CLAY-SHOVELER'S FRACTURE

Definition and Causes

The clay-shoveler’s fracture is an oblique fracture of the lower cervical or upper thoracic spinous processes, commonly C6 >C7 >T1. This uncommon breakage of the spine is a result of stress. It results from hyper flexion, a type of avulsion injury at the base of the spinous process. If the avulsion fracture is not limited to the spinous process but extends into the lamina, there is greater potential for spinal cord injury. This is a stable injury that was originally named for those who were mining clay, although it usually occurs in laborers who perform activities involving lifting weights rapidly with the arms extended. Examples of these activities include shoveling snow up and over the head backwards. The shear force of the muscles ( trapezius and rhomboid muscles ) pulling on the spine at the base of the neck actually tears off the bone of the spine.

Symptoms and Treatment

Symptoms of clay-shoveler’s fracture include burning, “knife-like” pain at the level of the fractured spine between the upper shoulder blades. The pain can sharply increase with the repeated activity that strains the muscles of the upper back. While the intense pain gradually subsides in days to weeks, the area can intermittently develop burning pain with certain activities that involve prolonged extending of the arms ( like computer work ).
The clay-shoveler’s fracture is diagnosed by an x-ray exam of the spine. Most patients require no treatment. Pain medications, physical therapy, and massage can be of help. Once the presence of segmental instability has been ruled out, clay-shoveler’s fractures can be treated non operatively. Occasionally, surgical removal of the tip of the broken spine is performed for those with long standing pain.

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