clavicle stress fractures are particularly rare , with only 16 reported cases.[18 ] they have been described in patients following radical neck dissection , following coracoclavicular ligament reconstruction and few sports - related cases .
stress fractures are injuries that typically occur in sport and are usually related to overuse .
we report a case of a clavicle stress fracture non - union secondary to weight - training .
this is the first reported case of a sports - related non union stress fracture of the clavicle .
a 47-year - old male who had been performing regular weight training for more than ten years , had increased the intensity of training over a two - week period .
he consulted with his family physician , who requested an x - ray investigation , which was reported as normal . with
the pain not abating , he was referred for a ct scan that revealed a linear defect confirming a stress fracture over the lateral third of the clavicle [ figure 1 ] .
ct scan of left clavicle delineating site of stress fracture ( arrowed ) he was treated symptomatically with oral analgesic and anti - inflammatory medication . after several weeks he was prescribed narcotic analgesics for the pain .
four months after the onset of symptoms , despite reduced activity and the use of narcotic analgesics , he continued to have pain and was referred to the authors ' sports medicine clinic .
the history confirmed the patient 's regular weight training program , usually five to six days a week , with increased intensity prior to the onset of symptoms .
clinically there was a tender swelling over the lateral third of the clavicle [ figure 2 ] .
a repeat x - ray confirmed the diagnosis of a hypertrophic non - union stress fracture of the clavicle [ figure 3 ] .
photograph showing clinical prominence of non - union stress fracture of left clavicle radiograph of stress fracture indicating hyperdrophic non - union the patient was advised to have surgery , which he underwent . at surgery the hypertrophic bone and the non - union
a seven - hole lcdc plate ( synthes usa ) was contoured and applied antero - superiorly across the fracture site [ figure 4 ] .
allomatrix injectable putty ( wright medical technology , arlington , tennessee , usa ) , was applied around the fracture site .
the post surgery x - rays revealed acceptable reduction and fixation [ figure 5 ] .
post - operatively a sling was worn for four weeks and thereafter the patient underwent rehabilitation .
the final follow - up was at 11 months from the non - union surgery .
intraoperative photograph of an lcdc plate over fracture site postoperative radiograph of internal fixator over fracture range of movement and strength were clinically symmetrical at final follow - up .
aerobic exercise ( running and cycling ) was permitted at four months following the non - union surgery .
light , but progressive gym activities were permitted six weeks later , as the patient did not experience any adverse effect from the aerobic activity . the clinical outcome was therefore deemed favorable , with the patient recovering fully from the injury .
the pectoralis major and deltoid muscles produce a downward force , whilst with the trapezius and sternocleidomastoid muscles will oppose this movement .
repetitive activation of these muscles may result in enough strain to overcome remodeling and create micro architecture disruption , eventually leading to a stress fracture .
lower limb stress fractures are more common than upper extremity stress fractures and may be diagnosed on history , physical examination and imaging ( including radiographs , bone scans , mri and ct scan ) .
those stress fractures that do occur in the upper limb are usually related to upper - limb dominated activities , such as throwing sports , swimming , baseball pitching and tennis .
clavicle stress fractures are particularly rare , with only 16 cases reported and only seven related to sporting activities [ table 1 ] . in patients diagnosed with clavicle fractures ,
the differential diagnosis should include traumatic or pathological fracture , neoplasm , infection , metabolic bone disease and bone dysplasia .
sprots related clavicle stress fracture we report a case of clavicle stress fracture with non - union in a middle - aged male after accelerated weight training .
this case is particularly unique in that not only is it one of a rare form of stress fracture , it is only the second reported case related to weight lifting and the first reported sports - related stress fracture with resultant non - union .
clinicians treating athletes should have a high index of suspicion because although rare , clavicle stress fractures should feature in the differential diagnosis of shoulder or clavicle pain .
 stress fractures are relatively uncommon sports injuries and when they do occur , are mostly found in the lower limb . 
 stress fractures of the clavicle are particularly rare , having been described in a number of non - sport related pathologies , such as nervous tics and post radical neck dissection . in sport , there have only been seven cases reported in the literature . 
 we report on a clavicle stress fracture in a 47-year - old male , partaking in recreational weight lifting activities . 
 this is the first reported case of a non - union stress fracture of the clavicle . 
 the patient underwent an open reduction and internal fixation and made a full recovery . 
INTRODUCTION
CASE REPORT
DISCUSSION