An unexpected break
This is an account of a cycling accident which resulted in a broken collar bone. Perhaps not of any great interest to most readers, but hopefully helpful to those who have recently suffered the same injury and are looking for information on the healing and recovery process and timescales without surgical intervention.
On September 1st. 2016 I arrived home from work, changed into my cycling kit and set off for my regular Thursday evening ride. Just over four miles into the ride, rounding a sweeping bend on a narrow, poorly surfaced lane I misjudged my speed and position and caught the sandy loose gravel at the edge of the road with my front wheel. In the second or two that followed, I tried to reduce speed and correct my line, both of which actions failed, and I was thrown over the handlebars landing heavily on my left side.
A motorist heading in the opposite direction saw my fall in his rear view mirror and reversed to see if I was okay. I knew immediately that I had broken my collar bone. I wasn't in too much pain but could feel the rough broken end of the bone pressing against the skin, forming a raised, tented area. When I tried to move my arm there was a grating feeling and a sharp sawing sensation as the rough bone cut against the tissue. Thankfully the bone hadn't penetrated the skin. Other injuries appeared superficial, consisting mainly of grazes on the usual points of contact with the ground; hand, knee, hip, elbow.
I inspected the bike and apart from some scuffs on the lever hoods it appeared to have got off relatively unscathed.
The motorist very kindly loaded my bike into his car and took me to the local pub, where I rang my wife to give her the bad news. She arrived within fifteen minutes and drove me to A&E at Arrowe Park Hospital. On the way to the hospital I inspected my kit. My jersey was shredded over the back of my shoulder, my Oakleys were covered in blood but undamaged and my helmet was smashed and compressed on the left side. I hadn't even been aware of a head impact with the ground but there was no doubt that there had been.
I was assessed quite quickly in A&E and sent for an X Ray, which confirmed that I'd broken my left clavicle. A young doctor made a poor attempt at cleaning the dirt filled wound on my knee, gave me a fabric triangular sling and a box of strong pain killers and an appointment to attend the fracture clinic ten days later. I was also handed two leaflets with basic information about shoulder and head injuries. It was also suggested that I contact my local GP practice to get the flesh wounds cleaned and dressed.
At home I found that I was unable to get out of my cycling jersey and had to cut it off. As it was damaged beyond repair anyway it didn't really matter. I struggled for about 30 minutes and eventually managed to get my base layer off without the need for scissors.
After a very uncomfortable night in a semi sitting position I walked the half mile to the local clinic and had the wounds on my knee and the back of my shoulder washed and dressed. The previous day I had been fitter than I had been in almost twenty five years, now it was all I could do to cover a mile on foot. The dressing on the knee fell off less than half way home.
The next ten days were spent doing very little. I went for a short walk every day, gradually increasing the distance covered. I managed the pain in my shoulder as necessary.
I'm self employed, so one of my first tasks was to contact about a dozen clients for whom I had outstanding work and give them the bad news. Thankfully all of them were very understanding and happy (or at least, prepared) to wait until I was able to work again.
On September 12th. I attended the fracture clinic. The doctor I saw had a copy of the X Ray taken on the day of the accident and explained how, although the collar bone was broken, it appeared to be following a smooth arc with signs of multiple small cracks which should heal nicely. He sent me for another X Ray and when I returned to the consulting room a very different picture was on the screen. This time, perhaps taken from a different angle it showed the two broken ends of the bone crossing over each other with a small gap between them. The overlap had in fact shortened the clavicle by about 2 cm. He then talked to me about the possibility of surgery, what it entailed, and the numerous associated risks. I told him that I wanted the quickest route to full recovery and would opt for surgery. He decided to consult with his Consultant, who decided that there was no need for surgery, telling me that even with as much as 2 cm separation, the bone would form new growth and heal perfectly satisfactorily. I was rather dubious, but left, with a far better sling and another appointment four weeks later.
X Ray 10 days after the crash. First appointment at the Fracture Clinic.
