Acute Arthroscopic Removal of a Bullet From the Shoulder

Abstract 

Arthroscopic procedures are frequently used for extraction of foreign bodies such as bullets from joints. Retained bullets have some effects as loose bodies that cause mechanical symptoms and destroy articular cartilage. Bullets and lead particles in synovial fluid dissolve in time and cause periarticular fibrosis, chondrolysis, hypertrophic arthropathy, and sometimes chronic lead intoxication. A 21-year-old man was treated after he sustained a gunshot wound to his left shoulder. Shoulder arthroscopy was performed through the standard posterior portal. The bullet was observed in the posterior recess and was removed by means of a 10-mm cannula placed anteriorly. The use of arthroscopy for removal of the bullet from the shoulder joint of this patient minimized surgical dissection and blood loss and reduced the likelihood of complications. The patient was free of symptoms within 1 month. Given the disadvantages of traditional techniques such as heavy blood loss, large incisions, high risk for neurovascular anatomic structures, poor visualization of articular surfaces, and prolonged recovery times, we recommend arthroscopic removal of foreign bodies from the shoulder joint as an excellent choice for the treatment of patients with such intra-articular injuries.

Key Words: Gunshot wound, Arthroscopy, Bullet, Shoulder joint