Barbotage

Pain Management

What is a Barbotage?

An ultrasound guided barbotage or lavage is a procedure to treat a specific type of calcific tendinosis called hydroxyapatite deposition disease. The barbotage involves using a needle to flush out and aspirate some of the calcium which is a thick paste contained within a hard outer shell. This can be followed by fenestration of the remaining calcium deposit, if indicated. Not all calcifications that are seen in tendons are amenable to this procedure and not all calcifications that are amenable can be completely removed. Due to the probability of inducing inflammation in this area when breaking up and removing some of the calcium, an injection of corticosteroid is done at the end of the procedure. Barbotage is commonly performed in relation to the rotator cuff tendons of the shoulder.

For information about the post care instructions, click here.

FAQs

How do we know the barbotage/lavage is being performed in the correct location?

A barbotage is performed under ultrasound guidance to allow the Radiologist to visualize the needle while viewing the calcification that is being targeted for treatment.

What can I expect at my appointment?

Once you arrive at the clinic you will be asked to complete a few forms pertaining to the appointment. To allow adequate time for this, please arrive 15 minutes prior to your scheduled appointment time. You may be instructed to change into a gown for your procedure.

You will be taken back to a private exam room for your procedure. One of our technologists and a Radiologist will review your previous diagnostic imaging, discuss the reason for your referral to Beam Radiology, and explain the details of the recommended pain management treatment.

Communication is very important to Beam, and you will be given opportunity to ask any questions you may have before beginning. You will be positioned so that the Radiologist can access the affected area. The targeted area will be disinfected with a cleaning solution. To ensure effectiveness and accuracy, ultrasound will be used in real-time to guide the injection.

The Radiologist will inject a local anaesthetic to numb the area. A needle attached to a syringe of anesthetic and saline will be used to flush out the contents of the calcification. This may be followed by a fenestration of the remaining calcium deposition. Once complete the Radiologist will inject a dose of corticosteroid medication and long-acting aesthetic to help minimize discomfort after the procedure. If there are multiple calcifications more than one appointment may be required, separated by several weeks. A barbotage can be repeated if the burden of calcium is still of significant size and/or symptomatic after the first attempt.

Following your procedure, you will be directed to wait for a brief observation period. One of our technologists will review the post-procedure care with you, and then you will be free to leave the clinic.

What are my expected results post injection?

With successful treatment, we hope the body will continue to resorb any remaining calcium, providing pain relief that can last weeks, months, or even years. Some patients may experience discomfort in the area for several days after this procedure. The steroid injected requires 2-5 days to take effect, with full effect, or pain relief, taking place up to two-weeks post-injection. A follow-up ultrasound may be booked 8 weeks after the barbotage to re-evaluate for any remaining calcification.

What are the risks associated with my injection?

This procedure is performed using sterile technique. Very rare complications include allergic reaction, infection, and bleeding.

If you have diabetes, you may experience a temporary elevation in you blood sugar as a result of the corticosteroid medication. If you monitor your blood sugar, you may have to adjust your medication accordingly. Common side effects of corticosteroid can include temporary flushing (warmth and redness) in the face, neck, and chest, as well as temporary sleep disruption or even a flare up of symptoms. If you experience these side effects, they will resolve on their own over the course of the week.

What is the post-care following this treatment?

Keep the area clean and dry. Avoid hot tubs, pools, or baths for 48 hours. You can shower normally.

You may use ice and anti-inflammatories, or pain medication if needed, before the corticosteroid takes effect.

You can perform your normal daily activities but avoid strenuous activities for 7 days following the procedure.

For information about the post care instructions, click here.