Clay-shoveler fracture

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Clay-shoveler fracture
Synonyms	Clay shoveler's fracture
Pronounce	N/A
Specialty	Orthopedic surgery
Symptoms	Neck pain, shoulder pain
Complications	N/A
Onset	Sudden
Duration	N/A
Types	N/A
Causes	Trauma, repetitive stress
Risks	Manual labor, contact sports
Diagnosis	X-ray, CT scan
Differential diagnosis	Cervical spine fracture, muscle strain
Prevention	N/A
Treatment	Pain management, physical therapy
Medication	N/A
Prognosis	Good with treatment
Frequency	Rare
Deaths	N/A

A Clay-shoveler's fracture is a type of spinal fracture that occurs in the cervical vertebrae, specifically affecting the spinous process of the lower cervical vertebrae, most commonly at the C7 level. This injury is typically caused by sudden muscle contraction or direct trauma to the spine.

Etiology

The name "Clay-shoveler's fracture" originates from the early 20th century when Australian clay miners were noted to suffer from this injury due to the repetitive and forceful shoveling of clay. The sudden downward force exerted on the spine during shoveling could lead to an avulsion fracture of the spinous process.

Pathophysiology

The fracture occurs when the trapezius muscle and other muscles attached to the spinous process contract forcefully, causing a piece of the bone to break off. This is an avulsion-type fracture, where the muscle pulls a fragment of bone away from the main structure.

Clinical Presentation

Patients with a Clay-shoveler's fracture typically present with:

• Localized pain at the site of the fracture, often exacerbated by movement.
• Swelling and tenderness over the affected spinous process.
• Limited range of motion in the neck.

Diagnosis

Diagnosis is primarily made through radiography. A lateral X-ray of the cervical spine will typically show the fracture of the spinous process. In some cases, a CT scan may be used for further evaluation.

Treatment

Treatment for a Clay-shoveler's fracture is usually conservative, as the injury is considered stable. Management includes:

• Rest and avoidance of activities that exacerbate symptoms.
• Analgesics and anti-inflammatory medications for pain relief.
• Physical therapy to restore range of motion and strengthen neck muscles.

Prognosis

The prognosis for individuals with a Clay-shoveler's fracture is generally excellent. Most patients recover fully with conservative treatment, and the fracture typically heals without complications.

See also

• Cervical vertebrae
• Spinal fracture
• Trapezius muscle