Shoulder calcific tendinitis Barbotage
Barbotage, also known as ultrasound-guided calcific lavage, is a minimally invasive procedure used to treat calcific tendinitis, most commonly affecting the rotator cuff tendons in the shoulder.
It involves using ultrasound to guide a fine needle directly into the calcium deposit and gently flushing it with saline to break it down. The calcium is then washed out or softened, allowing the body to reabsorb the remainder more easily.
This procedure can provide significant pain relief and improve shoulder movement.
Why Barbotage Works
Calcific tendinitis occurs when calcium deposits form within a tendon. These deposits can:
Increase tendon pressure
Cause intense inflammation
Restrict movement
Trigger severe pain, especially at night or when lifting the arm
Barbotage helps by:
Breaking down and removing the calcium deposit
Reducing pressure within the tendon
Settling inflammation
Restoring more normal tendon function
Allowing you to progress with rehabilitation more comfortably
Most patients experience noticeable improvement within days to weeks.
Who Is Barbotage Suitable For?
Barbotage is recommended for people who have:
Symptomatic calcific tendinitis confirmed on ultrasound
Severe or persistent shoulder pain
Sleep disturbance caused by shoulder pain
Reduced range of movement
Failed to improve with physiotherapy, rest, or medication
It is especially effective when the calcium deposit is in the resorptive phase, where it becomes softer and easier to aspirate.
What Happens During the Procedure?
Under continuous ultrasound guidance, the procedure typically involves:
Local anaesthetic to numb the skin and surrounding tissues
A fine needle inserted directly into the calcium deposit
Repeated flushing (barbotage) with sterile saline to break up and aspirate the calcium
Optional injection of a small amount of corticosteroid into the subacromial bursa to reduce post-procedural irritation and pain
The procedure usually takes 20–30 minutes and is well tolerated.
You may notice chalky calcium coming out through the needle during the lavage—this is normal and indicates good clearance.
Why Ultrasound Guidance Is Essential
Barbotage relies on precise targeting of the calcium deposit. Ultrasound ensures:
Accurate needle placement within the deposit
Safe navigation around tendons, nerves, and blood vessels
Complete visualisation of the deposit during lavage
The highest likelihood of successful calcium breakdown
Reduced discomfort and improved clinical outcomes
Ultrasound-guided barbotage is considered the gold standard for managing calcific tendinitis.