Barbotage for Calcific Tendonosis of the Rotator Cuff

Barbotage is an ultrasound-guided needle procedure that breaks up calcium deposits in the rotator cuff tendons, the cause of calcific tendinitis. The shoulder is numbed, ultrasound pinpoints even small deposits, and a needle is passed through them so the body can absorb the calcium. Liquid deposits may be drawn out, and a steroid may be injected into the bursa. It is an outpatient procedure with no general anesthesia and no radiation. Afterward, use acetaminophen rather than anti-inflammatories and avoid heavy lifting for at least 2 weeks.

What is Barbotage?

Barbotage is an ultrasound-guided procedure that involves the introduction of a needle through the skin to break up calcific deposits within a tendon that might be restricting mobility and causing pain. Ultrasound imaging enables your doctor to accurately pinpoint these calcium deposits for accurate needle placement.

Indications for Barbotage

Barbotage is an established treatment for calcific tendinitis in the rotator cuff of the shoulder joint. It is one of the primary causes of shoulder pain, usually seen in adults between 40 and 60 years of age. Calcific tendonitis of the rotator cuff may manifest as pain in the front or back of the shoulder that makes it difficult to raise the arm.

Benefits of Barbotage

The advantages of ultrasound-guided barbotage therapy include:

• Performed as an outpatient procedure
• General anesthesia is not needed
• Precise localization of even tiny calcific deposits
• Good visualization of the needle tip
• Can identify associated conditions within the shoulder such as bursitis
• Minimal damage to surrounding healthy tissue
• No exposure to harmful radiation
• Faster recovery compared to alternative treatments such as arthroscopy or surgery

What to Expect from the Procedure?

The barbotage procedure involves the following steps:

• The skin over the shoulder is marked and sterilized.
• A local anesthetic is injected to numb the area.
• A gel is applied on the skin and an ultrasound transducer is glided over the skin surface to pinpoint the location of the calcific deposits.
• Under ultrasound guidance, a needle is passed through the area using short motions to break up the calcium deposits. 
• The broken-down calcium deposits are resorbed by the body over time.
• If the calcium deposit has a liquid consistency, aspiration of the liquid will be attempted.
• Lastly, a steroid may be injected into the bursa to minimize inflammation.

Post-Procedure Care

To optimize recovery following barbotage, the following may be recommended:

• Use of acetaminophen (brand name: Tylenol) is recommended to minimize discomfort. Anti-inflammatory medications should be avoided, as they might interfere with the break-up and resorption of calcium by the body.
• Icing and elevation of the area to reduce swelling and discomfort is recommended.
• Avoid heavy lifting for at least 2 weeks.
• Physical therapy can help improve range of motion and function in the shoulder.

Risks of Barbotage

Barbotage is a very safe procedure; however, there is a minimal risk of:

• Pain
• Infection
• Allergic reaction to local anesthesia
• Failure to respond to treatment

Barbotage is often discussed for patients whose pain is being driven by rotator cuff calcification. It can be especially valuable when chronic rotator cuff pain persists despite rest and medications. Because accuracy matters, in-office ultrasound is often part of evaluating and guiding this treatment.