Barbotage

This is the procedure to break the calcium lumps developed in the inner tendons of shoulder (calcific tendonitis).  It is done as an outpatient procedure using ultrasound guidance.

There is no preparation required for this procedure.  The procedure takes around 30 minutes and will be performed by a specialist shoulder radiology consultant.  It will help if you can wear clothing that will allow you to easily expose the shoulder in question. You will be asked to strip to the waist and to change into a gown. Bras can be left on but with the strap on the affected side down.

After an initial ultrasound examination in the sitting position, the barbotage is performed when you are lying down on a couch.  With a thin needle the whole injection area is first numbed. The calcific deposit is then approached with one or two needles and multiple punctures are performed. The procedure is highly precise and the needle is continuously watched on the ultrasound.  Care is taken to minimise injury to the tendon. Sometimes water pressure is used through the needle to break and suck the calcium deposits in the area.  Following the barbotage, an injection of steroid (triaminosolone) and local anesthetic (bupivicaine) is administered.  The injection site will be covered with a small dressing which can be removed after 24 hours.

Following the procedure you will be asked to rest in the department for 15- 20 minutes, until you are comfortable.   You will be asked not to drive following the procedure and therefore you may wish to bring a friend or a relative with you or alternatively use a public transport.  Although for the first few hours after the barbotage the shoulder will feel numb due to anesthetics, it is advisable to continue your painkiller medications for the first few days alongside the exercises.  This is because the steroid will generally take 3 to 7 days to work.  The shoulder may look or feel bruised for a few days.   There are no specific restrictions after the procedure and once the discomfort from the procedure eases, usually 2-5 days, you could commence shoulder exercises.

The steroid injection is a very safe drug with approval for use in joints.  It can be used safely with other conditions with no significant drug interactions.  The injection is precisely injected and works on the injected area only. It has no general effects and does not put you at risk of putting on weight.  Even if you are on oral steroids, there is no need to change your dose. However, if you are a diabetic and take insulin, it may affect your blood sugar levels initially.  Side effects are very rare and include-

  • Skin thinning, dimpling and change in skin colour at the site of injection.
  • Flushing and redness of the face for a few days. It is more of a nuisance rather than reaction and usually settles down over a few days.
  • The area of injection may look or feel bruised for a few days.
  • Infection is a very unusual complication which can occur from any kind of injection. If the injection area becomes red, hot and swollen and you feel unwell you should seek immediate medical help.
  • Serious or breathing related side effects are not expected with this injection and if such symptoms are encountered, you should seek immediate medical help via a GP or emergency department.

After your study the report is forwarded directly to Mr Smith, who will arrange to see you accordingly.

 

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