Barbotage Procedure for the Shoulder: A Complete Guide

Calcification in the rotator cuff tendons commonly causes severe shoulder pain. When simple treatments fail, the barbotage procedure — also called shoulder lavage or aspiration — directly removes the calcium. Dr Masci performs ultrasound-guided barbotage at his London clinics as a one-stop visit: consultation, diagnostic ultrasound, and procedure in a single appointment. So what does a barbotage shoulder procedure involve? How effective is it? And what should you expect afterwards? This guide answers it all. For the condition itself — causes, symptoms, and the full range of treatments — read our guide to calcific tendonitis of the shoulder.

What is calcific tendonitis of the shoulder?

Ultrasound image showing calcific tendonitis of the shoulder before barbotage

Calcium can build up in most tendons, and the rotator cuff is the most common site. The deposits usually cause no pain until the body tries to remove them — a phase called resorption. The immune response triggers intense inflammation around the deposit.

Symptoms are often acute and severe. Night pain is typical, and some patients reach the hospital because any shoulder movement becomes impossible. Ultrasound diagnoses the problem best: it finds deposits that an X-ray or MRI can miss, and it shows whether a deposit is ‘soft’ — actively resorbing and painful — or ‘hard’ and quiet. Read the full condition guide here.

What is a barbotage procedure?

Barbotage is an advanced ultrasound-guided procedure that removes calcium deposits from the rotator cuff. The procedure combines needling — breaking down the calcification — with lavage, which flushes the calcium crystals out and aspirates them with sterile water. You will hear the terms barbotage, lavage, and aspiration used interchangeably; they describe the same procedure.

Barbotage works best for deposits larger than 0.5 cm and in the resorptive (soft) phase. Ultrasound guidance is non-negotiable: the needle must precisely reach the centre of the deposit.

How does Dr Masci perform a barbotage shoulder procedure?

Calcium can build up in most tendons, and the rotator cuff is the most common site. The deposits usually cause no pain until the body tries to remove them — a phase called resorption. The immune response triggers intense inflammation around the deposit.

Symptoms are often acute and severe. Night pain is typical, and some patients reach the hospital because any shoulder movement becomes impossible. Ultrasound diagnoses the problem best: it finds deposits that an X-ray or MRI can miss, and it shows whether a deposit is ‘soft’ — actively resorbing and painful — or ‘hard’ and quiet. Read the full condition guide here.

What is a barbotage procedure?

Barbotage is an advanced ultrasound-guided procedure that removes calcium deposits from the rotator cuff. The procedure combines needling — breaking down the calcification — with lavage, which flushes the calcium crystals out and aspirates them with sterile water. You will hear the terms barbotage, lavage, and aspiration used interchangeably; they describe the same procedure.

Barbotage works best for deposits larger than 0.5 cm and in the resorptive (soft) phase. Ultrasound guidance is non-negotiable: the needle must precisely reach the centre of the deposit.

How does Dr Masci perform a barbotage shoulder procedure?

The procedure follows clear steps. Dr Masci scans the shoulder to locate and stage the calcium deposit. He cleans the skin with an antiseptic and uses a strict sterile technique. He injects local anaesthetic into the skin and muscle — essential, because inflamed calcium is tender. He then guides a larger needle into the centre of the deposit and pulses sterile water to break up and flush out the calcium, sometimes using more than one syringe. Finally, he usually injects cortisone into the bursa above the tendon, which prevents pain if calcium debris enters the bursa and improves the overall result.

[VIDEO: re-embed the lavage video — currently broken on the live page]

The whole appointment takes around 30 minutes. Dr Masci has performed thousands of ultrasound-guided procedures and teaches advanced injection techniques, including barbotage, to doctors across the UK and Europe. Read about his injection expertise here.

How effective is the barbotage procedure?

The evidence strongly supports it. Studies suggest a 70% chance of pain relief following barbotage. A study comparing all calcific tendonitis treatments found barbotage to be the most effective. Barbotage with a cortisone injection into the bursa beats both a simple cortisone injection and shockwave therapy, and a recent review found barbotage outperformed shockwave in both the short and long term.

How much does a barbotage procedure cost in London?

Dr Masci performs the barbotage procedure as part of a one-stop visit at his London clinics, with fees starting at £420 at his Chelsea clinic — including consultation, diagnostic ultrasound, and the procedure. Other clinic locations cost more. Review the full fees here or contact his team for a quote. All major private insurers cover the procedure.

Recovery after barbotage

Expect soreness for 3–5 days; we prescribe pain medication to cover this. Rest the shoulder for a week and avoid overhead activities. After a week, resume low-level upper-body activity. Start physiotherapy at 10 days and hold off on heavy weight training for at least 2 weeks.

Frequently asked questions about the barbotage procedure

Does barbotage hurt?

It can — inflamed calcium is tender — but local anaesthetic keeps discomfort short-lived. An experienced doctor and ultrasound guidance make a real difference to comfort.

What are the side effects of barbotage?

Barbotage is generally safe. Possible complications include acute pain after the procedure, bruising, bursitis, infection (around 1 in 10,000), and, rarely, rotator cuff tendon rupture. We avoid the procedure when a rotator cuff tear coexists with calcification — another reason the diagnostic ultrasound matters.

Do you have to inject cortisone with a shoulder barbotage?

Usually, yes, after removing the calcium. Calcium debris can enter the bursa during the procedure and cause pain; cortisone in the bursa can prevent this and improve the result. If cortisone’s risks outweigh its benefits for you, the procedure works acceptably without it.

Can I drive after a barbotage procedure?

Not on the day. You should be able to drive the following day.

Are PRP injections effective for calcium deposits?

No. PRP has evidence for rotator cuff tendonitis and partial tears, but no evidence supports PRP for relieving pain from calcium deposits.

What if barbotage fails?

A second barbotage at 6–8 weeks helps some patients. Even with repeat procedures, about one in three patients has ongoing pain. The next options are focused shockwave therapy, the Tenex procedure — a more advanced technique using ultrasonic energy and water irrigation to dissolve calcification more aggressively, or surgery. A recent study found surgery to be slightly better than non-surgical treatment, although both groups improved, so reserve surgery for genuine treatment failures.

Are all calcium deposits painful?

No, most are not. Only around a third of people with shoulder calcification have pain. Deposits become symptomatic when the body starts removing them, and some disappear without ever hurting. Our calcific tendonitis guide explains the stages in detail.

Final word from Sport Doctor London about the barbotage procedure

Barbotage is the most effective single procedure for painful rotator cuff calcium deposits, with around 70% of patients gaining relief. The key is the doctor: choose a physician genuinely experienced in advanced ultrasound-guided techniques.

Dr Masci performs the barbotage procedure in London as a one-stop visit for £420. Contact his team here or call +44 (0) 203 488 0350 — the admin team replies within 1–2 working days.

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