Photo Rounds

Clavicle pain, swelling, and bump

A 17-year-old boy was brought in to see his family physician (FP) after falling off his skateboard and landing directly on his lateral shoulder, causing immediate pain. On physical exam, the FP noted a bump in the middle of his clavicle. The FP ordered an x-ray.

What's your diagnosis?


The x-ray revealed a midclavicular fracture. Clavicular fractures are common in both children and adults, and are most commonly caused by accidental trauma. The most common place of fracture is in the midshaft, but the clavicle can also fracture distally. Many fractures can be treated conservatively, but patients with significant displacement or distal fractures should be referred for surgical evaluation.

In this case, the FP treated the patient conservatively with a sling, which the patient wore for approximately one of the recommended 3 weeks. A follow-up x-ray demonstrated good healing. The bump over his clavicle was still palpable, but did not bother him.

Photo and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley, H. Clavicular fracture. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:601-604.

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