Breaking My Left Clavicle!
by Ace Hoffman
October 23rd, 1996
(Note added April 25th, 2002: Hi Jewel, and welcome to the "Clavical Club!" We hope you heal well! -- Ace)
First of all, let me tell you where your clavicle is: it's in the shoulder, on the upper part of the shoulder. It's a fairly long and fairly straight bone that runs from your neck to the edge of your shoulder. Also known as the collarbone.
One way to break it is to dive off the front of your mountain bike and land on your shoulder with your arm at your side. Crunch! Nothing came through but a lump under the skin.
We were about three miles into the ride at 'Calaveras' and I was riding in front. I tend to try to go faster when I ride in front than I would normally go, because I hate to be tailgated. I think this may have caused me to enter a short steep downhill with excessive speed. As you may know, I feel that excessive speed or rather, a failure to slow down when necessary is the #2 cause of accidents when mountain biking. Having someone behind you who had already run up your tail once that ride, can be a real distraction. And distractions can be dangerous.
I should have crept over the edge so that I didn't gain too much speed on the way down. But instead I entered at 5 or 8 miles an hour which was way too fast for a rider of my capabilities. Heck, I should have stopped and walked! I had done this part of Calaveras once before, about a month earlier and was showing off the trail to two other riding buddies. Last time, my wife walked this hill, but she was on the other side of the country (in Atlanta, Georgia) this time.
I was looking forward to this particular section of three or four sharp little hills, each about 15 to 25 feet tall. The hill I bought it on was the smallest and first of the set, but it was also the most difficult.
It has two very deep V-shaped ruts running along it, one in the middle, and a much bigger one on the left side. I might have been able to go down the right side instead of riding in either rut, but that is a bumpy and narrow ride. The last time, I remembered choosing one of the ruts. You generally can't get out of a rut once you are in it. To stay balanced I had to lean to one side as I got near the bottom. Sometimes leaning is the only way to stay upright and have the wheels go where you need them to go.
This time, I went down the left rut, which gets to be about two feet deep and very V-shaped with sharp fairly smooth sides. Rather than riding in the center of the rut, which was sandy, I tried to stay up on the left hand wall of the rut. As I got near the bottom of the hill, the bike slid down into the base of the rut, which was sandy and after about three feet of plowing through the sand with the front wheel, the wheel finally dug in and pretty much stopped and I went over the handlebars as the bike flipped. I had not been far enough back on the seat--or better yet, behind the seat. My center of gravity was too far forward. The gravity of the situation was suddenly apparent.
Normally you instinctively try to get an arm out in front of you before you land. If I had done this, I might have broken the arm, but at any rate the arm would have broken the fall. For some reason I didn't get the arm forward and instead I landed--crunch--on my left shoulder and on my helmet. (Count me as one more life definitely saved by a helmet.) I landed off to the left side next to the trail in the bushes, and I think the reason the arm was still at my side instead of out front protecting the body was that as I tried to move it up it got knocked back by all the sagebrush and scrub as I flew threw the air to my destination with dirt, my decimation by the dirt.
The instant I landed I knew I had hit very, very hard and expected that I had broken or dislocated the shoulder. I heard two distinct crunching sounds in rapid succession, that sounded like two small branches breaking, but somewhat muffled. I continued sliding along the dirt for another couple of feet and stopped against some shrubbery. I rolled over and sat up and as my friend yelled down from the top of the hill "Are you alright?" I touched the shoulder area with my other hand and could feel a bone significantly out of place. "No" I replied. "I think I broke my shoulder." I looked around for some broken sticks to explain the two cracking sounds I had heard, but there were none. That's when I knew I had a serious booboo.
I tried to stand but felt dizzy, and in fact had to lie down for about 10 minutes as I lolly-gagged in pain. One of my riding buddies poured water on my head because I was sweating. I lay on my right side with my left arm stiff at my side. Finally, I was able to stand up without feeling queezy. We put the left arm in a sling made from the spare tube I carried and I began to walk out with someone else taking two bikes. This sling was repeatedly admired by the various medical personel that attended me.
We decided to go to the nearest houses rather than back to the car, and one partner rode ahead. But when I finally got there and an ambulance came (and a fire truck and a K-9 police unit, too!) everyone suggested that if it wasn't too much trouble, we should drive ourselves over to the hospital and save some money. I guess I didn't look too bad at this point, having recovered my color and balance and at least a little nerve. Someone asked me, which put it in no uncertain terms: "Are you tough?" I laughed and said "I don't know, I guess so. I made it this far!" and shrugged my shoulder--and winced in pain.
