COLLARBONE-AREA STRAIN, DELTOID MUSCLE
DEFINITION--Injury to the deltoid muscle or tendon that attaches to the collarbone (clavicle). Muscle, tendon and bone comprise a unit. The unit stabilizes the shoulder and allows its motion. A strain occurs at the unit's weakest part. Strains are of 3 types:Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in the muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair.
BODY PARTS INVOLVED
Deltoid muscle and deltoid tendon in the collarbone area.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
SIGNS & SYMPTOMS
Pain with motion or stretching, particularly throwing.
Swelling in the collarbone area.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or tendon (visible with X-rays).
Inflammation of the tendon sheath.
Prolonged overuse of the deltoid muscle-tendon unit.
Single violent injury or force applied to the collarbone area.
RISK INCREASES WITH
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Previous shoulder or collarbone injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Use proper protective equipment, such as shoulder pads, when appropriate.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the collarbone area to rule out fractures.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic shoulder following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injections of corticosteroids, such as triamcinolone, to reduce inflammation.
For a moderate or severe strain, use a sling for at least 72 hours.
Resume your normal activities gradually.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when pain subsides. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe deltoid strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.