Numbness After Clavicle Fracture Surgery
Clavicle fractures are common injuries, and some displaced fractures may require surgical fixation using a plate and screws. While fixation can help restore alignment and support fracture healing, patients may experience changes in sensation around the surgical area after the procedure.
One of the potential complications is numbness of the skin below or around the collarbone. This can occur when small sensory nerves near the clavicle are affected during surgery.
A study conducted at Tan Tock Seng Hospital in Singapore examined the frequency, severity and natural progression of this numbness in patients who underwent plate fixation for displaced midshaft clavicle fractures. The researchers followed 38 patients for an average of 23.2 months.
Orthopaedic Surgeon Dr Wang Lushun of Arete Orthopaedic Centre was the lead author of the study, together with Muliang Ang, Keng Thiam Lee, Ganesan Naidu and EBK Kwek. At the time of the research, the authors were affiliated with the Department of Orthopedics at Tan Tock Seng Hospital, Singapore.
The findings provide useful information for patients considering or recovering from clavicle fracture surgery, particularly regarding what they can expect if numbness develops around the incision.
Why Can Numbness Occur After Clavicle Surgery?
The skin around the clavicle receives sensation from branches of the supraclavicular nerve.
This is a sensory nerve originating from the superficial cervical plexus. Its branches supply sensation to areas around the:
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Upper chest
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Shoulder
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Skin below the clavicle
Because these small nerves can cross the area where a surgeon needs to make an incision to access the clavicle, they may be stretched, irritated or injured during surgery.
The study specifically investigated sensory changes following plate fixation using a horizontal skin incision over the clavicle.
What Is Cutaneous Hypoesthesia?
Cutaneous hypoesthesia means reduced or diminished sensation in the skin.
Patients may describe it as:
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Numbness
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Reduced sensitivity
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A "dead" feeling in the skin
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Altered sensation when touched
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Increased awareness when clothing contacts the area
It is different from complete loss of sensation throughout the arm and does not necessarily indicate damage to the major nerves responsible for arm movement.
In the study, the sensory change was specifically related to the skin around the clavicle and was considered a minor neurological complication of the surgery.
What Did the Research Investigate?
The researchers wanted to understand three main aspects of postoperative numbness:
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How frequently it occurs
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How much it affects patients
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How the numbness changes over time
Rather than relying only on clinical examination, the researchers also asked patients about their experience with numbness and whether it affected everyday activities.
The study included patients who had undergone plate fixation for displaced midshaft clavicle fractures between 2009 and 2011.
How Many Patients Developed Numbness?
Of the 38 patients included in the study, 21 reported postoperative numbness.
This corresponds to an incidence of 55.3%.
This was higher than the 10% to 29% incidence reported in some earlier literature cited by the researchers.
The authors suggested that sensory loss after clavicle plate fixation may have been under-recognised or under-reported in previous research.
It is important to note that the study involved a relatively small group of patients and used a specific surgical approach, so its 55.3% figure should not be interpreted as the expected rate for every patient undergoing clavicle fixation.
When Was the Numbness Usually at Its Worst?
Most patients who developed numbness reported that it was most noticeable during the first month after surgery.
Of the 21 affected patients:
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18 reported that numbness was worst during the first month
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1 reported the worst numbness at three months
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2 reported persistent numbness without improvement by the last follow-up
The researchers suggested that the numbness may become more noticeable once the immediate postoperative pain from the fracture and surgery begins to settle.
How Severe Was the Numbness?
At the time when numbness was at its worst:
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6 of 21 patients (28.6%) described it as severe
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9 of 21 patients (42.9%) described it as moderate
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6 of 21 patients (28.6%) described it as mild
More than half of the affected patients, 11 out of 21, reported an area of numbness larger than the size of their palm.
These findings demonstrate that the sensory changes could be noticeable during the early recovery period, even though they did not necessarily become a significant long-term problem for most patients.
