Time for some New Years Barbotage!

Triathlon Forum
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No, its not some weird game…

It is a medical procedure where a doctor jams a needle into a calcified tendon (under ultrasound guidance), and moves it around to break up the calcified deposits and squirts saline in and then tries to suck out the chunks. Doesn’t that sound nice?

I did a quick search of forums and related posts and found nothing, so if you have a link/previous thread/post that is relevant, please post it here!

I am scheduled to have this done on my right supraspinatus tendon this Thursday!

Here is the current state of things (for those not medically inclined, the arrow is pointing at a “bone” that should not be there, it is part of the supraspinatus tendon):
http://i65.tinypic.com/2edppqt.jpg

Are you wondering: so what? Long story short, I have had right shoulder pain (always very localized, very mechanical, in the front, like something hitting/getting pinched under the acromion) off/on for 12 years, initially diagnosed as a simple case of impingement (I was a childhood swimmer, and it’s the right shoulder and I breathe exclusively to the left). But I think it was some kind of a partial tendon rupture that never healed correctly (I lifted something that was much heavier than expected with straight arms down in front of my thighs, and heard and felt a distinct “pop”, before this all came about). It seemed to initially improve with rotator cuff strengthening exercises…

Since taking up triathlon, and swimming regularly again in the past 3 years (and biking on my elbows…), it has turned into a 24/7 pain. You should see the pillow cave I “sleep” in! So I figure it can’t really get any worse than it is. I have not swam in 3 months and it is not any better…

The lesson I learnt: doctors sometimes make the wrong diagnosis (geez, I even do that sometimes!)

If your problem is not improving with the therapy prescribed, ask yourself/your doctor if the diagnosis is correct, and ask for another opinion, or repeat imaging etc.

I feel good that it “only” took me 12 years to act on this shoulder…(I waited 16 years with my left hip injury, but that’s a story for another day!)

To be continued…

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Good luck on Thursday. I had the same treatment done last February after living with increasing pain from a football injury. Over a year it got worse and worse to the point where swimming a length would have me crying…shortly after that I had to quit running too because it would hurt so much. And sleep? Forget it! One thing I remember from the Dr’s office was that he can always tell who has this problem by looking in the waiting room to see who looks like a bag of shit from no sleep. The only saving grace was that I could still ride my bike. Well, mountain bike and road bike on trainer…the tri bars would have been too painful.

How did the procedure go?

I had a 5cm calcium deposit right under the tendon so the Dr froze it up as best he could (He mentioned that it was going to hurt no matter what) and then with the help of ultrasound he went after the calcium. Some of it was like toothpaste so that was sucked out pretty easy with a needle, the harder stuff he broke up as best he could with another needle. He finished up with another needle (steroid/freezing) to help with the pain and recovery of the tendon because of the abuse it takes from the needles. The pain was about a 7…I have had worse at the dentist…but by the drive home it was a solid 9. (The only thing more painful has been a kidney stone). I had to move the seat belt shoulder strap it hurt so much. The pain slowly dissipated but it took a while.

Recovery

The recovery was pretty quick (took a month off work but could have gone back sooner if I didn’t have so many sick hrs banked) but the pain in the tendon area made gradual progress…almost like steps. I’m pretty sure this was from the broken up calcium floating around before it was re-absorbed. For example, the pain was in the same spot at the same level for about two weeks…to the point that I thought the procedure had not worked… then one night something went click and it hurt way less. This happened a couple times. After three months it was about 75% and after six months it was about 95%. The best part is now…at 10 months it feels even better than before I injured it! It’s like the procedure has turned back the clock on my 43 year old shoulder, it’s stronger than ever and completely pain free.

TL;DR Had same thing done, shoulder feels fucking amazing.

Best of luck and if anyone has any questions let me know.

Cheers

3

Thank you MukMuk for sharing your experience!

Well, it’s done, and now we wait.
Here is 1 of 3 syringes with chalky powder in it.
http://i68.tinypic.com/ekkrnr.jpg

The purpose is not to suck out all the calcium, but to break it up, so that your body can absorb it over time. The doctor also injected steroid into the bursa. I was able to drive myself home (shifting with my left hand for the most part) before the lidocaine started wearing off. The whole thing took 2 hours, most of it waiting. The actual procedure was about 20 minutes.

