Name of the Procedure:

Removal of foreign body, shoulder; deep (subfascial or intramuscular)

Summary

This procedure involves the surgical removal of a foreign object that has penetrated deeply into the shoulder area, situated beneath the fascia or within the muscle tissue.

Purpose

The procedure addresses situations where a foreign object, such as a piece of glass, metal, or wood, has lodged itself deeply in the shoulder. The goal is to safely remove the object to prevent infection, persistent pain, or damage to surrounding tissues and structures.

Indications

• Persistent pain or tenderness in the shoulder
• Signs of infection around the area of the foreign body
• Difficulty in shoulder movement or functionality
• Visible or palpable foreign material under the skin
• X-ray or imaging evidence of a foreign object in the shoulder

Preparation

• Patients may be instructed to fast for a specified period before the procedure, usually 6-8 hours.
• Medication adjustments may be necessary, including stopping blood thinners.
• Pre-procedure imaging tests like X-rays, CT scans, or MRIs may be performed to locate the foreign object precisely.

Procedure Description

1. The patient is placed in a comfortable position, typically lying down, and the affected shoulder is sterilized.
2. Local or general anesthesia is administered to ensure the patient feels no pain during the procedure.
3. A small incision is made over the area where the foreign body is located.
4. Using special surgical instruments, the surgeon carefully dissects through tissues to reach the foreign object.
5. The foreign object is identified and gently removed.
6. The incision site is thoroughly cleaned and then stitched closed.
7. A sterile dressing is applied to protect the wound.

Duration

The procedure typically lasts between 30 minutes to 1 hour, depending on the complexity and location of the foreign body.

Setting

The procedure is usually performed in a hospital or surgical center, often as an outpatient service.

Personnel

• Orthopedic surgeon or general surgeon
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)
• Scrub technician

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to nearby muscles, nerves, or blood vessels
• Incomplete removal of the foreign body
• Anesthesia-related risks

Benefits

• Removal of the foreign body alleviates pain and prevents infection.
• Restores normal shoulder function and mobility.
• Minimizes the risk of long-term damage to shoulder structures.

Recovery

• Post-procedure, the patient may experience mild pain or discomfort, managed with prescribed pain medications.
• The incision site should be kept clean and dry; follow specific wound care instructions provided by the healthcare team.
• Avoid strenuous activities and heavy lifting for a few weeks.
• Follow-up appointments will be necessary to monitor healing and remove stitches if applicable.

Alternatives

• Watchful waiting if the foreign body is not causing symptoms or complications.
• Non-surgical removal using imaging guidance if the foreign object is less deeply embedded and accessible.
• Pros and cons of alternatives depend on the location, type, and symptoms caused by the foreign body.

Patient Experience

During the procedure, under anesthesia, the patient should feel no pain. Post-procedure, some discomfort or soreness is expected, which can be managed with medication. Ensuring proper rest and adhering to aftercare instructions will support a smooth and swift recovery.