What's the Diagnosis? By Dr. Patrice Baptista

A 4 yo M presents to Urgent Care with R shoulder pain after a fall off his bed. Father denies any head trauma or other injury. On exam, he has decreased ROM at the R shoulder and tenderness and ecchymosis along the distal/mid clavicle. Neurovascular exam is normal. An xray is done and shown below. What's the diagnosis?  (scroll down for answer) 




Answer: Acute fracture of the R mid clavicle with minimal inferior displacement

  • Etiology:
    • Most commonly caused by fall onto shoulder (85%), less commonly fall onto outstretched hand
  • Presentation:
    • patients typically present w/ guarding/favoring of affected arm
    • may see gross deformity, focal tenderness, swelling or ecchymosis of the clavicle
    • pain is worse w/ ROM
  • Diagnosis:
    • often diagnosed by history and physical exam
    • plain radiography
  • Allman System used to classify clavicle fractures based on location:
    • Group I- middle third clavicle fracture (80%)
    • Group II- distal third clavicle fracture (10-15%)
    • Group III- proximal third clavicle fracture (5%)
  • ED management:
    • must perform neurovascular exam due to close proximity to brachial plexus and subclavian vessels
    • non-displaced (or minimally displaced) fractures are often managed non-operatively 
    • operative management determined by location, stability and degree of displacement
    • orthopedic referral
    • emergent surgical consult for airway or great vessel involvement



Allman, Fred L. “Fractures and ligamentous injuries of the clavicle and its articulation.” The Journal of Bone & Joint Surgery 49.4 (1967): 774-784.

Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am. 2020;38(1):103-124.