What is a shoulder barbotage procedure?
Ultrasound-guided barbotage is a special procedure for treating shoulder calcification (calcific tendonitis). In this procedure, aspiration and/or breaking down of the calcium material within the rotator cuff tendon is accurately attempted under ultrasound guidance using a special needle. This is combined with a subacromial bursa steroid and local anaesthetic injection. To find out more, please continue reading our article.
What is shoulder calcification (calcific tendonitis)?
Calcific tendonitis (also known as calcific tendinopathy) refers to inflammation of the rotator cuff tendons (called tendonitis) secondary to the deposition of calcium material within the tendons. The rotator cuff consists of 4 tendons (the supraspinatus, infraspinatus, subscapularis and teres minor tendons). They form a complete cuff of tissue surrounding the shoulder joint and play a vital role in shoulder movement and stability. To learn more, please see our article about shoulder calcification (calcific tendonitis).
How does ultrasound-guided barbotage-lavage work?
In this procedure, aspiration of the calcium deposit is accurately attempted under ultrasound guidance using a special needle. This is combined with a subacromial bursa steroid and local anaesthetic injection. The lavage and breaking down of the calcification will help the body to get rid of the calcium material, and the subacromial bursa injection will help settle down the bursal inflammation. Numbing medication (local anaesthetic) injection is usually used before the procedure to numb the skin and the subacromial bursa.
How is ultrasound-guided barbotage-lavage done?
I will speak to you on the day about the procedure and answer your questions. Then you will be positioned appropriately on the examination table. The area of calcification will be assessed with ultrasound to determine the exact site and best approach. Then, the skin will be cleaned and prepared, and a numbing medication will be administered to the skin using a small needle. Numbing medication will also be injected into the space overlying the area of calcification (called the subacromial bursa). This will minimise the pain you feel during the procedure. Then, a special needle will be inserted into the area of calcification and aspiration or breaking down of the calcium material is attempted under continuous ultrasound guidance. The subacromial bursa will be injected with steroids and numbing medicine to reduce the bursal inflammation.
A small plaster is usually applied to the site of injection. You can remove this later during the same day. You can eat and drink normally before and after the procedure. You can shower as usual but avoid very hot showers/steam rooms. It’s advised not to drive immediately after the procedure. Rest the area and avoid extraneous activities for about 1 week following the procedure. To read a step-by-step guide about how the procedure is done, please see our article How is shoulder barbotage done?
What are the possible complications from an ultrasound-guided barbotage-lavage procedure for calcific tendonitis?
Generally, the procedure is very safe and routinely performed. Serious complications are very rare.
There is a small risk of infection, similar to any other steroid injection.
There is a small possibility of weakening of the rotator cuff tendon since the needle needs to go into the area of calcification within the inflamed tendon. Therefore, adequate shoulder resting for at least 1 week following the procedure is advised.
The area will be sore for 1-2 weeks following the procedure. After this, patients should start noticing improvement in the symptoms.
If you have more questions about ultrasound-guided injections in general, please see our FAQs.
How long does an ultrasound guided barbotage-lavage procedure take?
The length of the procedure depends on the difficulty of the case and the doctor's experience. Usually, 30-45 minutes is a reasonable time for the whole procedure (including explanation to the patient and preparation).
Can ultrasound guided barbotage-lavage be repeated?
Yes, the procedure can be repeated after a few months (or sometimes we just repeat the subacromial bursa injection) if there are recurrent symptoms to help the body get rid of the calcification and help the rehab program.
Is ultrasound-guided barbotage-lavage painful?
The procedure can be painful, but most patients tolerate it well. A numbing medicine is initially injected into the tissues under the skin and into the bursa to achieve a good anaesthetic effect before the procedure.
What is the best type of scan to diagnose calcific tendonitis?
Ultrasound examination can readily visualise calcification within the rotator cuff tendons. MRI is also useful for the assessment. Both ultrasound and MRI can assess for any associated inflammation within the tendon and the subacromial bursa. A shoulder X-ray can be performed if there is uncertainty about the diagnosis, as it is excellent in picking up calcification.