Shoulder Barbotage (or needle lavage as it is referred to in the US) is a minimally invasive technique used to treat Calcific Tendonitis, a condition where calcium deposits form within the rotator cuff tendons in the shoulder, causing intense severe pain in the shoulder.
The most common affected tendon is the Supraspinatus tendon.
Barbotage is performed under ultrasound guidance, allowing the clinician to accurately locate the calcium deposit and break it down with a needle.
During the procedure, a needle is inserted into the into the calcified deposit to break up and aspirate the calcification, providing relief from the discomfort and pain.
This approach offers a non-surgical alternative to patients and has a high success rate in alleviating the pain. Many patients report significant pain relief with this procedure.
The risks associated with Barbotage are relatively low compared to surgery, and the recovery time is generally quicker than that of surgery.
This makes barbotage an attractive option for those suffering from persistent shoulder pain due to calcifications within the rotator cuff tendonitis.
Carrying out the procedure under ultrasound guidance ensures that the treatment is precise, which is essential for optimal results and reducing potential complications.
In this article we highlight the procedure, effectiveness and potential risks of ultrasound-guided Barbotage.
This should hopefully help you in making an informed decision about your treatment options for calcific tendonitis.
Clinical Background
Indications
The main indication for Barbotage is calcific tendonitis, a condition characterised by the deposition of calcium typically within the tendons of the rotator cuff.
Patients often present with a severe, persistent, and painful shoulder which has not responded adequately to oral pain killers or physical therapy.
Often shoulder movements in any direction cause severe pain.
Background of Barbotage
Barbotage traces back to early treatments of calcific tendonitis where non-guided methods were the standard.
With the development of musculoskeletal ultrasound technology, the diagnosis of calcium deposits within the rotator cuff tendons has drastically improved.
Barbotage in combination with a steroid injection is very effective.
Over time, techniques have been developed and the procedure further refined, making it a safe and reliable option.
Preparation
Patients are usually examined and have an xray or ultrasound scan to confirm the diagnosis of calcific tendinopathy.
Prior to the procedure, the affected area is sterilised with alcohol and chlorhexidine, and a local anaesthetic such as lidocaine is administered to reduce discomfort during treatment.
Procedure
During the Barbotage Procedure, the clinician guides the needle using ultrasound and inserts the needle into the calcium deposit. (the area is usually numb after having injected lidocaine around it during the preparation phase)
The technique involves lavage—the flushing or pumping the calcium deposit with saline or local anaesthetic solution—and aspiration, which is the suction of the calcific deposits.
This process helps to break down and remove the calcium.
Post-Operative Care
Following the procedure, patients may experience some discomfort or swelling, which is usually treated with painkillers or Ice packs.
The patient is often advised not to do strenuous activities with the shoulder for 10 to 14 days.
The clinician may recommend gentle exercises or physical therapy to strengthen the rotator cuff tendon which helps in recovery and maintain the mobility and flexibility of the joint.
This is important to prevent a condition called frozen shoulder.
Risks of Shoulder Barbotage
While the Barbotage technique for treating calcific tendinitis is very popular and often has less risks than surgery, patients should be informed about both immediate and long-term risks associated with the procedure.
Immediate Risks
Infection Risk: There is a small possibility of skin or joint infection following Barbotage, which while uncommon, can occur.
Pain and Inflammation: Some patients might experience acute pain and inflammation, or post-injection bursitis.
- Tendon Rupture: There is the possibility of tendon rupture, though this is thankfully quite rare.
Long-Term Risks
Recurring Symptoms: In some instances, symptoms can return, requiring further treatment.
Chronic Pain: There is a potential for ongoing pain in the affected area after the procedure especially if the calcific deposit is large and is unable to be completely broken down.
- Minor Complication Rates: The overall rate of minor complications has been reported at 7%.
Outcomes
The barbotage procedure is a relatively successful procedure for patients with calcific tendinitis of the shoulder.
Success Rates
Ultrasound Guided Barbotage has been associated with high success rates in treating calcific tendinitis. Clinical studies have reported good clinical success rates with this technique, with an improvement in pain and shoulder function.
Prognosis
Improved outcomes result from the accurate injection and targeting of calcium deposits and thorough removal via image guided needling and lavage.
However, reduced improvement in pain scores post-procedure sometimes can be linked to particular tendon characteristics and symptom duration. If the calcified deposit is quite large and unable to be removed, often a surgical procedure may be necessary.
Occasionally the calcium deposit may be too small to be removed in which case the pain may recur later on during a flare.
Patient Information
When patients are considering an Ultrasound Guided Barbotage, they should be aware of what to expect before and after the procedure.
This brief summary provides essential information regarding the pre-procedure expectations and the subsequent recovery and rehabilitation phases.
Pre-Procedure
Patients may also be informed that the treatment has a high success rate in reducing pain, backed by research showing over 70% improvement in symptoms of pain and functionality.
The shoulder is scanned and the area is marked carefully. Local Anesthetic is applied before the procedure to ensure patient comfort.
Recovery and Rehabilitation
Post-procedure care is essential for effective recovery. Patients should:
Modification of activity: Limited use of the affected area may be necessary initially especially for 2 weeks post procedure.
- Physical therapy: Mild discomfort is normal and as the pain decreases the patient should start exercises to strengthen the temporarily weakened rotator cuff tendon.
The rehabilitation exercises are important to regain full function, and a tailored plan will be given to them by their clinician.
Frequently Asked Questions
This section addresses common queries regarding the barbotage procedure for calcific tendinitis of the shoulder, detailing the most common questions asked and includes costs, side effects, pain level, aftercare, recovery time, and potential complications.
What are the typical costs associated with a barbotage procedure?
The costs for a barbotage procedure can vary depending on the clinic. Here at My MSK we charge £325 for this procedure. This also includes the steroid injection post procedure.
What side effects may be experienced after undergoing a barbotage procedure?
Following a barbotage procedure, patients may experience acute pain, bruising, and swelling. Infection is rare, with 1 in 10,000 cases reported, and there may also be instances of post-injection bursitis which itself is painful but often settles down after 7-10 days.
What level of pain should be expected during the barbotage procedure?
The procedure is performed under local anaesthesia to minimise discomfort, but patients may still feel some pain as the needle is inserted and the calcium deposits are aspirated. The clinician will do their best to minimise the pain during the procedure.
What aftercare is recommended following a barbotage procedure on the shoulder?
After the procedure, patients are generally advised to rest the affected shoulder for 2 weeks and apply ice to manage swelling. Pain killers can be taken, and patients should follow any specific aftercare instructions provided by their doctor.
What is the average recovery time after a barbotage procedure?
Recovery times can vary, but many patients return to normal activity levels after 4-6 weeks.
What are the potential complications that can arise from a barbotage procedure?
Potential complications from barbotage include tendon rupture, although this is uncommon. The procedure is considered relatively safe, with considerable benefits in reducing the pain and discomfort associated with calcific tendinitis.
Is Barbotage Procedure available in Manchester?
Yes! our Clinic in Deansgate, Manchester allows us to treat Manchester based Patients.
To Arrange a consultation simply visit our Booking Page or call us on 0333 772 9655.
