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Lucky Break

January 14, 2017

Left clavicle distal-end fracture

First let me advise caution when reading this. I am not a doctor. There are many kinds of fracture to the clavicle and some are very complicated with multiple breaks. I do not recommend that anyone takes the same course of action as me without getting authorisation from their doctor. I am still not sure I have taken the right action. But it was authorised.

I am seventy two in March. Around midnight on 21/22 December 2016 I broke my clavicle at the distal end. Thankfully the fracture is aligned. I came off my bike after having been to a Pub Quiz (I had been drinking). This is my second clavicle break. The first, perhaps twenty years ago or more, also in a biking accident, though not my fault on that occasion, was painful. I cannot remember how long it took to be able to reach my arm above my head but it seemed a long time.

This time I was only about two hundred yards from home when I came off. The initial pain was bad, I realised, or strongly suspected, the bone was fractured, and I had difficulty managing my bike one-handed out of consideration for my injured arm. As it was a downhill slope to home I painfully remounted my bike, checked that I could use the brake with my injured arm, and slowly cruised down the slope the rest of the way home. It was much easier than trying to walk with the bike. Feeling an idiot for coming off, I really wanted to get home as soon as possible and rest it up.

Getting undressed was almost unbearable. The next morning, although painful, I discovered it was not as painful as my previous fracture had been. Nevertheless I cried out a few times getting dressed. Without any desire to shower I took myself to A&E. The physiotherapist, a nice man in a bow tie, was very understanding, examined me and the X-rays revealed the fracture. I was told I could exercise my lower arm as much as felt comfortable and a triangular sling was given me with an appointment to return the next day to get a collar and cuff fitted. He advised that the bone might not knit completely.

When I saw the consultant (Mr Alistair Marsh) the following day my main concern was when I could get back to playing golf (ridiculous I know). For putting almost straight away, and your very short game about the same I was informed. I soon found that the collar and cuff was redundant. Almost a week later I took an eight iron to my course which is within walking distance and struggled with six holes, rather unsuccessfully. I used the left arm only to position the clubface in alignment and the right for power, which was not very powerful on its own. I think I have learnt something from the experience, for example, the left arm part of the swing may be responsible for pulling the ball since although I was not hitting it very far it was going straight (when I hit it properly).

To begin with I had difficulty in getting my left arm, the fractured arm above my head without pain. What I have been doing from day one to make this easier is to force it up to say the top of a door and pull down using the door to stretch it. I have also used the sink for sideways stretches and similarly the side of the door. This gives relief and at the moment I am very optimistic of a speedy recovery. My stepson took these photos on 30/12/16 to show what mobility I had achieved by then.

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Bruising round the shoulder

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Left arm reach up back

Because of the pain in returning to movement I experienced with my last collar-bone fracture I have been trying to continue as normally as possible in the hope that such pain is not a feature of this break. Up to now I am optimistic. I am guessing that one of the reasons for pain lifting the arm after it has been in a sling for three weeks is that the muscles used in that operation have gone to sleep. Why I have got so much movement after the accident when all other accounts I could find on the web suggest that should not be the case I don’t know. Perhaps with some breaks it is easier than others. Anyway, not being able to find anything comparable, I spoke to my GP. He was of the same opinion as me that if I could achieve movement without much pain he saw no reason why I should not continue. The scars on my back are from a recent bout of shingles.

clavicle-3

Left arm reach above head

I intended to try a few holes of golf again on 29/12/16 but it was very frosty so I thought not a good idea in case I fell. To treat the pain, especially early in the morning I have been using a Devil’s Claw (harpagophytum procumbens) gel which is cool and soothing. I have known about this African herb for more than forty years because my mother had a Health Food Store in the Isle of Man which my brother runs now. This is not an advert although I must say it has helped and if it has helped me it might help others. If I recall correctly we used to sell tablets for the treatment of rheumatoid arthritis where proprietary treatments were not helping. The general herbal treatment for fractures traditionally is comfrey. One of comfrey’s alternative names is knitbone. Devil’s Claw however treats the soft tissue and we already had some in the house.

I have taken no other analgesics except wine to get me off to sleep at night.

devils-claw

Devil’s Claw Gel

The above is an edited version of a comment made to the website of Dr  Howard Luks, MD.

http://www.howardluksmd.com/orthopedic-social-media/broken-clavicle-three-things-you-need-to-know/#comment-1464067

02/01/17 (Monday). First outing driving the car since I broke the bone. Experienced a bit of pain when changing into second gear (farthest away from shoulder) but otherwise no problems.

