CLAVICLE

Clavicle

The clavicle (collar bone) connects the upper limb to the trunk (Fig. 6.4). The shaft of the clavicle has a
double curve in a horizontal plane. Its medial half is convex anteriorly, and its sternal end is enlarged and
triangular where it articulates with the manubrium of the sternum at the sternoclavicular (SC) joint. Its
lateral half is concave anteriorly, and its acromial end is flat where it articulates with the acromion of the
scapula at the acromioclavicular (AC) joint (Figs. 6.3B and 6.4). The medial two thirds of the shaft of the
clavicle are convex anteriorly, whereas the lateral third is flattened and concave anteriorly. These curvatures
increase the resilience of the clavicle and give it the appearance of an elongated capital S.
The clavicle:

Serves as a moveable, crane-like strut (rigid support) from which the scapula and free limb are
suspended, keeping them away from the trunk so that the limb has maximum freedom of motion. The
strut is movable and allows the scapula to move on the thoracic wall at the scapulothoracic joint,1
increasing the range of motion of the limb.
P.674
Fixing the strut in position, especially after its elevation, enables elevation of the ribs for deep
inspiration.

Forms one of the bony boundaries of the cervico-axillary canal (passageway between the neck and
the arm), affording protection to the neurovascular bundle supplying the upper limb.

Transmits shocks (traumatic impacts) from the upper limb to the axial skeleton.

Clavicle
The clavicle (collar bone) connects the upper limb to the trunk (Fig. 6.4). The shaft of the clavicle has a
double curve in a horizontal plane. Its medial half is convex anteriorly, and its sternal end is enlarged and
triangular where it articulates with the manubrium of the sternum at the sternoclavicular (SC) joint. Its
lateral half is concave anteriorly, and its acromial end is flat where it articulates with the acromion of the
scapula at the acromioclavicular (AC) joint (Figs. 6.3B and 6.4). The medial two thirds of the shaft of the
clavicle are convex anteriorly, whereas the lateral third is flattened and concave anteriorly. These curvatures
increase the resilience of the clavicle and give it the appearance of an elongated capital S.
The clavicle:

Serves as a moveable, crane-like strut (rigid support) from which the scapula and free limb are
suspended, keeping them away from the trunk so that the limb has maximum freedom of motion. The
strut is movable and allows the scapula to move on the thoracic wall at the scapulothoracic joint,1
increasing the range of motion of the limb.
P.674
Fixing the strut in position, especially after its elevation, enables elevation of the ribs for deep
inspiration.

Forms one of the bony boundaries of the cervico-axillary canal (passageway between the neck and
the arm), affording protection to the neurovascular bundle supplying the upper limb.

Transmits shocks (traumatic impacts) from the upper limb to the axial skeleton.

Although designated as a long bone, the clavicle has no medullary (marrow) cavity. It consists of
spongy (trabecular) bone with a shell of compact bone.
The superior surface of the clavicle, lying just deep to the skin and platysma (G. flat plate) muscle in
the subcutaneous tissue, is smooth.

The inferior surface of the clavicle is rough because strong ligaments bind it to the 1st rib near its
sternal end and suspend the scapula from its acromial end. The conoid tubercle, near the acromial
end of the clavicle (Fig. 6.4), gives attachment to the conoid ligament, the medial part of the
coracoclavicular ligament by which the remainder of the upper limb is passively suspended from the
clavicle. Also, near the acromial end of the clavicle is the trapezoid line, to which the trapezoid
ligament attaches; it is the lateral part of the coracoclavicular ligament.
The subclavian groove (groove for the subclavius) in the medial third of the shaft of the clavicle is
the site of attachment of the subclavius muscle. More medially is the impression for the
costoclavicular ligament, a rough, often depressed, oval area that gives attachment to the ligament
binding the 1st rib (L. costa) to the clavicle, limiting elevation of the shoulder.
Variations of Clavicle

The clavicle varies more in shape than most other long bones. Occasionally, the clavicle is

pierced by a branch of the supraclavicular nerve. The clavicle is thicker and more curved in manual
workers, and the sites of muscular attachments are more marked.
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Fracture of Clavicle
The clavicle is one of the most frequently fractured bones. Clavicular fractures are

especially common in children and are often caused by an indirect force transmitted from an
outstretched hand through the bones of the forearm and arm to the shoulder during a fall. A fracture
may also result from a fall directly on the shoulder. The weakest part of the clavicle is the junction of
its middle and lateral thirds.
After fracture of the clavicle, the sternocleidomastoid muscle elevates the medial fragment of bone
(Fig. B6.1). Because of the subcutaneous position of the clavicles, the end of the superiorly directed
fragment is prominentreadily palpable and/or apparent. The trapezius muscle is unable to hold the
lateral fragment up owing to the weight of the upper limb, and thus the shoulder drops. The strong
coracoclavicular ligament usually prevents dislocation of the AC joint. People with fractured
clavicles support the sagging limb with the other limb. In addition to being depressed, the lateral
fragment of the clavicle may be pulled medially by the adductor muscles of the arm, such as the
pectoralis major. Overriding of the bone fragments shortens the clavicle.
The slender clavicles of newborn infants may be fractured during delivery if the neonates are broad
shouldered; however, the bones usually heal quickly. A fracture of the clavicle is often incomplete in
younger childrenthat is, it is a greenstick fracture, in which one side of a bone is broken and the
other is bent. This fracture was so named because the parts of the bone do not separate; the bone
resembles a tree branch (greenstick) that has been sharply bent but not disconnected.
The clavicle is the first long bone to ossify (via intramembranous ossification), beginning during the
5th and 6th embryonic weeks from medial and lateral primary centers that are close together in the
shaft of the clavicle. The ends of the clavicle later pass through a cartilaginous phase (endochondral
ossification); the cartilages form growth zones similar to those of other long bones.
A secondary ossification center appears at the sternal end and forms a scale-like epiphysis that begins
to fuse with the shaft (diaphysis) between 18 and 25 years of age and is completely fused to it
between 25 and 31 years of age. This is the last of the epiphyses of long bones to fuse. An even
smaller scale-like epiphysis may be present at the acromial end of the clavicle; it must not be
mistaken for a fracture.
Sometimes fusion of the two ossification centers of the clavicle fails to occur; as a result, a bony
defect forms between the lateral and the medial thirds of the clavicle. Awareness of this possible
congenital defect should prevent diagnosis of a fracture in an otherwise normal clavicle. When doubt
exists, both clavicles are radiographed because this defect is usually bilateral (Ger et al., 1996).