Clavicle: Difference between revisions – Physiopedia


 

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== Description  ==

== Description  ==

[[File:Clavicle anterior view.png|thumb|Clavicle anterior view]]

[[File:Clavicle anterior view.png|thumb|Clavicle anterior view]]

The Clavicle also known as the collar bone, is a sigmoid-shaped long bone<ref>Hyland, S and Varacallo, M. Anatomy, Shoulder and Upper Limb, Clavicle. Available from https://www.researchgate.net/publication/329717390_Anatomy_Shoulder_and_Upper_Limb_Clavicle Accessed 20 July 2020</ref> that makes up the front part of the shoulder. It sits between the shoulder blade and the sternum. There are 2 clavicles in a person, one on the right and the other one on the left side. It is the only long bone in the body that lies horizontally.   

The Clavicle also known as the collar bone, is a sigmoid-shaped long bone<ref>Hyland, S and Varacallo, M. Anatomy, Shoulder and Upper Limb, Clavicle. Available from https://www.researchgate.net/publication/329717390_Anatomy_Shoulder_and_Upper_Limb_Clavicle Accessed 20 July 2020</ref> that makes up the front part of the shoulder. It sits between the shoulder blade and the sternum. There are 2 clavicles in a person, one on the right and the other one on the left side. It is the only long bone in the body that lies horizontally.   

== Articulations ==

== Articulations ==

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== Blood Supply ==

== Blood Supply ==

The internal thoracic artery and suprascapular artery branches of the subclavian artery supply blood to the sternoclavicular joint. <ref name=”:3″ />

The internal thoracic artery and suprascapular artery branches of the subclavian artery supply blood to the sternoclavicular joint. <ref name=”:3″ />

== Nerve Supply ==

== Nerve Supply ==

The sternoclavicular joint is directly innervated by the the medial supraclavicular nerve (C3-C4) and the nerve to the subclavius (C5-C6). <ref name=”:3″ />

 

The sternoclavicular joint is directly innervated by the the medial supraclavicular nerve (C3-C4) and the nerve (C5-C6). <ref name=”:3″ />

== Muscle Attachments ==

== Muscle Attachments ==

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* The clavicle plays an essential role in functional movement, serving as the connection between the axial skeleton and the pectoral girdle. This allows the clavicle to act as a brace for the shoulder, allowing weight to be transferred from the upper limbs to the axial skeleton.<ref name=”:1″ />  

* The clavicle plays an essential role in functional movement, serving as the connection between the axial skeleton and the pectoral girdle. This allows the clavicle to act as a brace for the shoulder, allowing weight to be transferred from the upper limbs to the axial skeleton.<ref name=”:1″ />  

* The clavicle plays a protective role for neurovascular structures entering the thorax (for example brachiocephalic arterial trunk, internal jugular vein, [[Common Carotid Artery|common carotid artery]], [[Vagus Nerve|vagus]] and [[Phrenic Nerve|phrenic]] nerves) along with the sternum. <ref name=”:3″>Epperson TN, Varacallo M. [https://europepmc.org/article/nbk/nbk537258 Anatomy, shoulder and upper limb, sternoclavicular joint].</ref>

* The clavicle plays a protective role for neurovascular structures entering the thorax (for example brachiocephalic arterial trunk, internal jugular vein, [[Common Carotid Artery|common carotid artery]], [[Vagus Nerve|vagus]] and [[Phrenic Nerve|phrenic]] nerves) along with the sternum. <ref name=”:3″>Epperson TN, Varacallo M. [https://europepmc.org/article/nbk/nbk537258 Anatomy, shoulder and upper limb, sternoclavicular joint].</ref>  

* The [[Clavicular Fracture|clavicular fracture]] (broken collar bone) is most commonly caused by a fall or blow to the shoulder. It is usually managed with conservative management of wearing a sling and rest. If the fracture results in the bone piercing the skin surgery will be considered to fit a plate with screws. <ref>NHS. Broken collarbone. Available from: https://www.nhs.uk/conditions/broken-collarbone/ (accessed 20 July 2020)</ref>

