Presentation
Long-standing shoulder pain. Previous non-image guided SASD bursa injection of limited effect. Prior radiograph showed rotator cuff calcification.
Patient Data
Videos obtained during a US-guided rotator cuff barbotage procedure. A 21G needle enters the calcification within the supraspinatus tendon.
The first video is from the initial stages of pulsation lavage. The central aspect of the calcification has partially broken up and the pulsation lavage creates a contained 'snow storm'. The outer shell maintains its shape at this point.
The second video is during the later stages of pulsation lavage. The central calcification continues to move but now the calcification shape and superior aspect of the outer shell is collapsing.
Case Discussion
Pulsation lavage is a technique used for calcification barbotage, with the aim of breaking up the central calcification within a harder outer shell of calcification. The procedure involves cannulating an area of calcification with a larger bore needle, a 21G (green) needle in this case. A small volume syringe, i.e. 5mL, is attached to the needle with 3mL of a solution, which can be a combination of saline and/or local anesthetic. The fluid in the syringe is pushed in small pulses which will pump small jets of the solution into the central calcification.
It is important to ensure the patient is well anesthetized with a local anesthetic prior to cannulating the tendon and calcification. 8mL of 1% lidocaine was injected into the subacromial subdeltoid bursa prior to pulsation lavage in this case.