Clinical assessment In the setting of a suspected clavicle fracture, the physical examination should include both the shoulder and the arm to evaluate for possible vascular or brachial plexus injury Visual inspection and palpation of the clavicle for deformity or crepitus should indicate the location of the fracture Examination for an AC injury should include visual inspection for localized bruising and swelling as well as palpation of the joint during flexion and extension of the shoulder and distraction of the arm as it is placed in adduction If the injury is not severe and/or the diagnosis is uncertain, the Bell–van Riet test for isolated AC joint pathology is felt to be the most sensitive For this test, the affected arm is passively raised in full adduction to 90 degrees and crossed in front of the patient toward the contralateral shoulder while maintaining full extension The patient then attempts to elevate the arm against resistance If this maneuver results in focal pain at the AC joint and inability to maintain the arm in the adducted and elevated position, this likely indicates an unstable AC joint