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Barbotage

Calcific tendinopathy is the formation of hydroxyapatite/calcific deposits that develop within a tendon. It is an extremely common disorder causing periarticular disease in the form of tendinitis and/or bursitis. The condition commonly manifest in the rotator cuff of the shoulder. This can be a very painful condition leading to loss of movement and disturbed sleep.

These deposits can be associated with systemic disease however in many patients is occurs idiopathically without clear reason or cause. It is most prevalent in people between the age of 30-60. It is known to spontaneously resolve in some individuals but not all and can stay present within the tendon for many years.

How is calcific tendinopathy diagnosed?

The calcific deposits can be seen on X-ray, but ultrasound is better for finding small and immature calcification which can sometimes be missed on plain film. Ultrasound allows for multi directional assessment of the calcification in all angles to fully evaluate the location, size and density of the deposit.

Treatment

Initial treatment for this condition should include pain killers and anti-inflammatory medications, physiotherapy exercises are used to keep the shoulder moving to maintain strength and mobility. If this fails to resolve your problem there are other outpatient options to consider.

Initially a guided injection into the subacromial bursa can be used to control pain and settle any inflammation. Adherence to physiotherapy exercises following the injection are important to maintain the cuff capacity and tolerance.

If this fails to provide any long term benefit then an ultrasound guided barbotage procedure can be offered. This involves an anaesthetic injection into the shoulder to numb the area. Once anaesthetised the needle can be passed into the calcific deposit multiple times causing dissection and then aspirated into the syringe. This is repeated to extract as much as possible from the tendon in process called lavage.

This procedure usually takes 15-20 minutes and patients are encouraged not to drive following the procedure. We encourage patients to comply with their physiotherapy exercises after a couple of days. It can be sore for 24-48 hours once the anaesthetic wears off but local pain killers can help.

There is a 60-70% chance of resolution with barbotage sometimes a second procedure is required. Occasionally some do not get the desired outcome and therefore may require surgery.

Conditions used for:

  • Calcific tendinopathy
Full clinical assessment of shoulder problem including history of condition and impact it is having on quality of life.

Physical examination including ultrasound scan of shoulder.
Screening questions about other medical conditions and any medications currently taking.

Discuss potential risks of procedure or any reason procedure should not be undertaken that day. (Further imaging or medical information required)
Full explanation of procedure.
Procedure performed with aseptic technique.

Post procedure advice given of what to expect in next 24-48hrs. Advice on pain relief & what exercise to do and when following procedure.
Letter sent to patient & GP to update
patient GP records.