It's amazing how many nice people you meet mountain biking! It's even more amazing how many nice people you meet walking out of a mountain bike ride with a broken wing. At least half a dozen people went WAY out of their way to help me! People who hadn't even seen me were getting their neighbors and calling 911 to help. In the short walk out--not more than half a mile, I had help from mountain bikers, dirt bikers, and four-wheelers, not to mention local residents, some folks at a nearby church, and of course my two riding buddies. The paramedics, firemen and police were all cool, too! Even at the hospital the care and tenderness of the employees was great! If it weren't for the little problem of the bone being broken, I would have thought I was having a great time!
Someone gave one of us a ride around the park back to his pickup truck and he came back and we loaded the three bikes into the truck (I just watched) and headed to the hospital.
It took us over two hours by the time I finally got to the hospital,
and it was another hour before they started to treat me. The
treatment was actually amazing. All they did was give me some shots
in the general area and while that was taking affect, they took four
X-rays (for their own liability, I think. And two would have been
enough but the guy missed the target.)
My clavicle was broken in two places. Two long ones with a short little
one inbetween them. Ragged edges.
The doctor told me to sit up straight and move my arms as far back as I could "as if you were standing at attention." Back, back back. That's good. Now just let me put a brace on you and we can sign your paperwork and send you home!
That was it! I had set the bone in place myself! Next, I wear the brace for about three weeks. (I'm on day three right now.) It has to be tight. Pulling your arms back makes room for the clavicle to go back in place and it will heal itself in time--about six weeks (three in the brace, then three more). I've heard that in England they don't use the brace at all.
The first few days I thought I needed my friends to help me take off the strap and put it back on, which I wanted to do once a day in order to take a shower. But then I studied the clipping mechanism on the back and figured out how I could reach around and unstrap it myself, making me totally independent. I could even drive right away, and obviously I'm typing...
The following conversation did not occur, thank goodness: "Doc, can I clarify one thing? "What?" "Will I ever be able to play the clavichord again?" "Yes." "How about the clavier?" "Sure." "The clarinet?" "Presumably." "The clarion?" "Don't see why not." "Never could before. Can I drink claret?" "Not while you're on these" he said, giving me a prescription pain killer.
Final verdict:
"Acute mildly comminuted displaced mid left clavicular fracture with approximately 3 cm of override. Exam is otherwise negative with no left AC joint separation."
158K high resolution version of this xray.
November 15th, 1996 followup:
Shoulder appears (and feels) like it's healing properly--or at least good enough to ride again. I hope to be off-road on my mountain bike again within a week or two. Every day (since the fragments fused) has shown some progress in reduced pain and increased strength and degrees of motion.December 18th, 1996 follow-up:
I was about to start riding again, but I happened to have a chest xray about a week ago and--practically by chance--the clavicle was in the picture. (See below.) It looks separated to me, and when I showed it to my General Practitioner, he agreed. I understand that the correct shot on the clavicle should be from 15 degrees higher up (this is straight on) but this does show the area.By the way: You should always try to have as few xrays as the doctors will let you get away with. One generally needs even less than that! Combining xrays is a good thing when you can do it. The Doctors and dentists seldom will try to do this. For example, I chipped a crown as well when I fell, but when I (finally) went to the dentist to get it fixed and get my teeth cleaned and checked, they first took one xray of the crown and then four 'regular' xrays. I contend it could have been just the four, not five. The crown was probably in the other four xrays. But I didn't speak up fast enough. Patients must always watch out for themselves. You don't want any needless xrays, but you get them all the time. Like the saying goes, if xrays are so safe, why do all the medical personel hide behind a lead wall when they take them?
I took the xray to my favorite shoulder surgeon and he tested me a bit
by seeing what forces I could oppose and decided I was fine. That's
the best news I've heard in two months! He said possibly the bones
still have not completely fused but it appears there is enough of
a fibrous mass around the two pieces that I have no more likelyhood
of breaking that shoulder than I have of breaking the other one.
