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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.
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 The calcification will then be attempted to be aspirated/withdrawn.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.
There is a very small risk of introducing infection and if you are allergic you may react to the drugs.
It can be a painful procedure, although with local anaesthetic most people tolerate the procedure.
There is a 60-70% chance of significant or complete improvement in symptoms and return to activities.(2)
Occasionally 2 treatments are needed at about 6 weeks apart. However about 1/3 of patients may not respond and may ultimately require surgery.
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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.
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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.
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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.