Ultrasound-Guided Barbotage
Ultrasound-guided barbotage is a very effective treatment for calcific tendonitis. It is a short procedure usually performed by a radiologist (X-ray doctor). First, the doctor will perform an ultrasound scan of your shoulder to locate the calcium. After it has been located, they will inject some local anaesthetic to numb the area.
After this, they will pass a fine needle into the calcium to break it up. They may also inject some fluid to help to make it into a liquid and then draw it up into a syringe. Often, they will inject some steroids into your shoulder too which can help settle down any inflammation that is also causing pain.
The whole procedure takes around 15-20 minutes to complete.
Before agreeing to this procedure, it is important that you are aware of the risks, as well as the benefits of the injection. The main benefit, of course, is to relieve shoulder pain. Although they are rare, here are the risks:
- Pain during the procedure: A little discomfort from this procedure is inevitable, but for most people it is no worse than any other injection. Do let the doctor know if it is too uncomfortable as they may be able to give more local anaesthetic.
- Allergic reaction: This is very rare, but can be life-threatening.
- Infection: This is rare, but can result in severe pain 1-2 weeks after the injection and may require surgery to wash out the injection.
- Change in the colour or texture of your skin where it is injected. This is very uncommon and more pronounced in people with darker skin colours.
- Steroid 'flare': This can result in a temporary worsening of pain from 1-3 days after the injection.
How successful is barbotage?
Overall, 80-90% of people get significant benefit from the barbotage procedure, allowing them to get back to their normal activities within a few weeks. If you have a large piece of calcium in your tendon, it may not all be removed in one go, so you may be booked in for a repeat procedure.
Recovery
What should I do after barbotage?
It is important to start physiotherapy as soon as possible after the procedure, ideally within a day or two. Avoid heavy use of your arm for a few days, but do put your arm through as much movement and stretching as possible so your shoulder does not stiffen up.