03/01/17 (Tuesday) I tried nine holes of almost one-handed golf. Again it was very unsuccessful and a lesson in how not to play golf. My playing partners were understanding but critical about whether I should be there so early. I decided not to continue after 9 holes though the injury had not been exacerbated.

When I get my arm into a certain position a kind of painful locking takes place so I am going to rest it for a week and see what happens. I still intend to continue doing day to day things as normally as possible with both arms since most of the time I am relatively pain-free. Working at arms’ length is uncomfortable, things like tying shoelaces can be painful, until I remember I can bend my knee and bring each foot up to my hands.

12/01/2017 (Thursday – three weeks after break)

Today I had my first 18 holes playing with both hands. It was not a great result (104) and I never got a single par. I started with a 9. Nevertheless most of the golf was acceptable and my left shoulder stood up well. I had a good number of bogeys with 4s on all par threes except one (which was a 6). I had another 9 coming in (on a par 5) and 52 on each half. Towards the end it was quite miserable. I was getting a bit of gyp and it was raining for the last seven holes. I put some more gel on when I got home and now, 8.15 p.m., it is comfortable again. I think it is mending well.

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Three months before the fracture at Lickey Hills. Photo credit: Aris

What I recall over the last eight days is that when I cease activity there is pain and some difficulty getting my arm back into action, especially with rotary movements, like inadvertently trying to pull a sweater over my shoulders as I used to do before my accident.  It seems to lock somehow and the muscle really hurts near the upper scapula almost like cramp. I always try to do the reverse of what I did before the locking took place. My solution to this locking, as it has been throughout, is to pull down on the top of door for example, not too heavily, then to push up under the door joist. One or the other or both tends to free it and take away the pain. Remember mine is a simple fracture.

I got a copy of a letter today to my surgery which was dictated 23 December 2016 and typed on 7th January 2017 after my visit to the QE Trauma Department. It shows that I have been doing the right thing in exercising while not very painful. It contained the following:

“He can gradually increase his level of activities as tolerated and return to doing things when he wants to. He can get back to playing golf as soon as he is able to wield a club and he can start driving when he feels it is safe to do so.”

This sound advice was given me verbally at the Trauma Department as well so I feel things are progressing well. I suspect the fact that the fracture according to the letter “is completely undisplaced” accounts for why I have been able to approach normality as quickly as I have. Many people with clavicle fractures have their arms in a sling for three weeks and thankfully I have been lucky enough to be where I am now. I cannot yet sleep on that side comfortably, but I hope to be able to do so soon.

13/01/2017 (Friday)

There are conflicting views on how fractured clavicles might be treated. I am almost certain everybody who gets one starts looking for advice. I am further convinced from what I’ve read that every case is different and each should be treated individually. For me I have been listening to my body and only doing what I consider not to be too strenuous while at the same time trying to get back to normal as soon as possible. I have lifted this text from the site beneath. It contains advice from experts.

“Non Operative treatment (middle third)
Treatment is purely symptomatic.
A little movement stimulates healing, too much movement slows it down.
A broad arm sling is used to support the arm for comfort. Use the arm for the activities of daily living, lifting nothing much heavier than a cup of tea for six weeks. This is then followed by a gradual increase in activities both in intensity and duration.
The clicking and movement of the fracture gradually reduces as the bones begin to become sticky and set.
“Listen” to the fracture, not literally but figuratively. If it aches a little that is OK, if it really hurts and aches that night or the next day after increased activity you have done a little too much.
That does not mean stop completely, just come down a little on your activities followed by a graduated increase in activity.”

http://www.cambridgeorthopaedics.com/cambridgefracture/patient%20info/clavicle%20fracture.htm#Non%20operative%20treament

Treatment of the lateral third is the same as treatment for the middle third.

Why am I healing so fast when others take so much longer is hard to say. I cannot account for it. Is it because I got straight back on my bike at the time of the injury? Has it fractured in a place where it is less painful? Is some of it based on desire or willpower to get better? I have read of people with clavicle trauma getting back to the gym after 3 weeks but they are usually cyclists not wanting their leg muscles to get out of shape. Is it because I have been using my shoulder muscles from day one? Is it because Devil’s Claw gel has enabled me to use these muscles? Have hospitals seen thousands of cases like mine? It may be with uncomplicated non-displaced fractures they do heal much faster. So nobody writes about them. Who knows? There seems to be nothing available about rapid healing on any searches I have done. My appointment at the trauma unit is on 3rd February when I hope to be given the all clear. Anyway I consider my fracture to be a lucky break.

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