Barbotage and Lavage of Calcific Tendonitis

Aka: Barbotage and Lavage of Calcific Tendonitis

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II. Definitions

  1. Barbotage
    1. Needling and breaking up of calcific deposits
  2. Lavage
    1. Flushing site (saline or Anesthetic) and aspirating deposits

III. Indications

  1. Rotator Cuff Calcific Tendinitis
    1. More likely to be effective if deposit is soft, fluffy, or irregular

IV. Precautions

  1. Procedure should be performed by experienced clinician

V. Adverse Effects

  1. As with any percutaneous procedures, risk of infection and bleeding

VI. Technique

  1. Ultrasound guidance is used to identify Calcium deposits
  2. Draw Lidocaine into syringe with 18 gauge needle
  3. Needle entry angled from below the calcification site (loosened deposits will fall with gravity)
  4. Inject and aspirate multiple areas at deposits
    1. Repeat until all accessible material withdrawn
  5. Consider 2 needle approach
    1. First needle injects
    2. Second needle aspirates from below first needle insertion site (loosened deposits will fall with gravity)
  6. Complete procedure with local Corticosteroid
    1. Inject Corticosteroid at subdeltoid or subacromial bursa

VII. References

  1. Warrington (2026) Crit Dec Emerg Med 40(2): 19

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