Calcification in the rotator cuff tendons is a common cause of pain in the shoulder. One of the treatment options for calcific rotator cuff tendinitis is a barbotage procedure. What is a barbotage procedure? How effective is it in treating calcification?
What is calcific tendonitis shoulder?
Calcium buildup can occur in most tendons of the body. A common site of calcium buildup is the rotator cuff tendons.
Symptoms
Generally, calcium deposits are not painful until the body tries to remove these deposits, also called resorption. The body mounts an acute inflammatory response, causing swelling around the calcium deposit.
Symptoms are often acute and extremely painful. Sometimes, patients present to the hospital with severe shoulder pain. Night pain is common. Pain is sometimes so intense that any movement of the shoulder is impossible.
Diagnosis
History of sudden severe shoulder pain is suspicious of calcific rotator cuff tendinitis. Often, we use imaging to see these deposits. Calcium is seen on plain X-ray and ultrasound. However, an MRI scan may miss calcium deposits, especially the small ones.
Generally, ultrasound is the best way to see calcium deposits. It can detect the location and characterise whether the deposit is inflamed and painful. For example, painful calcium deposits on ultrasound are often described as ‘soft’, meaning the body is trying to break them down.
Calcific rotator cuff tendinitis treatment
Treatment options for painful calcific deposits include physiotherapy, medication such as ibuprofen, shockwave therapy, cortisone injection, barbotage procedure and surgery.
Barbotage procedure for calcific tendinitis shoulder
Barbotage is an advanced procedure to remove calcium deposits. This procedure must be performed with ultrasound. The process involves needling of the calcification and a lavage. Needling breaks down the calcification, while lavage sucks out or removes the calcium crystals.
How is a barbotage procedure for the shoulder done?
Generally, we use an ultrasound, needles, and sterile water to flush out the calcification. A local anaesthetic is essential, as removing inflamed calcium is often painful. Some doctors inject cortisone into the bursa to help with pain after the procedure.
Usually, we start with an ultrasound scan to identify the location of the calcium deposit. Then, the skin is cleaned with antiseptic. Your doctor must use a sterile technique to reduce the risk of infection.
Next, local anaesthetic is injected into the skin and muscle superficial. Then, a larger needle is inserted into the middle of the calcium deposit. Your doctor will pulse water into the calcium to break up and flush out the calcium. Sometimes, more than one syringe is needed to remove these crystals. Finally, we inject cortisone into the bursa, which helps relieve pain if calcium enters the bursa.
Frequently asked questions about the barbotage procedure:
What are the barbotage side effects?
Barboatge is generally safe. However, complications are possible in any procedure.
These complications include:
- Acute pain after the procedure
- bruising
- infection (1:10000)
- Bursitis
- Tendon rupture.
Do we have to inject cortisone with a shoulder barbotage procedure?
We usually do this after removing the calcium. During the procedure, some calcium may enter the bursa, causing pain. So, injecting cortisone into the bursa will reduce this risk of pain. Also, we think the procedure is more effective if we inject cortisone into the bursa. However, it is perfectly acceptable not to inject cortisone if the risks of cortisone outweigh the potential benefits.
Does barbotage hurt?
Barbotage can be painful, but your doctor will use a local anaesthetic to make it less painful.
How effective is the barbotage procedure?
Studies suggest a 70% chance of pain relief following a barbotage procedure.
A recent study comparing all calcific rotator cuff tendinitis treatments found that barbotage was the most effective.
Another study found that a barbotage procedure with a cortisone injection into the bursa was more effective than a simple cortisone injection or shockwave therapy.
Can I drive after a barbotage procedure?
In general, you should not drive home after the procedure. However, you should be able to drive the following day.
What happens after the barbotage procedure?
We usually suggest resting your shoulder for a week. You will be prescribed pain medication to help with post-injection pain, which generally lasts 3-5 days. After a week, you can resume low-level upper-body activities. However, you should avoid heavy-weight training for at least two weeks.
You should start physiotherapy after ten days.
Are PRP injections effective for calcium deposits?
While there is some evidence for using PRP for rotator cuff tendinitis and partial tendon tears, there is no evidence that PRP relieves pain from calcium deposits.
What are other options if barbotage fails?
Sometimes, a second barbotage is performed at 6-8 weeks. Even with repeated injections, about 1/3 of patients experience ongoing pain. Other options include focussed shockwave therapy or surgery.
A recent study found that surgery was slightly better than other treatments- although both groups improved.
Are all calcium deposits painful?
No. Most calcium deposits are not painful. On ultrasound, we describe these deposits as ‘hard’. Generally, calcium becomes symptomatic when the body tries to remove it. Sometimes, calcium deposits can disappear without pain.
Final word from sportdoctorlondon regarding shoulder barbotage for calcific tendinitis shoulder
The barbotage procedure is effective for rotator cuff calcium deposits. You should see a doctor who is experienced in performing this procedure with ultrasound guidance.
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