A Current Concepts Review of Clavicle Injuries in Ice Hockey From Sternoclavicular to Acromioclavicular Joint

Abstract

Clavicle injuries are common in ice hockey, and a number of high-profile fractures and dislocations have occurred in elite hockey players in recent years. Acromioclavicular joint injuries, clavicle fractures, and sternoclavicular joint injuries are some of the most frequent hockey-related injuries treated by orthopaedic surgeons, and familiarity with the management of these injuries and sport-specific considerations for treatment and recovery are critical. Injuries involving the clavicle can sometimes be life-threatening, and subtle findings on physical examination and radiographic studies can have profound implications for treatment. The recent literature pertinent to the diagnosis and treatment of clavicle-related injuries in ice hockey players was reviewed and compiled into a clinical commentary. For ice hockey players, the upper extremity was traditionally considered a relatively well-protected area. However, given the evolution of the game and its protective equipment, the upper extremity now accounts for the majority of youth ice hockey injuries, of which clavicle injuries comprise a significant proportion. Acromioclavicular joint injuries are the most common injury in this population, followed closely by clavicle fractures. Sternoclavicular joint injuries are rare but can be associated with serious complications. The treatment of these injuries often differs between athletes and the general population, and surgical indications continue to evolve in both groups. Although the evidence regarding clavicle injuries is ever-increasing and the treatment of these injuries remains controversial, clavicle injuries are increasingly common in ice hockey players. Rule and equipment changes, most notably the increased use of flexible boards and glass, have been shown to significantly decrease the risk of clavicle injuries. We also recommend compulsory use of shoulder pads, even at a recreational level, as well as continued enforcement and evolution of rules aimed at reducing the rate of clavicle injuries. Future research should focus on equipment design changes directed toward clavicle injury prevention, standardized return-to-play protocols, and studies weighing the risks and benefits of nonoperative management of controversial injuries, such as type III acromioclavicular joint dislocations and diaphyseal clavicle fractures.

Keywords: acromioclavicular; clavicle; ice hockey; shoulder; sternoclavicular.

Figure 1.

Overview of clavicle anatomy and classification systems by area of injury. AC, acromioclavicular; CC, coracoclavicular; Lig, ligament; SC, sternoclavicular.

Figure 2.

(A) Rockwood type III acromioclavicular (AC) joint injury in an ice hockey player treated with AC ligament reconstruction. (B) After sufficient postoperative recovery and graduated return to play, the same player reported shoulder pain after a separate incident just over 1 year after surgical intervention, resulting from a collision into the boards. A distal clavicle fracture about one of the bone tunnels from the reconstruction is demonstrated. A decision was made for nonoperative management. (C) At 1 year after injury, the player had successful return to play. Images courtesy of Gregory Lervick, MD (Minneapolis, Minnesota).

Figure 3.

Athletic taping of acromioclavicular joint injury in youth ice hockey player.