Question
A 4 year old girl has a painless lump over her right clavicle that her parents first noticed in infancy. There is no history of trauma.
- Describe the findings and give the spot diagnosis.
- What is the differential diagnosis?
- What is the pathogenesis of your preferred diagnosis?
- What is your management?
Answer
Findings and diagnosis
- Painless prominence at the middle third of the right clavicle, with mobility at the site
- Congenital pseudarthrosis of the clavicle
Differential diagnosis
- Birth fracture of the clavicle, which is painful and heals with callus in weeks
- Cleidocranial dysplasia, usually bilateral with absent or hypoplastic clavicles, delayed fontanelle closure and dental anomalies
- Neurofibromatosis
- Post-traumatic nonunion
Pathogenesis
- Failure of fusion of the medial and lateral ossification centres of the clavicle
- Almost always right sided, attributed to pressure from the higher subclavian artery
- Left sided cases occur with dextrocardia, and bilateral cases are rare
Management
- Radiographs show smooth rounded bone ends without callus
- Observe if asymptomatic, as many cause no functional problem
- Surgery for pain, cosmetic concerns or thoracic outlet symptoms, usually between 3 and 6 years of age
- Excision of the pseudarthrosis, autogenous iliac crest bone graft and plate fixation, with high union rates
- Spontaneous union does not occur
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.