* The [[Clavicular Fracture|clavicular fracture]] (broken collar bone) is most commonly caused by a fall or blow to the shoulder. It is usually managed with conservative management of wearing a sling and rest. If the fracture results in the bone piercing the skin surgery will be considered to fit a plate with screws. <ref>NHS. Broken collarbone. Available from: https://www.nhs.uk/conditions/broken-collarbone/ (accessed 20 July 2020)</ref>

* Also check the related [[Acromioclavicular Joint Disorders]] and [[Sternoclavicular Joint Disorders]] pages to gain more insight into the clinical anatomy of the clavicle.

* Also check the related [[Acromioclavicular Joint Disorders]] and [[Sternoclavicular Joint Disorders]] pages to gain more insight into the clinical anatomy of the clavicle.

== Physiotherapy Relevance ==

== Physiotherapy Relevance ==

The Clavicle also known as the collar bone, is a sigmoid-shaped long bone[1] that makes up the front part of the shoulder. It sits between the shoulder blade and the sternum. There are 2 clavicles in a person, one on the right and the other one on the left side. It is the only long bone in the body that lies horizontally.

Right clavicle inferior view.png

Due to the clavicle’s structure, there are only two planar diarthrosis articulations that can be found. This type of articulation is also known as a ‘double plane joint’ – where two joint cavities are separated by a layer of articular cartilage.

The Acromioclavicular joint: The articulation between the clavicle and the Scapula.[2]

The Sternoclavicular joint: The articulation between the clavicle and the Manubrium.[2]

Acromioclavicular Joint (Articulatio acromioclavicularis)[edit | edit source]

This is articulation between the acromial end of the clavicle and the acromion of the scapula. It enables slight gliding movement about the shoulder region. It is a synovial joint surrounded by a capsule of articular cartilage filled with intra-articular synovium.[3]

Sternoclavicular Joint (Articulatio sternoclavicularis)[edit | edit source]

This is the articulation between the sternal end of the clavicle and the manubrium of the sternum. This synovial joint is important as it attaches the clavicle and scapula to the axial skeleton. The joint enables a variety of limited movements of the arm, including:

  • Protraction and retraction
  • Elevation and depression
  • Axial rotation

The suprascapular, thoracoacromial, and internal thoracic (mammalian) arteries are the ones that have been found to provide arterial supply to the clavicle in previous studies. [4]

The internal thoracic artery and suprascapular artery branches of the subclavian artery supply blood to the sternoclavicular joint. [5]

The clavicle and clavicular joints are innervated by the subclavian, lateral pectoral, and supraclavicular nerves. [6]

The sternoclavicular joint is directly innervated by the the medial supraclavicular nerve (C3-C4) and the subclavius nerve (C5-C6). [5]

A total of five muscles are attached to the clavicle, found distributed at either the lateral third or medial two-thirds of the bone.

A, left clavicle from above; B. right clavicle from below

Two muscles are attached to the lateral third of the clavicle:

  • The trapezius muscle, which is attached along the posterior surface of the lateral third of the clavicle.
  • The deltoid muscle, where the anterior portion of the muscle is attached to the periosteum at the anterior surface of the bone.

Three muscles are attached to the medial third of the clavicle:

  • The sternocleidomastoid muscle, the clavicular head of the muscle attaches to the medial third of the clavicle.
  • The pectoralis major muscle, which is attached to the anterior surface of the bone.
  • The subclavius muscle, which is attached to a groove found in the middle of the bone’s inferior surface. From there, the muscle extends into both lateral and medial areas of the clavicle.[3] It’s action is to draw the clavicle downwards and forward. [2]

Among them, deltoid and trapezius muscles provide the dynamic stability of the acromioclavicular joint. [7]

The acromioclavicular joint (AC) is stabilised by the acromioclavicular capsule and ligaments and the coracoclavicular ligament. [7]

