Diagnostic Approach to Unilateral Clavicular Pain

Diagnostic Imaging

• Standard radiography is the preferred initial study for evaluating clavicular pain, as it can effectively demonstrate fractures, dislocations, and shoulder malalignment, and should include at least three views: anteroposterior (AP) views in internal and external rotation, plus an axillary or scapula-Y view, performed with the patient in an upright position 1, 2
• If radiographs are noncontributory but symptoms persist, advanced imaging may be necessary, including MRI without contrast (rating 7/9) or MR arthrography (rating 9/9) for suspected soft tissue injuries 3, 4
• CT scan may be used for better characterization of fracture patterns when radiographs show bony abnormalities 1

Initial Treatment and Referral

• The American College of Radiology recommends immediate referral to an orthopedic specialist for unstable or significantly displaced fractures, presence of neurological deficits, or shoulder joint instability 1, 5
• Inadequate imaging leading to missed fracture components or underestimation of injury severity should be avoided, and orthogonal views should be obtained to prevent misclassification of acromioclavicular and glenohumeral dislocations 1, 5
• Delaying referral for surgical intervention when indicated can make stabilization more technically challenging 5