Old Clavicle Fracture, New Shoulder Pain

Shoulder Anatomy

Pain rarely comes out of nowhere. Often it can be traced back to old injuries that have thrown a wrench into the system.

Patient came in with anterior shoulder pain of 40 years that started after a car accident where she broke right clavicle/collarbone. Unfortunately at the time it was not properly diagnosed and she was not casted.

She recalls carrying her new born on that side and it being quite difficult, but considering her child was also injured in the accident, she was not very focused on her own injuries at the time.

When bones fracture all muscles attached to them undergo neurogenic inhibition (read: taps out) to encourage healing and reduce stress on traumatized area. Considering that the pecs, traps, deltoid, and SCM all have clavicular attachments, these structures were unavailable to support her child. Time to compensate.

The coracobrachilias is often overlooked and in this case was a major contributor to pain as it was called on to compensate many years ago and never learned how to relax. The tension reduced her ability to dissociate the humerus from scapula which turned a neurological compensation pattern into a structural one. This pattern was initially suspected as patient would always flex elbow and internally rotate shoulder while lying on the table, even after I would repeatedly straighten the arm. This led me to believe elbow flexors and/or shoulder internal rotators may be neurologically over active. I confirmed this hypothesis with Neurokinetictherapy testing.

After releasing the coracobrachilias and activating muscles attaching to the clavicle, there was immense relief of tension and an overwhelming sense of relaxation that she was unable recall ever experiencing in the arm. If tight enough, the coracobrachilias can entrap the musculocutaneus nerve, which supplies the bicep, potentially leading to further shoulder inefficiencies.

Lesson of the day? How people hold their body in space can be valuable hints when understanding how their body has compensated around trauma and pain.