The acromioclavicular ligament originates from the anteromedial edge of the acromion and inserts to the lateral aspect of the clavicle. It can be divided into three parts; superior, inferior and anterior. It provides horizontal stability to the AC joint. [8]

The coracoclavicular ligament consists of two ligaments trapezoid and conoid ligaments, which provide vertical stability to the AC joint. The trapezoid ligament is larger and roughly quadrilateral in shape, inserts onto the distal clavicle along the trapezoidal line/ridge and restrains posterior clavicular displacement and AC compression; while the conoid ligament is conical in shape, nearly vertical, located posteromedial to the trapezoid ligament and restraining superior migration of the clavicle. [7]

  • The clavicle plays an essential role in functional movement, serving as the connection between the axial skeleton and the pectoral girdle. This allows the clavicle to act as a brace for the shoulder, allowing weight to be transferred from the upper limbs to the axial skeleton.[3]
  • The clavicle plays a protective role for neurovascular structures entering the thorax (for example brachiocephalic arterial trunk, internal jugular vein, common carotid artery, vagus and phrenic nerves) along with the sternum. [5]
  • The clavicular fracture (broken collar bone) is fairly common and most commonly caused by a fall or blow to the shoulder. It is usually managed with conservative management of wearing a sling and rest. If the fracture results in the bone piercing the skin surgery will be considered to fit a plate with screws. [9] [10]
  • Also check the related Acromioclavicular Joint Disorders and Sternoclavicular Joint Disorders pages to gain more insight into the clinical anatomy of the clavicle.

Acromioclavicular joint mobilisation: As a manual therapy method applied by a physiotherapist, when added to standard physical therapy in frozen shoulder patients, it is more effective in improving outcomes such as pain, disability and active abduction range of motion than standard physical therapy alone. [11]

  1. Hyland, S and Varacallo, M. Anatomy, Shoulder and Upper Limb, Clavicle. Available from https://www.researchgate.net/publication/329717390_Anatomy_Shoulder_and_Upper_Limb_Clavicle Accessed 20 July 2020
  2. 2.0 2.1 2.2 The Essential Anatomy 5 App [Mobile application software]. (Version 5.0.8). 3D4Medical (2019). Accessed 20 July 2020
  3. 3.0 3.1 3.2 Kenhub. Clavicle. Available from: https://www.kenhub.com/en/library/anatomy/the-clavicle (Accessed 26 July 2020)
  4. Hyland S, Charlick M, Varacallo M. Anatomy, shoulder and upper limb, clavicle.
  5. 5.0 5.1 5.2 Epperson TN, Varacallo M. Anatomy, shoulder and upper limb, sternoclavicular joint.
  6. Leurcharusmee P, Maikong N, Kantakam P, Navic P, Mahakkanukrauh P, Tran DQ. Innervation of the clavicle: a cadaveric investigation. Regional Anesthesia & Pain Medicine. 2021 Oct 31.
  7. 7.0 7.1 7.2 Flores DV, Goes PK, Gómez CM, Umpire DF, Pathria MN. Imaging of the acromioclavicular joint: anatomy, function, pathologic features, and treatment. Radiographics. 2020 Sep;40(5):1355-82.
  8. Frank RM, Cotter EJ, Leroux TS, Romeo AA. Acromioclavicular joint injuries: evidence-based treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Sep 1;27(17):e775-88.
  9. Wakefield SM, Giannoudis VP, Giannoudis PV. Clavicular bone defects managed with free vascularised fibular grafting: evidence to date. European Journal of Orthopaedic Surgery & Traumatology. 2023 Jun 8:1-2.
  10. NHS. Broken collarbone. Available from: https://www.nhs.uk/conditions/broken-collarbone/ (accessed 20 July 2020)
  11. Rahbar M, Ranjbar Kiyakalayeh S, Mirzajani R, Eftekharsadat B, Dolatkhah N. Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial. Clinical Rehabilitation. 2022 May;36(5):669-82.

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