Persistent Pain after Clay Shoveler's Fracture Delayed Union: The Role for Ultrasound-Guided Corticosteroid Injection

Clay shoveler’s fracture is an avulsion fracture of the lower cervical or upper thoracic spinous processes. This injury can be seen in trauma and sports-related activity, and usually responds to rest from painful activity. Patients with persistent pain may be treated with surgical excision of the avulsion fragment. We describe the case of a 14 year-old competitive swimmer whose desire to return to sport after failed initial treatment led to pursuit of an ultrasound-guided anesthetic/corticosteroid injection of the avulsion fracture interval. This led to rapid symptom relief and return to sport. Such an injection may be useful for diagnostic and potentially therapeutic purposes prior to surgical excision in the cases of delayed union or non-union clay shoveler’s fractures.