Is the procedure that uses ultrasound guidance to break up calcific deposits in tendons called barbotage?

Barbotage: Ultrasound-Guided Procedure for Calcific Tendinitis

Yes, barbotage is the specific ultrasound-guided procedure used to break up calcific deposits in tendons. This technique involves needling and lavage (washing) of calcium deposits in tendons under ultrasound guidance 1.

What Barbotage Involves

Barbotage is characterized by:

• Ultrasound-guided percutaneous needling and lavage of hydroxyapatite deposits in tendons
• Typically performed with the patient in supine position
• Uses sterile technique with local anesthesia
• Involves puncturing the calcific deposit with a needle (commonly 18G)
• Flushing the deposit with saline solution to dissolve and aspirate the calcium
• Often combined with corticosteroid injection in the adjacent bursa

Clinical Applications

Barbotage is most commonly used for:

• Rotator cuff calcific tendinitis (RCCT), with prevalence up to 42.5% in patients with shoulder pain 1
• Can also be effective for other tendon calcifications:
  • Gluteus medius calcific tendinitis 2
  • Wrist and hand calcific tendinitis and periarthritis 3
  • Flexor carpi ulnaris calcific tendinitis 3

Effectiveness and Outcomes

Research demonstrates that barbotage is highly effective:

• Produces significant pain reduction and functional improvement in most patients 4
• Results in substantial improvement in pain, shoulder function, and quality of life at 6 months and 1 year 1
• Can lead to complete resolution of calcifications in 62-73% of cases after 5 years 5
• Most effective for larger calcific deposits compared to smaller ones 1
• Clinical outcomes improve even when calcium deposits cannot be fully aspirated 1

Technique Details

The standard barbotage procedure includes:

1. Diagnostic ultrasound to confirm symptomatic calcific tendinitis
2. Sterile preparation of the area
3. Local anesthesia administration (typically 10 mL lidocaine 1%)
4. Corticosteroid injection in the adjacent bursa (e.g., 4 mL bupivacaine and 1 mL methylprednisolone)
5. Puncturing the calcific deposit with an 18G needle under ultrasound guidance
6. Repeated flushing with saline solution until no more calcium enters the syringe
7. For solid deposits that cannot be aspirated, repeated perforations to fragment the deposits 1

Advantages Over Other Treatments

Barbotage offers several advantages:

• Superior clinical outcomes compared to extracorporeal shockwave therapy (ESWT) and subacromial injections alone after 1-2 years 1
• Minimally invasive alternative to surgical intervention
• Can provide immediate relief in many cases 3
• Low complication rates comparable to other minimally invasive techniques 1

Barbotage represents an important treatment option for patients with calcific tendinitis who have failed initial conservative management with rest, NSAIDs, and physical therapy.