Clinical assessment starts with inspection of the clavicle and shoulder. The skin is assessed for any tenting or open wounds.
Shortening of the clavicle can be identified by comparison to the opposite intact side by comparing the distance between two fixed bony landmarks such as the medial end of the clavicle (which is easily palpable) and the acromioclavicular joint.
Asymmetric shoulder drooping may also be evident.
Anterior rotational deformity may be indicated by the presence of ptosis of the shoulder and/or scapular winging.
After the patient’s clinical status has been established and stabilized, x-ray examination of the injured shoulder is mandatory. AP X-rays of the clavicle may underestimate the degree of injury or displacement.
To access radiographically the entire clavicle, specific views are required depending on the location of the injury.
30° cephalad (Serendipity) view
This illustration shows the typical sternoclavicular dislocation patterns seen in a serendipity projection.
For medial end clavicle injuries, CT imaging is often obtained to access better the fracture in the axial plane i.e. posterior/retrosternal displacement which is difficult to access on plain radiographs.