What is included in the physical exam for clavicle fractures?

Updated: Jan 14, 2019
  • Author: Benjamin P Kleinhenz, MD; Chief Editor: Craig C Young, MD  more...
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Answer

The patient may cradle the injured extremity with the uninjured arm.

The shoulder may appear shortened relative to the opposite side and may droop. Swelling, ecchymosis, and tenderness may be noted over the clavicle. Abrasion over the clavicle suggests the fracture was from a direct mechanism. Crepitus from the fracture ends rubbing against each other may be noted with gentle manipulation.

A thorough upper extremity examination is necessary, and special attention should be paid to the neurovascular status. Identification of an associated distal nerve dysfunction indicates a brachial plexus injury, and decreased pulses may indicate a subclavian artery injury. Venous stasis, discoloration, and swelling indicate a subclavian venous injury. [2, 3]

Difficulty breathing or diminished breath sounds on the affected side may indicate a pulmonary injury, such as a pneumothorax. Palpation of the scapula and ribs may reveal a concomitant injury. Tenting and blanching of the skin at the fracture site may indicate an impending open fracture, which most often requires surgical stabilization.


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