What is shoulder calcification (calcific tendonitis)?
Calcific tendonitis (also known as calcific tendinopathy) refers to inflammation of the shoulder rotator cuff (usually the supraspinatus or infraspinatus) secondary to the deposition of calcium (referred to as calcium hydroxyapatite). To learn more, please see our article about shoulder calcification (calcific tendonitis.
What is a shoulder barbotage/lavage procedure?
Shoulder barbotage/lavage is a special procedure in which aspiration or breaking down of the calcium material within the inflamed rotator cuff tendon is accurately performed under ultrasound guidance. This is combined with a subacromial bursa steroid and local anaesthetic injection and is used to treat calcific tendonitis. To find out more, please continue reading our article.
How is ultrasound-guided barbotage-lavage done?
A shoulder ultrasound will be initially performed. This will assess the size and location of tendon calcification to determine the best approach and rule out the presence of rotator cuff tears.
Then, the skin will be cleaned and prepared, and a numbing medication will be administered to the skin and the deeper tissues, including the space overlying the area of calcification (called the subacromial bursa). This will minimise the pain you feel during the procedure. Then, a special needle will be inserted into the area of calcification and aspiration of the calcium material is attempted under continuous ultrasound guidance.
A syringe containing normal saline (salty water) will be used to repeatedly inject and aspirate the calcium by using an intermittent inject-release technique (please see the video). As more calcium is drained, the water within the syringes will start to become dusty. So, the syringe will be replaced with a new one with clean water, and the washout process will be continued.
Following this, the subacromial bursa will be injected with steroids and numbing medicine to reduce the bursal inflammation.
It’s advised not to drive immediately after the procedure. Rest the area and avoid extraneous activities for about 1 week following the procedure.
The photos below demonstrate the calcified material after aspiration.
What are the possible complications from an ultrasound-guided barbotage-lavage procedure for calcific tendonitis?
Generally, the procedure is very safe and routinely performed. Serious complications are very rare.
There is a very small risk of infection, similar to any other steroid injection.
There is a small possibility of weakening of the rotator cuff tendon since the needle needs to go into the area of calcification within the inflamed tendon. Therefore, adequate shoulder resting for at least 1 week following the procedure is advised.
The area will be sore for 1-2 weeks following the procedure. After this, patients should start noticing improvement in the symptoms.
If you have more questions about ultrasound-guided barbotage, please see our article on ultrasound-guided shoulder barbotage procedure.
Shoulder conditions and treatments