Here is a before and after US picture. In the before image, the calcium deposit is one solid piece, creating a large shadow. In the after image, the calcium deposit is a broken up shell that does not cast a dense shadow. You can see the needle entering from the left side of the picture.
http://i68.tinypic.com/14aepa8.jpg http://i63.tinypic.com/afac29.jpg

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You drove home? Shit man, I have to HTFU!

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I was also wondering if you do manual labor to take a month off for something like this? I am going back to work on Monday! :slight_smile:

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Hope you get back in the pool soon Kat.

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Yup, work requires a significant amount of physical labour so I was basically told to not come back till I was fixed ha! Have a great recovery…I hope you feel like I do soon!

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Wow. Just absolutely f*cking wow. It’s been a little over a day, and though my anterior deltoid (where they jam the needle through on the way to the supraspinatus tendon) is still a bit sore, the improvement in the past 12 hours has been incredible, and the calcium deposit no longer bumping against the acromion every time I lift my arm is immediately noticeable. 3 years, 10K yards/week in the pool, with EVERY stroke hurting, over just like that. I can’t wait to get back in the pool and put some muscle on these chicken bones of mine!

I just did this, and it doesn’t hurt!
http://i63.tinypic.com/2i8ypux.jpg

Do you have shoulder pain? Have you been diagnosed with “swimmer’s shoulder”, “impingement syndrome”, “rotator cuff problems”? Has it been months/years since your last X-ray? See your doctor, and make sure it’s not a case of calcific tendinopathy!

Happy swimming!

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Thanks for this information! I have been having pain for nearly two years and my doctor did not even refer me for an ultrasound or xray until I went in recently to complain that I’m still experiencing pain. She only recommended that I do physiotherapy.

Finally I had ultrasound done and the technician saw calcification of my tendon. I am happy that this means that the condition is not permanent and that I could possibly have barbotage done as well to receive relief soon. I have been unable to swim for two years due to the incredible pain. I heard from other helpful people that I needed to swim more often to treat this condition. What a load of bull crap. It would only have increased the pain. There was a f*cking deposit in my shoulder tendon that needed to be removed!

I did a search for other people with this problem on Slowtwitch and found your post. Thank you for writing so clearly about having the condition and your treatment.

I am so excited that I finally return to triathlon!

Best wishes for your recovery, DrTriKat.

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I am glad you found the information in this thread helpful!

For you, and all others reading this, be careful with what you do in the 1-8 week period after the procedure.

I found out the hard way that steroid shot in the shoulder makes it 100% painless, and thus allows increased use without noticing that you are injuring it further.

So I would be very careful about any swimming or any hard lifting/shoulder exercises for the first 2 months after a steroid shot, until you can assess how it really feels.

Good luck!

11

Just joined after googling barbotage. I’m a 49 year old Remedial Massage Therapist just diagnosed finally with 8mm calcification within my right supra tendon, obviously impingement, subacromial bursitis, and degenerative osteoarthritis of the ac. Specialist recommended barbotage and first available date is Feb 21 2017! After reading your posts (some made me laugh…especially about the sleep cocooning we have going!), i have some questions. First, I’m pretty sure in my case, as I’m not a triathlete, this was caused by repetitive compressive loads on my dominant arm. So, after the procedure…then what? Even after waiting a while to heal, if we keep on doing the very thing that caused it, aren’t we just going to cause it again? How’s that working out for all of you? Have you resumed the same level of activity with no sign of recurrence? Also, I was glad to read about the false confidence the cortisone gives. I kind of thought as much. I wonder truly how much time off of my type of work i should take realistically to heal properly. I’m sure my GP will advise but I thought I would put it out to you too since you have had it. And how stupidly painful is the procedure? Thanks!

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Procedure itself is not that painful. Post procedure pain only for about a day, then cortisone kicks in.

I have now had 2 more cortisone shots because I tore my supraspinatus tendon swimming while the 1st cortisone shot was making my shoulder feel like it was fine. My shoulder is worse than before the procedure. The cortisone shots take the edge off for about 3-4 weeks, then the pain returns.

I was previously swimming 6 - 7,000yd/week (with the calcium in the tendon), it has been pretty much nothing for the past 8 months.

My doc is waiting till “the first of the year” to decide if we should do anything about it. At this point, I am not very optimistic.

