The clavicle is a curved bone that joins with the sternum. The scapula, the large flat triangular bone that forms the posterior part of the shoulder, joins with the clavicle and the humerus. Impairment is restrictive movement or range of motion (ROM) of a part, joint, or soft tissue, especially those imposed by disease or trauma.

Restriction of movement of the clavicle or scapula may be caused by fracture; dislocation; torn muscle; arthritis; adhesive capsulitis (see Diagnostic Code: 5200 Scapulohumeral ankylosis); tendonitis; peripheral nerve injury; or bursitis or a combination of the preceding etiologic factors.

Manifestations of the impairment may include: limitation of motion; pain; a pop felt on external rotation of the shoulder; a loose joint with excessive mobility; muscle weakness; joint dislocation; sagging shoulder; or crepitus over the scapula or clavicle.

Tests that may be used to determine clavicle or scapula impairment include: x-rays; computed tomography (CT) scan; magnetic resonance imaging (MRI); arthroscopy; arthrogram; nerve conduction tests; or electromyography.

Treatment of the condition will range from immobilization with a splint or cast, to possible surgical reconstruction of the joint or arthroscopic joint debridement. Physical therapy with range of motion is started as soon as possible along with muscle strengthening exercises.

• Nonunion of fractures may result if exercises are started before healing has occurred. Prolonged immobilization of joints may lead to stiffness and ankylosis. The wasting away of muscle may occur due to decreased usage and activity.

• When deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within scope of the claim, including those identified by the rating criteria for that condition in 38 CFR Part 4. This could include but is not limited to, scars as the result of surgical intervention for an SC disability. 

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Description of any instability and frequency of any dislocations is required.

• Multiple precedential decisions have impacted the application of 38 CFR 4.59 for musculoskeletal disabilities.  Refer to the M21-1 musculoskeletal disabilities section for a listing of impactful precedential court holdings, a brief description of the impact, and the applicability date (date of decision) for each.

• Separate evaluations may be given for disabilities of the shoulder and arm under 38 CFR 4.71a, diagnostic codes (DCs) 5201, 5202, or 5203 if the manifestations represent separate and distinct symptomatology that are neither duplicative nor overlapping. Refer to the M21-1 for examples of separate evaluations for disabilities of the shoulder and arm.  

• It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 CFR 4.2 – Interpretation of examination reports. If the report or examination is inadequate, the rating agency may return for a supplementary report. See 38 CFR 4.70 – Inadequate examinations. 

• None.