Saving the Shoulder: Acute Arthroscopic Removal of a Bullet Embedded in the Humeral Head - A Case Report.
- 1Department of Orthopaedics, Apex Super Speciality Hospital & PGI, Varanasi, Uttar Pradesh, India.
Abstract
Retained intra-articular bullets embedded within the humeral head are rare injuries that present significant diagnostic and surgical challenges. Failure to remove these retained projectiles may result in progressive cartilage damage, chondrolysis, infection, lead arthropathy, and, rarely, systemic lead toxicity. Although arthroscopic retrieval of retained intra-articular bullets has been reported, cases involving bullets deeply embedded within the humeral head remain uncommon, and the optimal surgical approach has not been clearly established. We report the successful arthroscopic removal of a large bullet embedded in the posterosuperior humeral head, highlighting the technical considerations and advantages of a minimally invasive approach. A 33-year-old male presented with a gunshot injury to the left shoulder. Initial trauma assessment confirmed no life-threatening injuries. Radiographs and computed tomography (CT) demonstrated a retained bullet measuring 1.5 × 0.6 cm embedded within the posterosuperior humeral head. After careful pre-operative planning, the patient underwent arthroscopic irrigation, debridement, and bullet retrieval in the lateral decubitus position. The bullet was successfully removed arthroscopically without conversion to an open procedure. The minimally invasive approach provided excellent visualization of the glenohumeral joint, facilitated thorough irrigation and debridement, and enabled safe retrieval of the embedded projectile while minimizing additional soft-tissue and cartilage injury. This case demonstrates that arthroscopic retrieval is a safe and effective treatment option for retained bullets embedded within the humeral head, even when the projectile is large and deeply impacted. Careful pre-operative CT evaluation and meticulous surgical planning are essential for successful management. By adding to the limited literature on this uncommon injury, this report supports arthroscopy as a valuable first-line approach that can reduce surgical morbidity, preserve shoulder stability, and provide practical guidance for orthopedic trauma and shoulder surgeons faced with similar injuries.
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BibTeX
@article{solanki2026saving,
title = {{Saving the Shoulder: Acute Arthroscopic Removal of a Bullet Embedded in the Humeral Head - A Case Report.}},
author = {Jayvirsinh Solanki and Mukesh Yadav and Amit Kumar Jha and Swaroop Patel and S K Singh},
journal = {Journal of orthopaedic case reports},
year = {2026},
month = nov,
doi = {10.13107/jocr.2026.v16.i11.8470},
url = {https://europepmc.org/article/MED/42997074},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Saving the Shoulder: Acute Arthroscopic Removal of a Bullet Embedded in the Humeral Head - A Case Report.
AU - Jayvirsinh Solanki
AU - Mukesh Yadav
AU - Amit Kumar Jha
AU - Swaroop Patel
AU - S K Singh
PY - 2026
DA - 2026/11/01
JO - Journal of orthopaedic case reports
DO - 10.13107/jocr.2026.v16.i11.8470
UR - https://europepmc.org/article/MED/42997074
AB - Retained intra-articular bullets embedded within the humeral head are rare injuries that present significant diagnostic and surgical challenges. Failure to remove these retained projectiles may result in progressive cartilage damage, chondrolysis, infection, lead arthropathy, and, rarely, systemic lead toxicity. Although arthroscopic retrieval of retained intra-articular bullets has been reported, cases involving bullets deeply embedded within the humeral head remain uncommon, and the optimal surgical approach has not been clearly established. We report the successful arthroscopic removal of a large bullet embedded in the posterosuperior humeral head, highlighting the technical considerations and advantages of a minimally invasive approach. A 33-year-old male presented with a gunshot injury to the left shoulder. Initial trauma assessment confirmed no life-threatening injuries. Radiographs and computed tomography (CT) demonstrated a retained bullet measuring 1.5 × 0.6 cm embedded within the posterosuperior humeral head. After careful pre-operative planning, the patient underwent arthroscopic irrigation, debridement, and bullet retrieval in the lateral decubitus position. The bullet was successfully removed arthroscopically without conversion to an open procedure. The minimally invasive approach provided excellent visualization of the glenohumeral joint, facilitated thorough irrigation and debridement, and enabled safe retrieval of the embedded projectile while minimizing additional soft-tissue and cartilage injury. This case demonstrates that arthroscopic retrieval is a safe and effective treatment option for retained bullets embedded within the humeral head, even when the projectile is large and deeply impacted. Careful pre-operative CT evaluation and meticulous surgical planning are essential for successful management. By adding to the limited literature on this uncommon injury, this report supports arthroscopy as a valuable first-line approach that can reduce surgical morbidity, preserve shoulder stability, and provide practical guidance for orthopedic trauma and shoulder surgeons faced with similar injuries.
SN - 2250-0685
SN - 2321-3817
ER -