Shoulder girdle injury
Clavicle fracture and AC joint injury after a motor accident
Clavicle and acromioclavicular injuries may heal with pain-free function, or leave deformity, instability and restricted shoulder movement. The assessment should identify the residual problem instead of treating the fracture grade or fixation plate as the percentage.
Motor accident injury
How can this injury happen?
Car or passenger collision
Seat-belt compression or side-door impact can fracture the clavicle or sprain the AC joint.
Motorcycle accident
Landing on the point of the shoulder commonly causes clavicle fracture or AC separation.
Pedestrian or cyclist impact
Direct shoulder impact can injure the clavicle, AC ligaments and surrounding soft tissues.
Injuries that can occur
- midshaft, distal or medial clavicle fracture
- AC joint sprain or separation
- non-union, malunion or symptomatic hardware
- associated cuff, scapular or brachial plexus injury
Symptoms and functional problems
- pain carrying or reaching across the body
- visible prominence or tenderness
- reduced overhead endurance
- numbness or irritation around hardware
Seek urgent medical assessment
Skin tenting, open fracture, breathing difficulty or neurovascular compromise requires urgent assessment.
Clinical evidence
What findings matter?
Fracture union, alignment, AC stability and active shoulder function should be documented. Cosmetic prominence alone is not assessed through the upper-extremity method.
| Record or examination | What it may establish | What it cannot prove alone |
|---|---|---|
| X-ray or CT | Shows fracture, union, displacement, AC alignment and hardware. | Appearance alone does not quantify function. |
| Shoulder and AC examination | Records cross-body pain, stability, tenderness and active movement. | Tenderness without permanent functional loss is not a table value. |
| Operative report | Explains fixation, ligament reconstruction and complications. | Hardware does not equal WPI. |
Movement in daily life
How movement affects real activities
Clavicle and AC injuries commonly affect overhead and across-body use. Active shoulder planes show whether the shoulder girdle has a permanent functional restriction.
Flexion
Lifting the arm forward and overhead, including reaching a shelf or putting on a shirt.
Active flexion and extension are rated through AMA4 shoulder Figures 36 to 38 when reliable.
Abduction
Lifting the arm sideways, including reaching away from the body or fastening a seat belt.
Active abduction and adduction are addressed by Figures 39 to 41.
External rotation
Washing hair, reaching behind the head and positioning the arm to put on a jacket.
Active external rotation is read with the shoulder rotation figures, not estimated from pain severity.
Internal rotation
Reaching behind the back for dressing, hygiene or fastening clothing.
Active internal rotation is addressed with Figures 42 to 44 and must be measured consistently.
Threshold injury is a separate question: a verified clavicle fracture or complete/partial AC ligament rupture may be non-threshold; a sprain without rupture may remain threshold.
Part 6 permanent impairment
How is CTP WPI assessed?
Active shoulder ROM is a verified method. If a residual clavicle or AC disorder is not covered, clause 6.24 permits a reasoned analogy, but the exact analogous AMA4 row must be verified before a value is used.
Measurement rules that apply
- Clause 6.50 requires active, not passive, range of motion for the impairment calculation. A goniometer should be used where clinically indicated, and unreliable movement should be repeated consistently before it is accepted.
- Clauses 6.51 and 6.52 permit a contralateral baseline only where the uninjured joint is a fair estimate of pre-accident mobility. The total upper-extremity impairment for each comparable joint is subtracted before conversion to WPI.
- Clause 6.67 prohibits upper-limb strength evaluation and AMA4 Table 34. A genuine peripheral nerve or muscle-bulk injury must use another permitted method without double counting.
| Method | CTP source | When it is relevant | Important limit |
|---|---|---|---|
| Active shoulder ROM | Clauses 6.50-6.52; Figures 36-44 | Permanent restriction caused by the shoulder-girdle injury. | Do not rate pain or prominence as an angle. |
| Assessment by analogy | Clause 6.24; upper-extremity disorders pages 58-64 | Objectively established residual deformity or instability not otherwise covered. | Rationale and readable source criteria are required. |
| Table 3 conversion | Clause 6.56 | Converts UEI to WPI. | Cosmetic disfigurement uses a separate body-system method. |
- Confirm union or malunion and current function.
- Separate cosmetic appearance from musculoskeletal impairment.
- Address a separate nerve injury only under clauses 6.58-6.60.
What cannot be combined?
- cosmetic and upper-extremity values for the same feature without separate impairment
- ROM and analogy rating the same shoulder restriction
- hardware discomfort as an additional percentage
What does not establish WPI by itself?
- fracture grade
- fixation plate
- visible bump alone
- tenderness without stable impairment
Motor accident examples
Clavicle fracture with full movement
A serious initial fracture may have little or no upper-extremity WPI if union and active shoulder function recover.
AC separation with persistent overhead restriction
Reliable active ROM may quantify the functional impairment; the separation grade alone does not.
Claim file preparation
Evidence checklist
Assessment source
Clavicle and AC joint WPI source
Assessment source: Motor Accident Guidelines v10.1 clauses 6.24 and 6.47-6.67; AMA4 shoulder Figures 36-44, upper-extremity disorders pages 58-64 and Table 3.
Threshold injury: Fracture or verified ligament rupture may be non-threshold; soft tissue AC sprain may remain threshold. WPI is separate.
What the assessor checks
- active ROM
- analogy rule
- Table 3 conversion
- separate cosmetic method
What does not establish the result by itself
- injury grade
- hardware
- prominence
- pain
Official sources
Related NSW CTP guides
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Frequently asked questions
- Does clavicle fixation have a fixed WPI?
- No. The assessor considers the permanent residual impairment, not the presence of a plate.
- Can a healed fracture have 0%?
- Potentially, if there is no assessable permanent movement, nerve or other impairment.
- Is an AC joint sprain threshold?
- It may be unless a partial or complete ligament rupture or another excluded injury is established.
- Does a visible bump count?
- Cosmetic appearance is not assessed through the upper-extremity method and must meet the separate applicable body-system rules.
- What if hardware remains painful?
- Pain alone is not added separately. The assessor must identify a permitted residual impairment method.