Arthroscopic removal of bullet from intra-articular compartment has been described for several joints. Only few reports dealing with this condition in the shoulder have been reported especially for the glenohumeral and the subacromial compartments. We report the story of a fifty-seven-year-old man presenting a bullet in the supraspinatus compartment of his left shoulder successfully removed by arthroscopy.
Arthroscopic removal of bullet from intra-articular compartment has been described for several joints [
A right-handed fifty-seven-year-old man in general good health complained for pain on his left shoulder for several months without limitations. In his past history, when he was thirty-one years old, he reported a shoulder gunshot injury. The bullet had a parallel course, fired from two meters, entered in the shoulder just above the collarbone, and stopped against the anterior aspect of scapula spine (Figure
Preoperative anteroposterior and axial radiographs showing the bullet in the supraspinatus compartment of the shoulder.
Sequence of events of the bullet extraction: (a) dissection around the bullet which is encapsulated in a fibrous scar, (b) removing of the fibrous scar around the bullet, and (c) bullet extraction with a pincer to grasp.
The bullet after its extraction.
This case report describes the removal of a low-velocity bullet from extra-articular compartment of the shoulder by arthroscopic procedure.
Previous descriptions also published reported situation of bullet extraction straight after gunshot injury and where the bullet was located on intra-articular position or subacromial space [
In our practice the bullet extraction for an isolated psychological reason is not an indication for surgery especially in the absence of clinical symptoms. However this patient presented a nontear tendinopathy due to subacromial impingement justifying acromioplasty associated with acromiocoracoid ligament section. The bullet extraction has been made on request of the patient who could not bear the presence of the foreign body and of the potential risk of blood toxicity due to retained bullets described in the literature, even many years after ballistic trauma [
Thus, the use of arthroscopy in the case of foreign bodies’ extraction is less invasive than conventional open techniques and allows associated procedure such as precise articular evaluation (cartilage, synovial, and tendons) and irrigation. More, the bullet removal by arthroscopic technique around the shoulder is achievable regardless the bullet position (intra or extra-articular compartment) and whichever the ballistic trauma delay is.
Level of evidence of this study is IV.
The authors declare that they have no conflict of interests regarding the publication of this paper.