hello I'm Nix Kumaravel I'm a radiologist at UT I'm the chief of
musculoskeletal radiology and I'm a professor of radiology and orthopedics here at UT.
What is barbotage?
Barbotage is a guided procedure where we use ultrasound to try and get
rid of calcium that's formed in your tendons which can be a cause of shoulder pain.
Do I need to prepare for this procedure?
There is no need to prepare for this in any particular way because this
is not done under general anaesthetic it is done under local anesthesia where we're
gonna sit you up put on some numbing medicine and direct a needle into your
shoulder using ultrasound. So there's no need to prepare for this procedure.
How is this procedure done?
The procedure is done in a sterile environment with ultrasound guidance where we use
numbing medicine to numb the skin on the top. Then we use a needle to advance the
needle directly into the rotator cuff tendon where you have the calcium. Then
we break the calcium down. The calcium is broken by using either Saline by itself
or saline with some local anesthetic. Then we suck the bits of the calcium
that's broken down out. Sometimes we're not successful at getting all the
calcium out that is still perfectly fine because this would just mean that we
- just the intention was to break the calcium down rather than to get rid of
all of it. Once we're done with that we would inject a little bit of steroid and
some local anesthetic to take care of the pain and the effect that happens
after that.
What should I expect after the procedure?
the typical relief from these as the local anesthetic works straight away so
you should have some pain relief after the procedure because we've got lots of
local anesthetic into your shoulder at that time. The local anesthetic will last
for about four hours or so. The steroid that we inject usually takes
about 48 hours to work so there's going to be some discomfort later on in the
day after you have the procedure. So what our advice all our patients is to take
some kind of painkillers typically the over-the-counter drugs are fine we
should take care of your pain for the first couple of days til the steroid
starts working. After the first 48 hours you should gradually get some pain
relief in your shoulder and it should be back to a level that's comfortable at
the end of maybe a week or ten days at the maximum
How long does it last?
on an average in majority of our patients we find that it lasts for about
six months or so it doesn't get rid of all your calcium completely but it's
comfortable enough that you're able to use your shoulder and the effect from
the injection itself goes on for about six months
after six months some of our patients come back for a repeat procedure and
sometimes able to continue even without a second procedure that's it varies
depending on a person-to-person basis
What do I need to avoid after the procedure?
there's no major restriction I would ask you to be gentle with your arm because
it's gonna be uncomfortable and sore don't lift anything very heavy beyond
five to ten pounds for the day or so give yourself some rest
usually don't get back to aggressive activity about a week or ten days you
should be able to get back to gentle activity afterwards and continue on to
your regular activities beyond seven to ten days after that.
Are there any downsides to this procedure?
The biggest downside is usually having a needle placed in your shoulder. Nobody likes that.
We'll try and make it as gentle as you possibly can to put the needle in there
and one of the effects that happens when you break down calcium in a tendon
is that it can also set off some inflammation or
inflammatory process and this can be resulting in some shoulder discomfort
and pain and that should be covered partly by this steroid that we inject. In
some patients the pain is a little bit more aggressive. In those situations
we request them to continue taking the painkillers for a longer period like two
to four weeks.
Are there any side effects?
Like in any needle based procedure you can get minor things like bruising a
tiny bit of bleeding is possible. One major stuff that we always worry
about is infection. Infection is something that becomes a part of any needle based
procedure into a joint so just like any other procedure you would like to be
careful about watching yourself over the next few days after the procedure. If you
have increased warmth develop a fever in those situations please reach out to
your physician or to us to help you out