The purpose of this article is to document the recovery of a broken clavicle that occurred from a nasty bike accident I had this summer. In researching treatment options, I found tons of information about the injury from people in similar situations (the more details the better). However, when it came to recovery, particularly from a surgical repair, I found much less detailed information that discussed the recovery journey. In particular, what were the detailed issues/complications people experienced, and what were the exercises people used to best regain mobility and strength. So I am going to write this blog, and update is as I go, for friends that have a similar fact pattern such that they can better decide their own treatment options knowing what is on the backside of the course they choose.
I now know that clavicle fractures are super common among avid cyclists (and other active sports people). I can finally call myself as a real cyclists! As I spoke with other cyclists, they would ask the question rather casually “Is this your first one?” and then they would go on to tell you how many they had, what happened, 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 badge of honor among car enthusiasts, much like a clavicle break is among serious cyclists. Anyways back to the story…
So, once you break your clavicle, the treatment options are: (1) doing nothing and allowing it heal naturally with your arm in a sling for weeks on end; or (2) get a surgical repair that uses either (i) a plate with screws fixed atop the bone, or (ii) a long pin inserted along the entire bone axial.
My story begins on June 28th, 2017. At the time, I am a 50 years old and in good physical health – some might say better than most – but it’s all relative. I just like to stay super active and outside. More specifics on that as we go.
I was riding to work early on a Saturday morning (6:00am) as 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 after that over the 4th of July. I was riding on a flat segregated bike trail, cruising through a beautiful field at ~25mph (I commute on a eMachine) watching a whitetail deer bound across the field ahead of me when suddenly a dog blasted full tilt out of the tall grass next to me. Apparently, I was the next biggest thing moving through the field for the dog to catch. As I watched the dog underestimate the speed I was traveling at and about to go under my wheels, I reacted by grabbing my breaks to avoid the dog, and then: the bike high-sided me. I flipped over completely, fully am clipped in, and I landed directly on my head, bike in the air 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 all my plans, meetings, obligations, responsibilities, and initiatives were changed – and at that moment, without notice or warning – the power of that feeling hurt more than my body. It was pure emotion, pure thought, and one of the more interesting aspects of experiencing a server 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 over to HCMC. Since it was early, 6:50am, I received a lot of attention quickly. After inspection, it was 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 cheek bone, 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 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, but it’s only a collarbone. I am so grateful that is all that happened in this accident. In my hospital selfi, 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 on 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 was thinking “Don’t you see that bone sticking up into my trapezius? Because I can feel it! Doesn’t that need correction ASAP!” Obviously the clavicle was not shortening because the bone was jammed up 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 you can see in the picture, it was really broken. And I am really active (5X ironman finishes, and assorted other ultra-activities). 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 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 me 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 (not really), 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 backwards 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.
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 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 6th 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 on Tylenol only. A tip here, 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 getting up and moving around.
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 backwards 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 inform me 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 the stiffness and inflexibility of 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% 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 And this gal had good information: Remove This Plate
Hearing about others experiences was very helpful to me, and has helped to give me more confidence in choosing the treatment option best for 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, let me say that I subscribe to the following philosophy for a healthy life: 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. Finally, as a background to my accident and recovery, I was nursing a very sore lower back which results after years of running, mogul skiing, and high intensity activity. I mention this because I have been really slow to get back to running in this recovery. Another philosophical reference and approach of mine is: Everything for a reason. There exists a seed of equivalent benefit in any “hardship.” So this accident has been a great opportunity to relax my back for several months and overall give my body an extended break after years of constant activity. And surprise, my lower back is feeling great!
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 – move 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 motion until it’s uncomfortable. If it hurts or is uncomfortable – stop immediately – move on.
- 20 minutes – pool with small breast strokes. 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.
Tomorrow, I will 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 get the bug out as soon as the fracture is well healed. In my mind, I see no reason for the bone and tissue 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.
To-be-continued with an update after the doctor 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!!