Pain in the shoulder region can be due to any number of structures in the area and the clavicle is one of them. The clavicle, or collarbone as most of us refer to it, is the bone that connects the arm to the rib cage. It helps to transmit force from the arm to the torso as well as in stabilizing the arm when it moves. The collarbone also plays a role in protecting the internal organs in the chest cavity just like the ribs and sternum. Just behind the clavicle lies the apex of the lungs.
As with any part of the body, collarbone pain is usually an indication of tissue injury or damage. There are various mechanisms by which this occurs and some can be serious while others less so. Pain is often associated with inflammation and even though bone is among the hardest structures in the human body, it is not immune from injury, diseases and inflammation. Sometimes the pain that is felt as collarbone pain is not from the bone itself but rather from the surrounding structures or organs.
It is also important to note that collarbone pain may not be related to the clavicle or soft tissue around it. For example, clavicle pain can sometimes be associated with heart conditions, as is the case with left arm pain seen in heart attacks. Similarly, right shoulder pain may sometimes be seen with a condition like gallstones originating from the upper abdominal area.
Causes of Clavicle Pain
Collarbone pain can occur for any number of reasons as would pain elsewhere on the thorax, especially bones. Most of the time the pain originates from injuries but the collarbone can also become infected, weakened or cancerous as with any part of the body. This can give rise to the bone pain. Similarly the structures around the bone, include ligaments, muscles and organs like the lungs. Sometimes the pain to the area originates at a distant site and either radiates or is referred to the clavicle.
Injury to the bone is often associated with trauma like a blow or fall. Not all injuries will lead to fractures but can still cause significant clavicle pain even though the bone is so strong. These types of bone injury are often acute meaning that it will last for a short period of time and resolve on its own in due course. In most instances the soft tissue lying over the bone is also injured and can also contribute to the overall pain described as clavicle pain.
A fracture or broken bone is one of the worst outcomes of trauma. It is more likely to occur with a fall, assault or as part of a car accident injury. The fracture can be either classified as simple or compound. A simple fracture is a break in a part of the bone with any damage to surrounding structures or organs. A compound fracture is where the break in the bone also damages surrounding soft tissue and may even penetrate the skin to protrude through it.
Cancer of the bone is not a common cause of clavicle pain but it is a possibility. The cancer may arise in the bone itself, in which case it is referred to as a primary malignancy, or it can spread to the bone from other sites in which case it is referred to as secondary cancer. This metastatic spread is more likely to occur with cancer of surrounding organs like lung cancer that may then spread to the collarbone (clavicle). The collarbone pain may not always emanate from the clavicle itself but from surrounding tissue.
Muscles that attach to the clavicle can also be the cause of perceived collarbone pain although the bone itself is not diseased or injured. There are several muscles that attach to the clavicle, including muscles of the neck, chest and shoulder. Most often muscular pain is due to muscle strain like with carrying heavy weights or prolonged use. Other possible causes include muscle tears spasm, blunt or sharp force trauma. Tendons may also become inflamed (tendonitis) or torn either partially or sometimes completely.
The clavicle articulates on one end with the shoulder blade and on the other end with the breastbone (sternum). These joints can be diseased in various ways that can lead to pain which may be described as collarbone pain. Arthritis is the more common cause and this term simply means that the joint is inflamed. It does not indicate the cause of the disease. Ostearthritis is where the joint cartilage and bone is worn down. Rheumatoid arthritis is where the joint is inflamed due to autoimmune factors. Post-traumatic arthritis arises after an injury where the joint is strained and septic arthritis is caused by an infection.
Bands of connective tissue known as ligaments provide support and stability to muscles, joints and bones. These bands can become injured in the same way as tendons of the muscles. When the ligament is strained and inflamed, it is often referred to as a sprain. Ligament tears may be partial or complete and is usually associated with sharp force trauma or high impact force that causes sudden and excessive stretching of the ligament to the point where it may tear.
Pain is only a symptom of some underlying problems and other symptoms often accompany the pain. This includes:
- Swelling over and around the location of the clavicle (collarbone).
- Redness and heat of the skin over the collarbone.
- Pain during breathing.
- Pain with arm movements.
- Limited range of motion of the arm on the affected side.
- Bleeding is more likely to occur with a compound fracture or sharp force injury.
Acute symptoms are those that arise suddenly and are typically severe. It is usually associated with trauma, fractures and muscle strain. Chronic symptoms are usually associated with conditions like rheumatoid arthritis. These symptoms arise gradually and tend to persist for long periods of time. Collarbone (clavicle) pain should always be investigated by a medical professional, especially if it is persistent or the pain is worsening. Investigations like an x-ray may be necessary to identify the underlying cause.