Can Clothing or Shoulder Straps Make the Numbness More Noticeable?
Yes.
The study specifically examined whether patients became more aware of the numb area when something came into contact with the surgical site.
Among the 21 patients who experienced numbness, 15 patients (71.4%) reported increased awareness when straps or clothing came into contact with the affected area.
This may be particularly noticeable when:
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Wearing a backpack
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Carrying a shoulder bag
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Wearing clothing that rubs against the scar
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Applying pressure to the area
However, the degree to which this affected patients varied.
How Much Did Numbness Bother Patients?
Although numbness could be noticeable, relatively few patients considered it a significant problem.
At the point when symptoms were at their worst:
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2 patients considered it a significant bother
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4 considered it a moderate bother
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7 considered it a mild bother
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8 were not bothered by it at all
This distinction is important.
A patient can have a relatively large area of altered sensation without finding it significantly disruptive to everyday life.
Does the Numbness Improve Over Time?
For most patients who developed numbness, the answer was yes.
19 of the 21 affected patients (90.5%) reported that the severity of numbness improved over time.
At the final follow-up, which occurred an average of 23.2 months after surgery, the proportion of all patients reporting numbness had decreased from:
55.3% initially → 36.8% at final follow-up.
Seven of the 21 patients who initially experienced numbness reported complete resolution.
This means that although the majority experienced improvement, some patients continued to have some degree of altered sensation.
Can Numbness Persist for Years?
Yes.
Among patients who developed postoperative numbness, the researchers found that some degree of numbness remained in 66.7% of affected patients at the final follow-up.
However, persistent numbness did not necessarily mean persistent significant discomfort.
Only one patient continued to report severe numbness at the final follow-up, and none of the patients were significantly bothered by the sensory changes at that stage.
The researchers therefore concluded that numbness can persist for up to two years and may potentially be permanent, but it generally becomes less troublesome over time.
Why Is the Supraclavicular Nerve Vulnerable During Surgery?
The anatomy of the supraclavicular nerve helps explain why sensory changes may occur.
The nerve branches travel across the region of the clavicle and supply sensation to the skin around the shoulder and upper chest.
Depending on the individual, the nerve may divide into:
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Medial branches
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Intermediate branches
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Lateral branches
The location and branching pattern can vary between individuals. This anatomical variation can make it difficult to completely avoid the small sensory nerves during a surgical approach to the clavicle.
Is Postoperative Numbness a Serious Complication?
In most cases described by this study, numbness was a sensory complication rather than a major functional neurological deficit.
The study did not report major neurological complications related to the surgery.
The numbness primarily affected skin sensation rather than the patient's ability to move the arm.
However, patients should understand that sensory changes can sometimes persist for an extended period.
Does Numbness Mean the Surgery Was Unsuccessful?
No.
Postoperative numbness does not necessarily indicate that:
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The fracture has not healed
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The plate is incorrectly positioned
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The surgery has failed
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The shoulder is damaged
It can occur because small sensory nerves near the incision have been affected during the surgical approach.
The patient's overall recovery should be assessed based on factors such as:
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Fracture healing
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Shoulder movement
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Strength
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Pain
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Function
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Hardware position
Numbness is only one aspect of postoperative recovery.
What Should Patients Expect During Recovery?
Patients recovering from clavicle fixation may experience different symptoms at different stages.
Early Recovery
During the first few weeks, patients may experience:
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Surgical pain
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Swelling
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Bruising
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Numbness around the incision
According to this study, numbness was most commonly at its worst during the first postoperative month.
Intermediate Recovery
As pain and swelling settle, patients may notice that the area of altered sensation becomes less prominent.
The researchers found that the vast majority of affected patients reported improvement over time.
Longer-Term Recovery
Some patients may continue to experience a smaller area of numbness even after the fracture and surrounding tissues have healed.
This does not necessarily mean that the sensation will continue to interfere with daily activities.
When Should You Speak to Your Orthopaedic Doctor?
