Review Question - QID 213759

A 27-year-old man presents to the emergency department after falling off a wall while intoxicated and running from the police. He is currently combative and requires security to be restrained. He is talked down and states that his shoulder hurts. He is still intoxicated and cannot recall his medical history nor his home medications. His temperature is 99.1°F (37.3°C), blood pressure is 127/88 mm Hg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 98% on room air. The patient's exam is notable for a deformity over his shoulder, and he is covered in small bruises and abrasions. A radiograph of the shoulder is performed as seen in Figure A. The patient becomes combative and begins attacking the physician when the physician attempts to examine the extremity. The patient is treated and calms down. Notably he demonstrates a nystagmus while relaxing in the bed. As the physician is about to examine the extremity, the patient demonstrates notable respiratory distress and severe stridor. Which of the following is the most likely etiology of this patient's symptoms?