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A 53-year-old man with a history of schizophrenia was brought to the Emergency Department
(ED) by police and paramedics for medical clearance after his landlord called 911
out of concern for the patient's health. The patient had no complaints on arrival
in the ED. The patient denied any recent problems and stated he regularly saw his
psychiatrist for his schizophrenia. The patient's vital signs were normal with the
exception of a temperature of 38°C (100.4°F). Physical examination was notable for
a 4-cm metallic foreign body exposed and protruding from the anterior aspect of his
right shoulder through a prior surgical incision site (Figure 1, Figure 2). Around the wound site, there was granulation tissue with purulent drainage. Upon
further questioning, the patient reported that he had undergone a total right shoulder
arthoplasty 3 or 4 years prior, and stated that his shoulder had been in this position
since the surgery. He denied any recent fevers, pain, or difficulty with moving his
right shoulder or arm.
Figure 1Photograph of anterior right shoulder with prosthesis protruding from wound site.