Nonetheless, for safety, or mental peace of mind, I bought--and intend to use--a full chest protector. At least for a while. It weighs less than a pound but it still feels a little like overkill. Of course, I won't feel that way next time I'm sitting on the ground wondering why I failed to negotiate a section I'd done before...
December 21st, 1996 follow-up:
I rode today, almost exactly two months after the accident. I experienced very little shoulder pain and--surprisingly--nearly total confidence. There seemed to be virtually no fear of riding. It was wonderful!March 25th, 1998 follow-up:
Things didn't quite work out as well as expected (my 100% healthy pronosis was somewhat premature) but I'm riding now and have put hundreds of miles on my bike in the last few months. There is occasional soreness in the area where the break was, but it's no big deal. The main thing to prevent stiffness or soreness seems to be to lift weights periodically, but I feel that is a vital excercise for mountain bikers anyway. (To keep their arms strong so they can handle unusual bike attitudes without letting the handlebars turn on them unexpectedly.)It took me another 9 months to be able to ride after first starting again, but it had "little" to do with the broken clavicle. It turns out I had also dislodged, displaced, or broken my coccyx (also known as the tailbone -- it's the triangular bone at the base of the spine). Apparently the bike's top tube or perhaps the seat hit me when I crashed.
After long rides (generally about 5 hours or more) I would have excruciating lower back pain two days later. After several rides like this over a period of a few months I went back to the doctor, who had me bend over and he felt around the area.
Suddenly I jumped forward and exclaimed that he had, for sure, found the proper spot. He declared that I had a bruised or broken coccyx and would need to spend from 6 weeks to three or four months being gentle to it.
So I started to do that, but nothing got better. In fact, after the visit to the doctor, it was actually a good deal worse to the point where nearly every day was filled with terrible back pain. Then finally, after about five long months of not riding (this would be around August, 1997) I decided to take matters into my own hands, so to speak, and attempt to set the tailbone properly myself. While I am no doctor and am not recommending anything to anyone, I can say it worked. Within days the pain subsided at last, and in a few months I began riding and soon realized that there was absolutely no pain anywhere. I'm truly recovered at last! (Actually this was a bit optimistic. This tailbone injury comes and goes now, and has turned out to be the most significant lasting effect from the accident.)
It's possible that another decision concurrent with the decision to attempt some self-bone setting really did the trick, but I doubt it. However, for what it's worth, here's what else I did: The very next day, there were unusually large ocean waves, and being an experienced body surfer, my wife and I went in, although it was a bit crazy and hardly anyone else was in the water. But we like big waves (8 feet "faces", for example) and these were the best we had seen all summer. So, throwing caution and common sense to the wind (or to the waves, which generally come from the wind) we went in. As I said, the pain the next day was less, so we went in again, and continued to do so for nearly a month straight, going in every day. Several big storms with wonderful huge waves in September kept me from getting back on the bike too soon (a common enemy of good healing). Now, everything's cool. Life is grand and we ride about twice a week.
To get to this ride:
NOTE: THIS RIDE IS AT LEAST HALF HOUSES NOW! I haven't been back in about two years to determine exactly how much is left, but it it's not what it used to be (this note added April, 2002).
Calaveras Ranch is a small area at the end of Carlsbad Village Drive in Carlsbad, California. Get off Interstate I-5 at Carlsbad Village Drive and go East. Go about 4 miles, to the very end of that road, (formerly known as Elm Street) and turn right at the T junction. Calaveras is directly in front of you before you make the turn.
Park in the lot of the Carlsbad Recreation Center which is on your right. Cross the street and enter into the park on the dirt road opposite the small basketball courts. There are numerous ways down into Calaveras Ranch. The highest hill is directly in front of you and there are several nice technical climbs up it. Explore!
After reaching the top, go around behind this tall hill. There are numerous trails and some of them are nice singletracks while others are fire roads. Watch out for deep stream beds, ruts, rocks, and everything else. This ride is full of surprises so be careful!
There are probably 25 miles of trails in this small park only a couple of miles across. The trails are used by dirt bikes and 4-wheel drive vehicles and occasionally a horse or two. It's not a real pretty area (but the view from the peak is worth the climb). The reason I like Calaveras, aside from it being less than 5 miles from home, is that it has many good technical sections, a lot of elevation change, and some really fine singletrack.
And if you go there and see me walking down one deeply rutted slope, you'll know why. I think I'll always have bad memories of that one little stretch.
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