Barbotage Injection

Firstly, you will have been diagnosed with having symptomatic calcification by one of our specialists. The word ‘symptomatic’ is important, as sometimes these calcifications are present in the rotator cuff tendons but are not actually anything to do with your shoulder pain. Diagnosis will typically be confirmed with ultrasound, but they can also be seen on plain film X-ray. MRI can be less sensitive at seeing these calcifications. 

Ultrasound provides excellent imaging of rotator cuff calcification, including confirming the exact location and the size of the calcification in both axial and sagittal planes, along with the density of the calcification. These can range from immature-appearing with little or no acoustic shadowing to more mature pieces of calcification that are dense, impeding the ultrasound beam from passing through them.

Patients will typically be laid in a supine position or in long sitting for comfort. Once the calcification is located using ultrasound, the area will be marked, prepped and cleaned.

Firstly, for anaesthesia, the subacromial bursa is infiltrated with local anaesthetic. Once anaesthesia is confirmed, the piece of calcification is targeted with a needle and passed into multiple times. This is aimed at breaking up the calcification into small pieces, and through a process known as lavage, these small pieces can be extracted in a vacuum effect using saline. The procedure is finished with injecting steroid into the subacromial bursa for post-procedural pain relief.

The process can vary in duration but typically takes around 15 minutes to complete once all preparations are in place.

This is a minimally invasive procedure and is considered very safe. However, as with any injection, there are risks associated with barbotage, including but not limited to bleeding/bruising, infection, possible allergic reaction to the medication and persistence of symptoms/reoccurrence. Iatrogenic injury to the rotator cuff is a possibility as well but is rare. For more information regarding the generic potential risks, please see our corticosteroid injection page

All other treatment options will be discussed with you, allowing you to make an informed decision about whether or not barbotage is right for you.

Studies generally show a 70% chance of prolonged pain relief following a barbotage procedure.

Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment–nonrandomized controlled trial – PubMed

Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients – PubMed

Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique – PubMed

However, there are so many variables with barbotage that make the outcome always difficult to fully predict. Including the size of the calcification, the density of it and also the appearance of the surrounding rotator cuff. Research does also contradict its effectiveness in the long term.

Determining the efficacy of barbotage for pain relief in calcific tendinitis – PMC

Procedures may be repeated if there is a partial response or return of symptoms after a period of time, but we would usually not offer more than 2 procedures before escalating care for consideration of arthroscopy, which is usually definitive but does also have the associated risks of surgery.

We strongly advise you not to drive following your procedure, and you should make arrangements for someone to come with you who can drive you home. Most patients will be able to drive the following day.

You should keep the injection site clean and dry for at least 48 hours and leave any dressing in place. We usually suggest resting your shoulder for a week. After which time you can resume low-level upper body activities; however, you should avoid heavy weight training for at least 2 weeks.