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median nerve, nerve hydrodissectionn

Ultrasound-guided barbotage hydrodissection

March 11th 2016

The definition of barbotage is the repeated injection and aspiration of fluid from a confined space.

Barbotage therapy is an established technique for the treatment of calcific tendonosis  of the rotator cuff.

 

Advantages of Ultrasound-guided Barbotage Hydrodissection over Surgery

  • Outpatient procedure

  • General anesthesia not required

  • Precise localization of calcification, even tiny

  • Easily identify the relationship with tendons, bicipital groove, bony structures

  • Most direct way to the target

  • Excellent visualization of the needle tip

  • Precise advancement of the needle into the calcification

  • Minimal damage to tendon

  • Identification of associated conditions : bursitis, tear (rare)

  • Non ionizing technique (lower risk than x-ray guidance)

A diagnostic ultrasound scan is performed firstly.

The skin is then marked and sterilized and local anaesthetic is given.

Using the ultrasound image, the needle is guided into the calcification under direct vision. The calcification will then be attempted to be aspirated/withdrawn. To encourage healing the calcification is punctured several times under local anaesthetic. Finally the tendon is bathed in some more local anaesthetic.

 

Is it safe?

There is a very small risk of introducing infection and if you are allergic you may react to the drugs.

Does it hurt?

It can be a painful procedure, although with local anaesthetic most people tolerate the procedure.

Does it always work?

There is a 60-70% chance of significant or complete improvement in symptoms and return to activities.(2)

What if it fails?

Occasionally 2 treatments are needed at about 6 weeks apart. However about 1/3 of patients may not respond and may ultimately require surgery.

Works Cited

Adamov, Elizabeth, and Jonas M. Sokolof. “Poster 60 Ultrasound-Guided Median Nerve Hydrodissection in a Patient with Postmastectomy Lymphedema: A Case Report.” Pm&r 4.10 (2012): S209. Print.

Aina, R., E. Cardinal, N. J. Bureau, B. Aubin, and P. Brassard. “Calcific Shoulder Tendinitis: Treatment with Modified US-guided Fine-Needle Technique.” Radiology 221.2 (2001): 455-61. Print.

Comfort, Thomas H., and Ruben P. Arafiles. “Barbotage of the Shoulder with Image-Intensified Fluoroscopic Control of Needle Placement for Calcific Tendinitis.” Clinical Orthopaedics and Related Research &NA;.135 (1978): 171???178. Print.

Delea, Suzanne L., Natalia R. Chavez-Chiang, Janet L. Poole, Hillary E. Norton, Wilmer L. Sibbitt, and Arthur D. Bankhurst. “Sonographically Guided Hydrodissection and Corticosteroid Injection for Scleroderma Hand.” Clinical Rheumatology 30.6 (2011): 805-13. Print.

Gatt DL1, Charalambous CP. Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients. Arthroscopy. 2014 Sep;30(9):1166-72. doi: 10.1016/j.arthro.2014.03.013. Epub 2014 May 10.

Lee, S. Justin, Lynda T. Choyke, Julia K. Locklin, and Bradford J. Wood. “Use of Hydrodissection to Prevent Nerve and Muscular Damage during Radiofrequency Ablation of Kidney Tumors.” Journal of Vascular and Interventional Radiology 17.12 (2006): 1967-969. Print.

Parlier-Cuau, Caroline, Valerie Vuillemin-Bodaghi, M. Wybier, P. Champsaur, and J. D. Laredo. “Percutaneous Management of Painful Shoulder.” Seminars in Interventional Radiology 19.3 (2002): 197-204. Print.

Patel, Manish I., Daniel Spernat, and Ernesto Lopez-Corona. “Hydrodissection of Neurovascular Bundles During Open Radical Prostatectomy Improves Postoperative Potency.” The Journal of Urology 186.1 (2011): 233-37. Print.