Question
I am 23 years old now and I broke my collar bone playing
soccer abour 7 years ago. At the time of the break the doc
chose to let the bone heal on its own and said I did not
require surgery.  A few years later I started having pain in
my clooar bone, shoulder and scapula area of my back on the
side of the break.  I went to an ortho surgeon and after an
x-ray and MRI I was told I should have a metal plate and
screw put in to help with the discomfort because the collar
bone did not heal properly.  This is a pretty traumatic
surgery and I dont exactly have the time to be out of work
and school to have it done.  I am now having constant pain
in all the same areas but worse then ever, even the
slightest bit of throwing a ball and my shoulder hurts very
badly.  I was wondering if there is any type of massage
therapy that can be done or if a chiropractor can fix any of
this. I am just tired of the pain but don't want to have the
surgery.  Thanks for you time.

Answer
Dear Meagan,

Shoulder injuries sure can be tough, and the fact that you fractured the collar bone doesn't make your case any easier...

The collar bone's attachment to your sternum or breast bone is the ONLY solid bone to bone joint that connects your entire shoulder girdle to the trunk of your body. After it leaves the sternum, it attaches to the shoulder blade near the tip of the shoulder. The shoulder blade is attached to the back of your thoracic cavity simply through muscles, allowing it to "float" and thus allowing your shoulder to perform some amazingly complex movements. The upper arm bone is attached to the shoulder blade by what is called a ball and socket joint. The only other ball and socket joints in the body are at the hips. The shoulder joints are much more shallow and much less stable. They do, however, allow for much more movement than the hip ball and socket joints.

It is possible that during your injury that you not only broke the collar bone, but that you might have injured other shoulder joint components, such as the acromial/clavicular joint (where the collar bone attaches to the shoulder blade) or the sternoclavicular joint (where the collar bone attaches to the sternum). Both of these joints should be evaluated for stability. Do you get any popping in the chest when you move your shoulder and arm? Have you ever had the shoulder evaluated by x-ray while holding a weight in the hand of the injured shoulder?

When the collar bone is injured, it alters the mechanics of the shoulder, often resulting in additional mechanical issues, such as with the supporting muscles of the shoulder. The muscles of the shoulder and shoulder blade play a very key role in stabilization of the shoulder joint.

If you were in my clinic, I would evaluate these additional two joints. I would also take a long hard look at the muscles around the shoulder joint, such as the rotator cuff muscles. These are the muscles that are attached to the shoulder blade and to the head of the upper arm bone.. This set of muscles are often the cause of shoulder pain, and they can be treated quite easily, if involved, by a chiropractor or physical therapist, as long as they are not completely torn at the tendon or at their attachments. Other muscles that might be involved with your pain include the pectoral muscles, the levator scapula muscle, the Sternocleidomastoid muscle, and the deltoid muscle. Each of these should be evaluated and treated accordingly.

Meagan, you can always have surgery after everything else has failed, but once you have surgery, you can never go back again and undo it. My advise would be to seek out a good chiropractor who will evaluate your shoulder movement and give him/her a good try. Don't expect instant success. Give him or her about 2-4 weeks. If you find that you are getting some success, give them some more time. Make sure that the chiropractor is not claiming that adjustments of the spine alone are going to fix the problem, or that adjustments of the shoulder alone are going to fix your problems. These would be red flags. Find another one, and try again. If the chiropractor does not help, try a physical therapist. Whichever you try first should include in their first visit a good examination. A good treatment plan might possibly include trigger point work in the malfunctioning muscles, stretching, and strengthening techniques. Electrical stimulation and ultrasound might be helpful to control the symptoms but will not improve things for the long term. Shoulder mobility techniques and doctor assisted active range of motion techniques might also be useful.

If you find that the chiropractor/physical therapist and the exercises are helping, remember to continue your exercises at home and your maintenance care with your doctor.

One last thought. If your collar bone is truly and severely deformed, it could be causing significant movement/mechanical problems that can be fixed by nothing short of surgery. Keep an open mind to all potential treatments. Exhaust your non-invasive options first, and work your way gradually toward the most invasive options last.

Good luck Meagan. I hope that my answer gives you at least some ideas. It has been my pleasure!  Let me know how things work out for you, and what you have decided to do!