So if you decide to do it, I would advise for you to wait at least 3 months before doing anything like lifting or using tools with the arm (and no swimming). This will allow the steroid to wear out of it, and let you feel how it is. Make sure you do range of motion right away, and start up really light rotator cuff exercises while waiting to heal maybe after 2-3 weeks. That is just what I wish I had done, not official “doctor” advice. BTW all my doc told me was to take it easy for 1 week after the procedure, which clearly is not enough.

Good luck whatever you decide!

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Ok that helps a lot, thank you. I wonder if the cortisone is really necessary. I’d rather deal with “true” pain than do what you did, if you know what i mean. I will explore this further.

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Hi,
Just came across this thread. I have calcific tendinitis in my right shoulder - pain for the last three years have tried physiotherapy which didn’t help me at all. Waited for orthopedic surgeon who mentioned Barbotoge which I and my family Dr never heard of. Regardless was eager to have a possible option of releif however the wait time where I live is up to a year. So I went to a private clinic and paid for it to be done. initially I was quite sore then after about 2 weeks it got better, then nothing I was elated finally relief I could sleep felt great! But… 7 weeks after the pain is back all day everyday can’t sleep I feel so disappointed. Back to orth dr more x-rays and most likely another recommended barbotoge which again I will have to pay for because I’m not waiting a year. Feeling frustrated and wondering if this will even help me. Has anyone else had to go for two treatments so close?

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Had the barbotage and cortisone last November. Got me in on a cancellation. Yup doc said take a week off of work. I took 18 days, then modified duties for 2 weeks. Took Christmas off another week. Was feeling good but slowly things became bad again. After another ultrasound discovered i had a tear in the supra . Wondering did the barbotage cause it? Did the cortisone? I did not overdo anything so not sure. I do know that cortisone weakens tendons a lot. So now booked in for PRP platelet rich plasma treatment on May 23. Has anyone had this done in this forum? In principle it makes sense but would like to chat with someone who actually had it done. In Canada it’s not covered and will set me back $850 per treatment. I may need 3.

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I am glad you found the information in this thread helpful!

For you, and all others reading this, be careful with what you do in the 1-8 week period after the procedure.

I found out the hard way that steroid shot in the shoulder makes it 100% painless, and thus allows increased use without noticing that you are injuring it further.

So I would be very careful about any swimming or any hard lifting/shoulder exercises for the first 2 months after a steroid shot, until you can assess how it really feels.

Good luck!

Hi to all!
One week ago I had the barbotage procedure done in my right shoulder due to calcified tendon.
I am still in great pain, can’t do anything, I take painkillers and still can’t sleep at night. No steroid or saline was infused after the procedure, maybe that’s why I an in such a great pain…Has anybody felt that way? I wonder how many weeks are needed in order to overcome the pain. I’ve read here that you drove after the barbotage done!!! Oh my!!! One week has gone by and I can’t even raise my hand to touch the steering wheel…feeling really down here…please help!!!

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It will take a while for the pain to subside. My full recovery was over a year and still my shoulder hurts with longer swims or harder efforts. I had repeat MRI and ultrasounds last year and up to 6 months after the tendon was still frayed (but calcium was mostly gone.) Just today I re-injured it lifting a chair at work…It’s probably just a matter of time before calcium lumps form in the tendon again, then I’ll have more barbotage maybe. Best of luck and patience. Take it really slow.

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I just had my second round of barbotage. The first one went off without a hitch. Some soreness for the first day or so but started feeling better quickly and felt great for about 2 months before the pain returned. Fast forward 5 months and I had the second round just a few days ago. This time the pain has been much worse (during, immediately after). It felt a bit better after 24 hours but now we are at 72 and I can barely move my arm. Sleeping was almost impossible last night. I’m icing it periodically and takinf Tylenol and Aleve. I’m wondering how recovery ended up for you and if it’s normal to be in this much pain in the entire arm. Any feedback is appreciated.

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So sorry to hear that you are in great pain.
Unfortunately that’s what I faced for a long time because the barbotage procedure led to iced shoulder for me. I could not lift ,move or raise my arm for 2-3 months and it was only after physiotherapy that I managed to strengthen and finally move and raise it. I also took a lot of painkillers!
Fortunately, my shoulder is doing just fine now, no calcium clods on the tendon any more, no need for a second barbotage.
I hope it won’t take that long for you, the healing, I mean.