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Clay Shoveler's Fracture
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Clay Shoveler's Fracture
Jackie Kerner
Origin story:
Diagnosis
Stress-type avulsion fracture of the lower cervical or upper thoracic spinous processes
Originally described in Australia, among clay shovelers. The reason is due to the stickiness of clay. As clay shovelers lift the shovel upwards to toss the clay from deep ditches, the clay tends to stick to the shovel. This results in sudden forces on the neck and back muscles leading to the avulsion fracture.
What is it?
Diagnosis is made with lateral radiographs of the cervical spine
Avulsion:
Action of pulling or tearing away
Anatomy
Can you find the fracture?
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Direct trauma to spinous process
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Most commonly C7, but can affect C6 to T3
Clay shoveler's fractures can occur at more than one spinal level, although this is rare
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Usually occurs midway between the spinous tip and lamina while the person is hyper-flexing their neck
Indirect trauma: sudden muscular/ligamentous pull
IN DEPTH
Presentation
Symptoms:
Sudden onset of pain between the shoulder blades or base of neck
Reduced head/neck ROM
Localized swelling and tenderness
Increased discomfort upon palpation
Operative vs. Nonoperative
Treatment
Surgical Excision
Indications:
Persistent pain or non-union
Failed conservative treatment
Occasionally, surgical removal of the tip of the broken spine is performed for those with longstanding pain
Conservative Methods
Orthotic Intervention
The preferred method of treatment...
Rigid cervical collar
This fracture is considered stable, and it is not associated with neurologic impairment.
Management involves only cervical immobilization with an orthotic device for comfort
NSAIDs
Most common method for pain control
EVENTS
37-year-old man had a sudden lower posterior neck pain during his golf swing
During the physical examination, he complained about severe tenderness between both shoulder blades, limitation in range of neck motion, and a cracking sound in the painful posterior cervico-thoracic junction
Initial cervical spine X- rays showed an isolated spinous process fracture C-7 vertebra
Case Study
Treatment
He was prescribed analgesics and muscle relaxants.
Cervical immobilization was done for 4 weeks with a cervical collar brace.
IN BRIEF
Resources
Watts, Evan. “Clay-Shoveler Fracture (Cervical Spinous Process Fractures).” Orthobullets, 23 June 2021, https://www.orthobullets.com/spine/12284/clay-shoveler-fracture-cervical-spinous-process-fractures.
Ok, Young Cheol, et al. “A Golf-Related Multiple Spinous Process Fracture (Clay-Shoveler's Fracture) of Cervico-Thoracic Spine: A Case Report.” Journal of Korean Neurotraumatology Society, vol. 4, no. 2, 2008, p. 97., https://doi.org/10.13004/jknts.2008.4.2.97.
Botz, Balint. “Clay-Shoveler Fracture: Radiology Reference Article.” Radiopaedia Blog RSS, Radiopaedia.org, 26 Oct. 2021, https://radiopaedia.org/articles/clay-shoveler-fracture-2?lang=us.
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