Ultrasound Guided Barbotage for Calcific Tendonitis

In some patients a deposit of calcium can form in the tendons of the body, most commonly in the rotator cuff tendons of the shoulder. One treatment modality that can be used to eliminate the calcium deposit and avoid surgery is ultrasound guided barbotage. It is done as an outpatient procedure using ultrasound guidance.

There is no preparation required for this procedure. The procedure takes 30 minutes and will be performed at our office. It will help if you can wear clothing that will allow you to easily expose the shoulder in question. You will be asked to strip to the waist and to change into a gown. Bras can be left on but with the strap on the affected side down.

After an initial ultrasound examination, the barbotage is usually performed when you are lying on your side. With a thin needle the whole injection area is first numbed. The calcific deposit is then approached with one or two needles and multiple punctures are performed. The procedure is highly precise and the needle is continuously watched on the ultrasound. Care is taken to minimize injury to the tendon. Sometimes water pressure is used through the needle to break and suck the calcium deposits in the area. Following the barbotage, an injection of steroid and local anesthetic is administered. The injection site will be covered with a small dressing which can be removed after 24 hours.

Following the procedure you will be asked to rest in the office for 15- 20 minutes, until you are comfortable. You will be asked not to drive following the procedure and therefore you may wish to bring a friend or a relative with you or alternatively use a public transit. Although for the first few hours after the barbotage the shoulder will feel numb due to anesthetics, it is advisable to continue your painkiller medications for the first few days alongside the exercises. This is because the steroid will generally take 3 to 7 days to work. The shoulder may look or feel bruised for a few days. There are no specific restrictions after the procedure and once the discomfort from the procedure eases, usually 2-5 days, you could commence shoulder exercises.

The steroid injection is a very safe drug with approval for use in joints. It can be used safely with other conditions with no significant drug interactions. The injection is precisely injected and stays in the region of the inflammation and pain. Even if you are on oral steroids, there is no need to change your dose. However, if you are a diabetic and take insulin, it may affect your blood sugar levels initially. Side effects are very rare and include:

  • Skin thinning, dimpling and change in skin colour at the site of injection.
  • Flushing and redness of the face for a few days. It is more of a nuisance rather than reaction and usually settles down over a few days.
  • The area of injection may look or feel bruised for a few days
  • Infection is a very unusual complication which can occur from any kind of injection. If the injection area becomes red, hot and swollen and you feel unwell you should seek immediate medical help.
  • Serious or breathing related side effects are not expected with this injection and if such symptoms are encountered, you should seek immediate medical help via a GP or emergency department.

If you are interested in barbotage please contact the office to discuss your options.