The next four weeks were also spent doing very little. I walked a lot, hoping not to lose too much fitness. I became well known to the staff in all the local cafés and discovered parts of my local area that I never knew existed. The walks had to be planned to pass as many benches and gates as possible, as the discomfort in my shoulder area became intolerable and I needed to stop; resting my elbow on the arm of a bench or the top of a gate to support the weight for about ten minutes every mile or so. The sling provided little support but held the arm in a position of relatively restricted movement. I grew to hate the sling, as it had to be worn day and night.
Although the main break was the collar bone, I had also damaged my shoulder blade, which gave me constant pain, though more of a dull ache than the sharp sawing and grating of the collar bone.
By the end of September I decided to see if I could get my bike on the turbo trainer and try to see if I was able to pedal a little. The first attempt was very difficult. I couldn't support any weight at all through my left arm, and even getting in a riding position was painful and tiring. I managed two short turbo sessions that week and decided to wait until I'd seen the doctor at the fracture clinic before trying again.
On October 10th. I once again attended the fracture clinic, had another X Ray and this time saw the Consultant. The X Ray showed some new bone growth. The Consultant manipulated my arm and shoulder, which grated and creaked. He said that he was pleased with progress and that I was to return in another four weeks.
Perhaps I misheard him but I was sure he said that I was okay to start doing light exercise with the arm. I arrived home from the appointment, put my cycling kit on and got my bike out. Once astride it I found that I couldn't get on to the saddle because I had no strength or stability in my shoulder to support my weight on the handlebars. Eventually I managed it by leaning against a wall, and I rolled off down the road. Fortunately I live on a slight hill so was able to let the bike run a little whilst I got comfortable. The thought then crossed my mind that at some point I'd have to brake and put a foot down. Thankfully the roads were quiet and I managed it.
Pedalling wasn't a problem and I began to gain in confidence - that was, until riding along a main road I put my arm out to indicate I was turning right. Immediately my left arm gave way and I lost control, very nearly repeating my crash. Somehow I held the bike upright, but headed straight home. Still; five weeks and four days after the accident and I was back on the bike.
After another five days I was out again, this time feeling a little more confident I rode 16 miles in exactly an hour, meeting up with some friends at Eureka Cycle Café. This time I was able to more easily push myself up on to the saddle and even lift myself out of the saddle a little when climbing. I found that the more I did, the more I felt to be strengthening the union between the two broken ends of bone.
On November 7th. I was back at the fracture clinic, hoping to be discharged, but after another X Ray and a manual assessment of the state of the bone union I was once more sent away for another four weeks.
During this period I started to drive again and sought out information on private physiotherapy for when I was eventually discharged. I even started to do some light work, though I tired and became quite uncomfortable very quickly. It did feel as though the bone was fusing together, but with that also came a tightening in the whole shoulder area. My range of movement was very restricted, and, if anything, the discomfort increased.
I returned again to the fracture clinic on December 19th. and was discharged. I was immediately referred to a physiotherapist within the department who assessed my range of movement and flexibility. She told me that I would have a course of physiotherapy at Clatterbridge Hospital, which is only a few miles from home.
X Ray on the day of discharge from the Fracture Clinic.
My first appointment was on January 5th. I was told that I had a frozen shoulder and given a series of simple exercises to be completed three times a day. By the time I returned for my second appointment a week later my range of movement had increased by a significant amount and my pain levels diminished substantially. Another week later and progress was still being made.
I was signed off by the physiotherapy department on February 6th. and have continued to make good progress since.
My confidence, fitness and pace on the bike is returning and I have now have no pain in the shoulder. I am noticeably (to myself) shorter in the left shoulder - probably about the 2 cm I mentioned earlier. I doubt anyone else would notice. At the point of the fracture I have a large mass of bone, but it is smooth and no longer feels as though it is sawing through my skin from the inside. I feel perfectly straight and balanced on the bike, which is great, as I had visions of always pulling to the left. I'm once again able to lift heavy weights without the fear of the union in the bone coming apart.
The whole experience was frustrating, sometimes painful, certainly uncomfortable. It was financially not ideal not to be working for almost four months. However there were some positive things to come out of it all. I got to explore my local area on foot during the pleasant autumn weather. Probably more satisfying was the fact that, working for myself, I'm used to little more that three weeks holiday each year. This gave me a much needed, if unexpected break.
