Short Answer
At The London Ultrasound Clinic, we see many patients who arrive worried and frustrated by the pain of calcific tendinosis. From our experience, ultrasound guided barbotage is one of the most effective ways to remove calcium deposits from the rotator cuff and relieve pain. The procedure uses a fine needle to break up and wash out the calcium under precise ultrasound guidance. Barbotage helps reduce pain, restore movement, and often avoids the need for surgery.
Understanding Calcific Tendinosis
Calcific tendinosis occurs when calcium builds up inside a tendon, most commonly in the supraspinatus. Many patients have struggled for months with sharp pain, night pain, and difficulty lifting the arm. The calcium deposit can feel like a stone inside the tendon, causing irritation and inflammation around the surrounding tissues. Symptoms often flare during the resorptive phase, when the body attempts to break the deposit down naturally. This can be extremely painful. While some cases resolve on their own, many patients come to us because the pain affects sleep, exercise, work, and day to day life.
What Barbotage Involves
In our clinic, barbotage is performed using real time ultrasound guidance to ensure complete accuracy. After numbing the skin and tendon with local anaesthetic, a fine needle is guided directly into the calcium deposit. Gentle needle movements break the deposit into a softer paste. Saline is then used to wash the calcium out. In many cases, a significant amount of material can be removed during the procedure. Once the calcium has been cleared as much as possible, we usually place a small amount of steroid and local anaesthetic around the tendon to calm irritation. The procedure takes around 20 to 30 minutes and patients usually walk out feeling comfortable. Most people are surprised at how straightforward and tolerable the treatment feels.
How Barbotage Works
The aim of barbotage is to soften, break down, and flush out the calcium. Removing the deposit reduces mechanical irritation inside the tendon, which is often the main cause of pain. Clearing the calcium also gives the tendon a better chance to heal. Patients often notice movements such as reaching or lifting feel easier within days to weeks. Night pain also improves as inflammation settles.
What to Expect After the Procedure
It is normal to feel some soreness for a day or two after treatment. This usually responds well to ice, gentle movement, and the medications placed around the tendon during the procedure. Avoid heavy lifting or overhead loading for a few days before gradually returning to normal activity. Physiotherapy is an important part of long term recovery. We regularly work with physiotherapists to build shoulder strength and control once the calcium has been removed. Patients who commit to a structured rehabilitation plan tend to recover quicker and maintain improvements for longer.
Recovery and Long Term Outlook
From our experience, barbotage has a high success rate when the calcium deposit is well defined and accessible on ultrasound. Many patients notice significant improvements within two to six weeks. Most people need only one session, although a second treatment can help if the deposit is very dense or large. Compared with steroid injection alone, barbotage addresses the root cause by removing the calcium rather than only calming inflammation. This often leads to longer lasting relief and better shoulder function.
Is Barbotage Right for You
We consider barbotage for patients with ongoing pain from calcific tendinosis that has not improved with physiotherapy or other treatments. It is especially helpful when the calcium deposit is clearly visible on ultrasound and located in a position that is safe to access. Barbotage may not be suitable if symptoms are not caused by calcium or if the deposit is very small or too deep within the tendon. In every case, we assess your shoulder with high resolution ultrasound and discuss the most appropriate treatment for your condition.
References
- de Witte PB, Selten JW, Navas A, et al. Calcific tendinitis of the rotator cuff. Shoulder and Elbow. 2014;6(3):183 to 187
- Del Cura JL, Torre I, Zabala R, LegÃŗrburu A. Sonographically guided percutaneous needle lavage in calcific tendinitis of the shoulder. AJR Am J Roentgenol. 2007;189(3):W128 to W134
- Louwerens JK, Sierevelt IN, van Hove RP, van den Bekerom MP. Comparing surgical, needle lavage and shockwave treatment for calcific tendinitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3770 to 3779