Broken collar bone (clavicle) – The collar bone (see picture) acts like a strut to the shoulder joint and is frequently broken either by falling onto an outstretched arm or directly onto the shoulder. Considerable pain is felt on the top of the shoulder and the person is unable to use their arm. Treatment: X-ray to confirm the diagnosis. If there are any pins and needles or numbness in the arm they should be checked by a medical doctor. If there are no complications, the arm must be rested in a sling for about 3 weeks (which takes the weight of the arm off of the fracture) to allow the break to heal and also reduces the pain. However, if the arm is in a sling for 3 weeks the elbow will stiffen because of lack of use – to stop this, remove the arm from the sling twice per day and move the elbow and wrist through full range while supporting the weight of the arm – see following exercises: After about 3 weeks (depending on how painful the area is) stop using the sling. The shoulder joint will be stiff due to inactivity and will need to be gently moved to loosen it. Exercises 1,2,3 and 4 should be started and carried out 5 times every 3 hours. If pain is felt, especially if it does not settle within minutes – STOP. Leave for a few days and restart when only discomfort is felt. Try to use the arm normally, but do not start heavy arm activities for about 6 weeks after the injury (as pain allows). Exercise 1 - Stand sideways on to a wall. Slowly walk your hand and arm up the wall as high as you are able, then lower. Repeat 5 times every 3 hours trying to get higher each time. This should give some mild stretch or discomfort, but must settle within minutes after. If it does not –STOP. Exercise 2- Stand facing a wall. Walk your hand forwards up the wall then lower. Repeat 5 times every 3 hours going higher each time if able. Exercise 3 – Stand close to a wall. Bend your elbow to 90 degrees, keep it close to your side and fix your hand against the wall. Now twist your body away to give a stretch to the front of your shoulder. Repeat 5 times every 3 hours and try to go further each time. Exercise 4 – Stand holding a stick or towel behind your back. Your painful arm should be in your lower back. Begin to straighten your upper (good) arm, which will pull your lower (painful) arm up your back and stretch. Repeat 5 times every 3 hours. As you regain more movement it is important to start doing normal daily activities gently as you are able and increase them steadily to regain normal full function. To increase the strength of the muscles around the shoulder, begin to use your arm more normally and increase your activity level carefully as symptoms allow. You should try the following: Exercise 5- Stand leaning against a wall. Lower your body against the wall slowly by bending your arms then straighten again. Do 10 times then rest for a few minutes then do a second and then third set. This should make your arm and chest muscles feel tired, but must NOT cause pain. If pain is felt, STOP. To progress this exercise you can step further away from the wall, or use a bench press machine in a gym. Exercise 6 - Exercise 6 is a progression of Exercise 5. You can start with hands and knees on floor and bend your elbows slowly (without letting your chest touch the floor). To progress this further you can start with your hands and feet on the floor (the traditional press up). Try 3 sets of 10 exercises. This can be made harder by doing more repetitions (i.e. 3 sets of 20, 30 etc) or by starting with your feet raised such as having them on a chair. This will put more body weight through the arms. Exercise 7 – Stand sideways on to a wall. Bend the elbow of your affected arm to 90 degrees and keep it in to your side. Hold a rubber theraband or a pulley in a gym. Turn your lower arm out slowly so stretching the band (or pulley). Do 3 sets of 10 exercises (you may vary the number depending on how easy you find this exercise). STOP if this causes pain. Try either less repetition or reduce the weight. Exercise 8 – This is very similar to Exercise 7 but this time you stand the other way around so that you pull the band INWARDS toward your stomach, not outwards. Stand side on to a wall. Bend the elbow of your affected arm to 90 degrees and keep it against your body. Hold a rubber theraband or pulley. Turn your lower arm inwards toward your body to stretch the band. Do 3 sets of 10 exercises (increase or decrease this number depending on how difficult you find this exercise). Do these strengthening exercises daily if possible and increase the number you do, as you are able.