The purpose of this blog is to document the recovery of a broken clavicle that occurred after a nasty bike accident. In researching treatment options for a broken clavicle (i.e. collar bone), I found tons of information about the injury. However, when it came to recovery, and particularly from a surgical repair and implant, I found little information. What I wanted to know was what were the detailed issues and complications people experienced, and what were the exercises people used to regain mobility and strength? So this blog, and its updates, are for friends that have a similar fact pattern so they can better decide their own treatment options.
It turns out, clavicle fractures are super common among avid cyclists (and other active sportspeople). I guess I can finally call myself a real cyclist! As I spoke with other cyclists, they would ask, “Is this your first one?” and then they would go on to tell me how many they had, what happened, and how they recovered. What a painful badge of honor among our cycling community – I had no idea.
Quick Sidebar Story: This reminds me when I snapped another bone several years back: The u-joint of my 1967 Pontiac 400. Too much rubber burning. When I informed my father-in-law about the problem he said, “Is that your first one?” Apparently he had six under his belt by the time he was 21. A snapped u-joint in a muscle car (which can inflict serious damage to your ride) is a badge of honor among muscle car enthusiasts, much like a clavicle break is among serious cyclists.
So, once you break your clavicle, the treatment options are: (1) do nothing and allow it to heal naturally with your arm in a sling for weeks; or (2) surgically repair it with either (i) a plate with screws fixed atop the bone, or (ii) a long pin inserted along the entire bone axial.
Background
My story begins on the morning of June 28th, 2017. At the time, I was 50 years old and in good physical health cycling in to work at 6:00am Saturday morning. That day, I had a lot of work to do, prepping for travel on Sunday, with several meetings over the next 4 days, and further holiday travel over July 4th. I was riding on a flat segregated bike trail, cruising through a beautiful field at ~25mph (I commute on an eMachine) when I saw large whitetail deer bound across the field ahead of me and then suddenly a dog blasting full tilt out of the tall grass under my bike. Apparently, after the buck, I was the next biggest thing moving through the field for the dog to catch. As the dog went under my bike, I grabbed my breaks to avoid the dog, and then high-sided the bike in a flip, fully clipped in, landing directly on my head with the bike overhead. The last thing I remember was the sound of the impact.
I was knocked out cold, and when I awoke, three joggers were standing overhead reassuring me that I was going to be alright and that an ambulance was on its way. Wow! As I lay on the ground, blood dripping down my forehead, I immediately recognized that I was really hurt. I also knew that my work day, with all my plans, meetings, obligations, responsibilities, and initiatives had changed – and at that moment, without notice or warning – that feeling hurt more than my body. It was pure emotion, pure thought, and one of the more interesting aspects of experiencing a severe accident.
The fire department was first on the scene (who took my bike back to the station – thank you guys!) until the ambulance arrived to take me to HCMC. Since it was early, 6:50 am, I quickly received a lot of attention. My exam revealed that I had suffered a major concussion and my clavicle was snapped – a mid-shaft fracture. That was the worst of it, and frankly, I felt as though I had cheated death, a cracked skull, a broken back, a snapped neck, a smashed eye socket and cheekbone, or massive jaw and teeth injury were all real possibilities.
So let me be clear on this point, I feel really lucky, my helmet was smashed into my forehead and I was going fast enough and hit with enough force to end up in a permanent coma, paraplegic, or worse. And while a clavicle fracture is painful and uncomfortable, it’s a collarbone. I am so grateful that is all that happened in this accident. In my hospital selfie, you can see the imprint the helmet left on my forehead – when I say I landed on my head, I mean I landed on my head.
On Monday, I went to see a highly recommended orthopedic doctor. When we reviewed the x-ray, he said that despite the large bone separation, there was little shortening of the length of the clavicle, and therefore we should wait and see before making a decision on surgery. What? For real? Apparently, if there is little shortening (overlap) of the clavicle, the preferred treatment is keeping it in a sling and waiting for the bone to heal itself (unless you are a professional athlete or your job demands you show up and use your arm).
Looking at the x-ray, I am thinking “Don’t you see that bone sticking up into my trapezius? Because I can feel it! Doesn’t that need to be corrected ASAP!” Obviously, the clavicle was not shortening because the bone was jammed u
p into the trap muscle (think of a knife jammed into a meaty steak), so my shoulder was not going anywhere. I thought to myself, “Hmmm, it looks to me like this break should be realigned.” As I pleaded my case to the doctor, he said “Make no mistake, I like to cut” but he seemed uninterested in my active lifestyle and said, “I will see you in a week to see if it moves, have a good weekend.” So I sought a second opinion.
The second orthopedic doctor said, “Yep, that break looks like it should be corrected with surgery, you’re an active guy and aligning it properly will be best for you.” After I told him he was my second opinion, and the first doctor said I should let it heal naturally, he said “Well, let’s wait a few days and see if it moves.”
So I waited over the July 4th weekend with a bone tip knife sticking into my trapezius (arghhh) thinking surgery for sure! That was until a friend shared a picture of the plate and screws that were installed into his collarbone the year prior. This was when I thought, “Whoooaaa… What is that?!!!” Suddenly this was a much bigger decision.
After a great holiday weekend sitting upright for three days in a chair on pain killers, I went back to see both doctors. I saw the second orthopedic first. We took another picture, and he said, “Yep, surgery, and I have time tomorrow morning, let’s get it done.” I said “Ok” – what else I am supposed to say. Then I drove myself to the other doctor, who took another picture, and said, “Man you look good, and I think surgery is going to be a step backward in your recovery.” Truth was, I was already starting to feel better (using a power washer and leaf blower over the weekend with my arm in a sling). I said, “Ok, are you sure?” He said, “Yep, we can always cut later, get on the physical therapy schedule, and see me in a month.” I said “Ok” and left.
