commonly fractured bone in ice hockey players.

 

The clavicle can break anywhere along the bone and the common mechanism of injury from ice hockey can be from a check into the boards or a fall onto the ice.  The bone can break cleanly in one spot or be in multiple pieces or fragments.  A player with a clavicle fracture will have pain in the shoulder area, bruising, sometimes there will be gross deformity of the contour of the shoulder, and there can even be tenting of the overlying skin.

 

You did the right thing by going to the Emergency Department for medical treatment to obtain x-rays of this injury. Your sports medicine physician should be able to discuss with you treatment options to help get the fracture to heal and have you back on the ice.

 

The majority of clavicle fractures can be treated conservatively without surgery in just a sling. This is often selected for players with minimally displaced fractures or with more simple patterns of injury. A sling is usually worn for 4 to 6 weeks, or until the fracture is healed on x-ray. Then, a period of physical therapy is usually required for at least a couple of weeks before returning to a collision sport like hockey. Physical therapy can be very helpful to regain strength in the shoulder. Return to the ice in these fractures can occur anywhere between 8 and 12 weeks from the injury depending on healing and recovery of strength.

 

Some clavicle fractures are significantly displaced or very comminuted and require surgery to fix to get you back to the rink. There have been some high profile ice hockey players that have had surgery for their broken clavicles in the last couple of NHL seasons. Patrick Kane fractured his clavicle during the 2015 season.

He was expected to miss between 10-12 weeks, but was able to return for the playoffs after seven weeks. A benefit of surgery for some clavicle fractures can be a more predictable and expedited return to sport, but you will need to discuss this with your physician to see if you fracture is appropriate or indicated for surgery.

 

Finally, the last thing to consider with return to the ice after a clavicle or upper extremity injury is shoulder dominance, which determines your stick grip. A left-handed player like yourself, places the right hand on the top of the stick for support, but most of the motion of shooting the puck occurs with your left shoulder. It may take you a week or two longer to get your strength back in your dominant shoulder before you hit the ice after a clavicle fracture.

 

Clavicle fractures are a common injury in ice hockey. Treatment for these injuries can range from a sling to even surgery if the fracture is severe. Ice hockey players can get back on the ice after the fracture has healed, they have pain free motion and their strength has returned.  This will allow the player to stick handle, shoot and receive contact with low risk of re-injury.

 

     

Lead physician at HockeyClan

Charles A. Popkin, MD is an Assistant Professor of Orthopedic Surgery at the Center for Shoulder, Elbow and Sports Medicine at Columbia University in New York. Dr. Popkin is currently conducting research on ice hockey injury prevention and has published on both youth and adult ice hockey injuries. A lifelong hockey enthusiast, Dr. Popkin has cared for college hockey teams in both Minnesota and Canada.

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