Some degree of numbness around the incision may occur after clavicle surgery, but patients should still report new or concerning symptoms.
Seek medical advice if you experience:
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Increasing numbness
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New weakness in the arm
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Significant changes in movement
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Severe or worsening pain
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Persistent swelling
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Changes in hand or arm sensation beyond the surgical area
These symptoms may have causes other than the expected local sensory changes and should be assessed.
Can the Risk of Numbness Be Eliminated?
It may not be possible to completely eliminate the risk.
The supraclavicular nerve has variable anatomy, and its branches may cross the surgical field.
The research discusses previous evidence suggesting that the orientation of the incision may influence the risk of postoperative numbness. However, the study itself specifically examined patients who underwent plate fixation using a horizontal incision and was not designed to compare different incision techniques.
The authors emphasised that patients should be informed about the possibility of persistent numbness before surgery.
What Did the Researchers Recommend?
Based on their findings, the researchers recommended that patients undergoing clavicle plate fixation should be warned before surgery that postoperative skin numbness is a relatively common possibility and can sometimes persist.
At the same time, patients can generally be reassured that most people who experience the problem report improvement over time.
This type of preoperative counselling allows patients to understand both the potential short-term discomfort and the possibility of longer-lasting sensory changes.
What Were the Limitations of the Research?
The study has several limitations that should be considered when interpreting its findings.
Small Patient Group
Only 38 patients with complete follow-up data were included.
A larger study would provide a more reliable estimate of how frequently postoperative numbness occurs.
Retrospective Design
The researchers reviewed existing medical records and used telephone questionnaires to assess symptoms.
A prospective study could collect information more systematically from before surgery through long-term follow-up.
Subjective Assessment
Numbness was assessed based largely on patients' descriptions.
The researchers acknowledged that objective measurements of skin sensation were not performed because specialised neurological equipment and personnel would have been required.
Specific Surgical Approach
The study focused on midshaft clavicle fractures treated with plate fixation using a horizontal incision.
The results should therefore not automatically be applied to every clavicle fixation technique.
What Can Patients Learn From This Research?
The study provides several useful points for people considering plate fixation for a clavicle fracture.
Numbness can be relatively common
More than half of the 38 patients in this study reported some postoperative numbness.
It is usually most noticeable early
Most affected patients reported the greatest degree of numbness during the first month after surgery.
It usually improves
Nine out of ten affected patients reported that their numbness became less severe over time.
It can persist
Some patients continued to have altered sensation at almost two years of follow-up, and complete resolution did not occur in everyone.
It is not usually a major long-term functional problem
Although the numbness could be noticeable when clothing or shoulder straps touched the area, only a small proportion considered it a significant bother, and none of the patients were significantly bothered at final follow-up.
A study involving 38 patients who underwent plate fixation for displaced midshaft clavicle fractures found that postoperative skin numbness was relatively common, with 55.3% of patients reporting some degree of altered sensation. Most affected patients experienced their worst symptoms during the first month after surgery, and 90.5% reported improvement over time.
At an average follow-up of 23.2 months, the proportion of all patients reporting numbness had decreased to 36.8%, with seven patients reporting complete resolution. Some degree of numbness persisted in a number of patients, but the long-term functional impact was generally limited.
The research highlights the importance of discussing sensory changes as part of informed consent before clavicle fracture fixation. While numbness may persist in some patients, the study found that it generally becomes less noticeable over time and is unlikely to be a significant long-term concern for most affected patients.
Research Reference
Wang L, Ang M, Lee KT, Naidu G, Kwek EBK. Cutaneous hypoesthesia following plate fixation in clavicle fractures. Indian Journal of Orthopaedics. 2014 Jan-Feb;48(1):10-13. DOI: 10.4103/0019-5413.125478. PMID: 24600056; PMCID: PMC3931138.
This article is for general information only and should not replace medical advice from a qualified healthcare professional.
