Congenital pseudoarthrosis of the clavicle (CPC) is not a common condition. The exact number of cases reported in literature is fewer than two hundred. We present four well-documented cases of true congenital pseudoarthrosis of the clavicle, including two cases of familial occurrence. None of the patients in this study were treated surgically. Evaluation of upper extremity function was done with use of the Constant-Murley method. In spite of clavicle pseudoarthrosis the score results were similar to the unaffected shoulder. Although vertical elevation of the upper ribs or cervical ribs has been suggested as a cause of congenital clavicle lesions, radiological examination failed to reveal such pathology in any of the patients described here. Clavicle pseudoarthrosis is generally regarded as a benign condition. The majority of patients who underwent surgery because of cosmetic or functional heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of their CPC and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option.