Barbotage, particularly for shoulder calcific tendonitis, may be a minimally invasive procedure, but it’s one that demands high precision, real-time imaging, and the right set of tools. For shoulder specialists, having the correct equipment not only enhances procedural accuracy but also improves patient outcomes and comfort.

This article offers a straightforward breakdown of the key instruments and devices that make barbotage possible, from imaging technology to needles and post-procedure materials. Related: Step by Step Guide to Barbotage

Why Equipment Matters in Shoulder Barbotage

When you’re navigating the tight anatomical space of the shoulder—especially the rotator cuff—every detail matters. The success of a barbotage procedure depends on visibility, needle control, and the ability to aspirate calcium deposits effectively. The tools used must balance sterility, comfort, and efficiency.

1. Ultrasound Machine with High-Frequency Linear Probe

Purpose: Real-time imaging and precise needle guidance

This is arguably the most critical piece of equipment in the barbotage toolkit. High-resolution ultrasound machines provide a detailed view of the soft tissues in the shoulder, allowing the physician to visualize the calcium deposit, guide the needle accurately, and monitor the flushing and aspiration process.

  • Preferred probe: Linear array, 7.5–12 MHz
  • Features to look for: Doppler mode for vascular identification, needle-enhancement settings

2. Sterile Ultrasound Probe Cover and Gel

Purpose: Maintaining a sterile field during imaging

Since the probe will be in close contact with the patient’s shoulder during the procedure, it needs to be properly covered with a sterile sheath. Sterile, single-use gel is also essential to maintain image clarity while adhering to infection control protocols.

3. Needles: Spinal and Hypodermic (18G–22G)

Purpose: Infiltration, flushing, and aspiration

The choice of needle gauge and length depends on the size and depth of the calcium deposit. Most shoulder specialists prefer an 18G or 20G needle for aspiration, as it allows easier removal of the chalky, paste-like material.

  • Needle types:
    • Spinal needle (longer): Ideal for deeper deposits
    • Standard hypodermic needle: Useful for shallow or superficial calcifications

Some clinicians also use dual-needle techniques—one for irrigation and the other for simultaneous aspiration.

4. Saline Syringes (10–20 mL)

Purpose: Flushing and hydrating the deposit

Sterile saline is injected into the calcified area to break up the deposit. Pre-filled saline syringes streamline this part of the process and help control pressure during the flush.

  • Saline may be warmed slightly for patient comfort
  • Multiple syringes are often prepared in advance

5. Sterile Aspiration Syringes

Purpose: Withdrawal of fragmented calcium material

Suction is applied using a sterile syringe (usually 10–20 mL) to aspirate the loosened material. Some specialists use lock-tip syringes for added control during aspiration.

6. Steroid Injection (Optional)

Purpose: Reduce post-procedure inflammation

A corticosteroid like triamcinolone acetonide may be injected into the bursal space after the procedure to minimize pain and inflammation. This is especially helpful in cases where the barbotage process causes mild irritation to the surrounding tissues.

7. Antiseptic Solution and Drapes

Purpose: Infection prevention

Sterility is non-negotiable. Prep solutions such as chlorhexidine or povidone-iodine are used to disinfect the skin. Sterile drapes isolate the procedure field and reduce the risk of contamination.

8. Bandages and Post-Procedure Supplies

Purpose: Site protection and aftercare

After the procedure, a small adhesive bandage or pressure dressing is applied. Cold packs and printed aftercare instructions are typically provided to the patient before discharge.

9. Disposal Units and Sharps Containers

Purpose: Safe handling of used equipment

All needles, syringes, and disposable items are discarded in accordance with biohazard regulations. Sharps containers must be immediately accessible in the procedure room.

10. Documentation Tools and Archiving Systems

Purpose: Record-keeping and patient follow-up

Ultrasound snapshots, procedural notes, and patient responses are documented immediately. Many shoulder specialists use EMR-integrated ultrasound machines that store both imaging and procedure logs seamlessly.

While barbotage may appear straightforward, it relies heavily on precision, control, and real-time visualization—especially in delicate shoulder anatomy. Every tool in the tray serves a vital role, and for shoulder specialists, understanding and mastering this equipment is key to delivering safe, effective treatment.

From the ultrasound probe to the post-procedure bandage, having the right tools in the right hands transforms barbotage from a good option into a great one.

FAQs About Barbotage Equipment

1. Can barbotage be performed without ultrasound?
It’s not recommended. Ultrasound provides the necessary precision to avoid damaging nearby structures and ensures the deposit is fully targeted.

2. Why use a large-bore needle like 18G?
Calcium deposits are thick and pasty—larger needles allow easier aspiration and reduce clogging.

3. How is the equipment sterilized?
Most items are single-use and pre-sterilized. Reusable components like ultrasound probes are disinfected per strict clinical protocols.

4. Do all specialists use steroid injections afterward?
Not always—it depends on the size of the deposit and the patient’s inflammation level. Some prefer to avoid steroids unless absolutely necessary.

5. Can this equipment be used for barbotage in other joints?
Yes, though sizes and approaches may vary slightly based on joint anatomy.

The information in this article is for educational purposes and Dr Kruse may recommend alternate treatment options to best address the individual patient’s needs.