Consider the Clavicle

LOOK - IDENTIFY - DESCRIBE

Linas Dziukas - Alfred Emergency & Trauma Centre

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 Two’s and Three’s

The clavicle has two curves

Seen from the front, the conoid

tubercle divides the clavicle into two
segments: lateral fourth and medial
three fourths

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 Two’s and Three’s
Seen from the front, the conoid tubercle divides
the clavicle into

• Flattened lateral fourth (the acromial end of the

clavicle) with

- two surfaces (superior and inferior)

- two borders (anterior and posterior). The

anterior border may have a small bony
prominence (deltoid tubercle) on the area of
insertion of the deltoid

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 Two’s and Three’s

Seen from the front, the conoid tubercle divides

the clavicle into

• Rounded medial three fourths (the shaft and the

sternal end of the clavicle) with

- three main surfaces: anterior, superior and

posterior (and a narrow inferior surface)

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 Lateral fourth Medial three fourths

Acromial end of clavicle

Shaft of clavicle

Sternal end of clavicle

Articular facet for

acromion

Conoid tubercle

© Linas Dziukas

Anterior View of Right Clavicle

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 Two’s and three’s : medial part of clavicle
from the front
First rib

2 Acromion

1
Clavicle

Medial Conoid

tubercle

3 Humeral head
Coracoid

6 process
5
4
© Linas Dziukas

Three muscles:
Three bony structures:

1. Sternohyoid
4. Manubrium

2. Sternomastoid
5. Costal cartilage of first rib

3. Pectoralis major 6. Bony part of first rib

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 Two’s and three’s : lateral part of clavicle
from the front

1 2
First rib
4
Clavicle

Conoid

tubercle
Humeral

head
Lateral
3

© Linas Dziukas

Two muscles:
Two bony structures:

1. Trapezius
3. Coracoid process

2. Deltoid 4. Acromion

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 proce

Two’s and three’s : the clavicle

from the front
1B
1A Conoid tubercle First rib

Acromion
2A
2B

Sublavius

muscle Medial
3A
3B

Humeral head Coracoid

Pectoralis minor

process muscle

© Linas Dziukas

Two intra-articular discs:

One strong laterally located ligament
One strong medially located ligament
1A. Disc in acromioclavicular joint
(coracoclavicular ligament) with two parts:
(costoclavicular ligament) with two parts:

2A. Disc in sternoclavicular joint 2A. Trapezoid ligament

3A. Posterior fibres

2B. Conoid ligament 3B. Anterior fibres

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 The Superior Surface of the Clavicle
66
1

3 9
5 7
4
2

1. Acromial end of clavicle

2. Shaft of clavicle

3. Sternal end of clavicle

4. Manubrium

5. Sternoclavicular joint

6. Base of spine of scapula

7. Coracoid process

8. Acromioclavicular joint

9. Acromion
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 The Inferior Surface of Clavicle
Anterior

A Anatomy: Regional and Applied

R J Last 7e
Lateral

1 2

2
1 3 4 7

6
5
B
1: Surface for first costal cartilge
5: Conoid tubercle

2: Costoclavicular ligament
6: Trapezoid line

3: Groove for subclavius

7: For acromion

4: Deltoid tubercle
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 3 8
10
4
2 7
6 9
5

1. Humeral head
6. Conoid tubercle

2. Acromion
7. Shaft of clavicle

3. Acromioclavicular joint
8. First rib

4. Acromial end of clavicle

9. Sternal end fo clavicle

5. Coracoid process 10. Sternoclavicular joints

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 3
5

6
1

7
4
8
9

1. Humeral head

2. Acromion

3. Acromioclavicular joint

4. Glenoid fossa

5. Lateral part of clavicle

6. Coracoid process

7. Midshaft of clavicle

8. Medial part of clavicle

9. Sternoclavicular joint

51 year old male

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 4

6
5
1. Humeral head
*
2. Glenoid fossa

3 7 *
1
3. Coracoid process
2

4. Conoid tubercle

5. Lateral part of clavicle

6. Acromioclavicular joint

7. Acromion

* Epiphyseal centres

15 year old male. Pain in shoulder after collision while playing football
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 Remember the Ligaments

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 Trauma to the Clavicle

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 Trauma to the Clavicle
Common injury

Management depends on

• Location of injury

- mid-shaft of clavicle

- medial end of clavicle

- lateral end of clavicle

• Severity of injury to clavicle

• Associated injuries to pectoral girdle

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 Injury to Middle Third of Clavicle

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 2 year old male
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 3 year old girl with painful right shoulder after a fall
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19 year old male

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 Classification of Midshaft Fractures of Clavicle

Need Reference

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 Injury to Medial Third of Clavicle

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 Sternoclavicular Joint

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 Anterior

Superior

Axial

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 41 year old man with painful upper chest after motor vehicle accident

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 A B

C D

41 year old man with painful upper chest after motor vehicle accident
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 A B

C D

41 year old man with painful upper chest after motor vehicle accident
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 Classification of Fractures of Medial End of
Clavicle

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 Injury to Lateral Third of Clavicle

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 A

81 year old male who fell onto shoulder

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 71 year old female
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Classification of Fractures of Lateral Part of
Clavicle
 A B

43 year old man with sore right

shoulder after a fall

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C
 14 year old male with pain in left acromioclavicular joint after injury during sport

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 21 year old male

35 year old man

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 Further Reading
1. Nicholson DA, Lang I, Hughes P, Driscoll PA. ABC of Emergency Radiology - The Shoulder. BMJ
1993; 307: 1129 - 1134
2. Antonio GE, Cho JH, Chung CB, Trudell DJ, Donald Resnick. MR imaging appearance and
classification of acromioclavicular joint injury. AJR 2003; 180:1103 - 1110

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