Decision Time
Contemplating what to do next I went back to internet research and I found no answers. Ultimately, I concluded that I was going to have a great recovery either way. I was strong (a dozen pull-ups no problem, regular workouts with 70lb+ dumbbells no problem, 100 push-ups no problem, etc.) But which way to go? I opted to keep my surgical appointment. I figured that because I was already feeling better, I was going to start getting busy, and I had the risk of a non-union (that is when the bone does not grow back together). It was clear from the x-ray that in order for the bone to heal back together naturally, the bone must somehow reconnect through the trapezius. That looked wrong to me and my proclivity towards staying busy and constantly moving was already taking hold. The thought of having surgery later after a non-union was something I did not want to deal with – drawing the recovery out even longer. And because I am active, over the long haul, I figured having the bone properly aligned for mobility and functionality was best. The risk of surgery was real and severe, but it was hard for me to quantify.
On August 6, 2017, I had my clavicle surgically repaired, whereby in my case the doctor made an incision along the collarbone, scraped the tissue away from the bone, placed
a plate along the top of the bone, and secured the plate with seven screws. It’s a day surgery and I was home later that afternoon.
Post-surgery, I managed my pain with medication, and after a few days was just taking Tylenol. Pro-tip: Being able to sleep in a chair or upright will be helpful if you go through any type of surgery. You are not going to sleep well, so being a little upright is helpful for getting up and moving around.
Recovery
As I write today, it is eight weeks post-surgery and the question in my mind is did I make the right decision? Well, the first doctor was right: Surgery feels like a step backward in terms of my recovery. While I still know I will make a strong and full recovery, there has been some real pain associated with the surgical repair. Today, as I write this post, I cannot wait to get the plate and screws out. Again, that is why I am writing this blog and documenting my recovery, so others can learn and make informed choices.
I am anxious to feel 100% and get to full power again. So while there are lots of resources on the web documenting clavicle fractures and treatments, I was challenged to find more information about the recovery from surgery. Obviously, everyone and every situation is unique, but my experience has been that the more I know about the particulars, the more it has helped me sort out and make decisions about my own path. Plus, for as much as there is on the web about clavicles and treatments, there is very little out there telling you about the physical therapy and recovery plan from a clavicle fracture.
Today, the feeling of stiffness and inflexibility from the plate and screws in my shoulder can best be described as having a big metal bug attached to my shoulder (it looks like that too). And today, I feel that until I get that metal bug off me, I am not going to feel as good as I could. I mean how would it be possible? Look at the metal and screws in my shoulder? Many people report no issues with plates and screws, but there are a few voices that report otherwise. One study I read reported 6% to 74% of people complain (what a range!) and remove the plate and screws. Another blog thread I found that was really helpful on this point and finally got me going to write this blog post is Triathlon Forum. I also found good information at Remove This Plate.
Hearing about others’ experiences was very helpful to me. Listen to your doctor, but be your own advocate! Right now, getting that metal bug off my shoulder feels like it will be necessary to return me to feeling more like myself. Of course, it’s still early, but that is what I am feeling today.
Current Rehabilitation Activities
Disclaimer: The activity routine to date is completely of my own design, as there is little on the web to tell me otherwise, and I have yet to see a physical therapist.
At the outset, I subscribe to the philosophy that: Motion is Lotion. I have found that when I am in motion, everything seems to get better. Whether it is my mental state, a sore muscle, or injury recovery – getting in motion, increasing blood flow and oxygen, is my go-to fix. That said, rest is super super important. In the end, I listen to my body.
My current daily routine is:
- 20 minutes – cable pulls. Up, down, back, front, push and pull, with 5 to 15 lbs. Do as many reps as I can during the time. Extend the range of motion until it’s uncomfortable. If it hurts or is uncomfortable, stop immediately and move on to something else.
- 20 minutes – dumbbell curls, tri extensions, bench press, with 5 to 10 lbs. Do as many reps as I can during the time. Extend range of motion until it’s uncomfortable. If it hurts or is uncomfortable, stop immediately and move on.
- 20 minutes – pool with small breaststrokes. Work to extend reach, stroke to the sides, stroke down, reach until its uncomfortable – stop or shorten stroke if it hurts.
This routine is really causing me to get some range of movement back and stimulating my muscles. I experience a lot of fascia tightness after the workouts – which is strange – the metal bug grabbing me – but overall I am feeling much better.
Doctor’S Appointment
Tomorrow, I meet with the doctor, take a picture, and talk about rehabilitation. I intend to ask for an appointment to remove the metal bug at the earliest date possible. With that on the calendar, I will continue to rehab and move forward, but I want to meet that day soon. Unless I experience a material change in the way I feel about the stiff metal bug on my shoulder, it will come out. And I am not going to wait a year. My thinking is to get the bug out as soon as the fracture is well healed. In my mind, I see no reason for the bone and tissue to connect at, or around, the plate and screws. I will be taking it as easy as I can, although I am now back on my daily bike commute to work, and activity just has a way of creeping into my life. Once the metal bug is out, I intend to wrap it with some strength and muscle for further protection, while being as careful as I can on the bike.
Read Clavicle Injury Recovery Part 2: Collarbone Fracture Rehabilitation Begins for an update after the doctor’s appointment and more specifics on a rehabilitation plan with input from a professional physical therapist.
Check back soon! Good luck with overcoming your own challenges!!