Ultrasound Guided Barbotage

What is a Barbotage procedure?

• Barbotage is a procedure used to treat calcific tendinopathy. Under local anaesthetic, a needle is used to breakdown the calcium deposits and aspirate it (draw it back into the syringe) where possible. Following this steroid is also injected into the surrounding bursa to help reduce pain and inflammation.
  

What is a Calcific Tendinopathy?

• Calcific tendinopathy is when calcium crystals are deposited within tendons, most commonly the shoulder rotator cuff tendons.
  
  The exact aetiology is unclear, but it has been attributed to chronic wear and tear. The calcium deposits can cause inflammation and there is often associated inflammation of subacromial bursa. This condition can therefore be very painful, and patients often present acutely.  

How do you diagnose Shoulder Calcific Tendinopathy?

• Ultrasound is often the best modality for the diagnosis of calcific tendinopathy. However, if the calcium deposits are large enough,they can also be seen on X-rays.

What are the treatment options for calcific tendinopathy?

• Conservative Management:
  Medication for pain relief Shoulder movement and exercise. A physiotherapist can help guide as to which exercises are best. 
  
  Interventional Management:
  Bursal steroid injections for pain relief If the above has not helped and if the calcific deposits are focal and large enough, you could be referred for an ultrasound guided barbotage procedure.
  
  Under local anaesthetic, a needle is used to break down the calcium deposits and aspirate it (draw it back into the syringe) where possible. Following this steroid is also injected into the surrounding bursa to help reduce pain and inflammation.
  
  Sometimes this procedure needs to be repeated and physiotherapy is usually beneficial after the procedure in order to aid the recovery process.          

Situations where Barbotage is not recommended

• Please note thatwe are unable to perform the barbotage procedure if you are on an anticoagulant. This would need to be discussed with your referrer first.

Risks of the procedure?

• It is considered a safe procedure generally as ultrasound guidance is used throughout the procedure to minimise risk. The injection is also performed in an aseptic manner using sterile equipment.  However, there is a small risk of infection (approximately 1 in 10, 000) following an injection.
  
  If you experience symptoms such as unexpected pain, warmth or redness around the area or develop a temperature, you should immediately consult your GP or attend A&E. Please explain that you have recently had an injection, as this could potentially be serious.
• Risks and side effects include the following:
• Minor bruising at site of injection
• Tendon damage / rupture
• Damage to surrounding vessels or nerves
  
• Failure of the procedure
  
• Worsening of pain
  
• Facial flushing
  
• Small risk of skin de-pigmentation or dimpling, at site of injection, due to the steroid.
  
• Diabetics may experience a temporary increase in sugar levels
  
• Possible changes to the menstrual cycle
  

Post Procedure Care

• The local anaesthetic will last between 4-6 hours and the area may start to feel uncomfortable and heavy afterwards.
  
  We advise caution of the affected shoulder for 48 and to avoid any strenuous activity for 7-10days. We advise arranging a friend or close family member to accompany you in clinic or drive you home afterwards.