Needle Aspiration and Irrigation of Calcium Deposits (Barbotage/Lavage)
This can be thought of as a “pressure wash” for your tendons.
This procedure is performed for calcific tendonitis, which is a term that refers to an inflamed tendon secondary to calcium deposits. This commonly affects the shoulder but can also affect other tendons in the body.
To perform this, an ultrasound is used to visualize the tendon and the specific areas where the calcium deposits are. Then with a small needle, the calcium is broken up with both the needle tip and a saline solution, then “sucked back up” (aspirated).
What is Calcific Tendonitis?
Calcific tendonitis usually affects individuals between the ages of 30 to 60, commonly involving the right shoulder and the supraspinatus tendon. There is an association with diabetes and hypothyroidism.
The exact reason why calcific tendonitis occurs in specific tendons and under which situations is unclear. In general terms, it is thought to be the body’s response to repetitive strain.
There are three described stages to calcific tendonitis, namely pre-calcific, calcific, post-calcific. It is within the middle, calcific stage that patients usually present to medical attention. There are three substages in this, formative, resting, and resorptive. All have varying degrees of pain, but the resorptive substage is the most painful, and can be quite sudden. This is when the body amounts an inflammatory response against the calcium deposits. At this point, the calcium deposits are toothpaste-like.
In the shoulder, the severity of symptoms and how long they last depend on the size of the deposits, and their relative position to the highest point of the shoulder (acromion).
What are the benefits?
Pain relief and restoring shoulder function.
What are the alternatives?
Extracorporeal shock wave therapy (ESWT) and steroid injections.
Regarding steroid injections, a 2013 study by Bas de Witte and colleagues, published in The American Journal of Sports Medicine, demonstrated that barbotage/lavage with a steroid injection is superior to a steroid injection alone in terms of short-term clinical outcomes.
To address the question whether barbotage/lavage should be combined with steroid at all, a direct randomized controlled trial in 2019 by Darrieutort-Laffite and colleagues, published in the Annals of Rheumatic Disease, demonstrated that barbotage/lavage with a steroid injection is in fact superior to barbotage/lavage without a steroid injection.
As for ESWT, this is a treatment commonly used for kidney stones but can also be used for calcium deposits in tendons. It is applied with high intensity sound impulses over the most tender areas.
In a direct randomized controlled trial in 2020 by Louwerens and colleagues, published in Arthroscopy, it was demonstrated that barbotage/lavage with steroid injections was more effective at 6 weeks for function than barbotage/lavage without steroid.
Presently, we do not offer ESWT at our clinic. Surgery is the most invasive treatment and is reserved as the last option.
How long will my pain be reduced?
The goal of the procedure is to breakdown and wash away painful calcium deposits. In that sense, combined with physiotherapy, we hope that the pain is dramatically reduced and remains that way.
How often can I have this done?
It is our goal that only one procedure is ever needed.
Who can’t have this done?
Any patient who may appear to have:
- Infection within the body, near the site of administration, or the actual joint itself
What are the side effects?
This depends on whether steroid was injected or not. Your physician can help guide you which option is better for you.
- Side effects of steroid: Glucorticosteroid injection
- Side effects of no steroid: Needle fenestration