About Calcific Lavage (Barbotage) for Calcific Tendinitis
Calcific tendinitis happens when calcium collects inside a rotator cuff tendon. Some deposits are soft, almost like toothpaste, and can be washed out through a needle. Barbotage does exactly that under live ultrasound, so the deposit and needle are visible the whole time.
The procedure is done in the office with local numbing medicine. It is often paired with a corticosteroid injection into the nearby bursa to calm the inflammation that makes calcific tendinitis so painful.
For harder deposits, or when the tendon itself is damaged, percutaneous tenotomy (Tenex) may be the better choice. Dr. Gruner uses ultrasound at your visit to help decide which approach fits your shoulder.
Where we use Calcific Lavage
What happens during treatment
- 1.
Dr. Gruner scans the shoulder to find the deposit, measure it, and check whether it looks soft or hard.
- 2.
The skin and the path to the deposit are numbed with local anesthetic.
- 3.
Under ultrasound, a needle is guided into the deposit. Fluid is gently flushed in and out to break up the calcium and draw it out.
- 4.
An injection into the bursa is often given at the end to calm inflammation. The visit usually takes under an hour.
Who may be a good candidate
- People with painful calcific tendinitis that has not settled with activity changes and rehab.
- Deposits that look soft on ultrasound and are large enough to target.
- People who want an office-based option before considering surgery.
Recovery
Most people use the arm for light daily tasks the same day and wear a sling only if it helps comfort. Soreness for several days is common as the numbing medicine wears off. Gentle motion starts right away, and a strengthening program builds over the following weeks. We follow up to check pain and motion and to repeat the scan when useful.
Risks and limits
Barbotage is generally well tolerated. Short-term soreness is common, and a flare of pain for a few days can happen as leftover calcium is cleared. Infection, bleeding, and tendon injury are rare. Not every deposit can be fully removed, and hard deposits may respond better to other procedures. It may not be right with an active infection or certain bleeding disorders.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about Calcific Lavage
- Is barbotage the same as lavage?
- Yes. Barbotage, lavage, and ultrasound-guided needle lavage all describe washing out a calcium deposit through a needle under ultrasound.
- Does barbotage hurt?
- The area is numbed first, so most people feel pressure rather than sharp pain. The shoulder is often sore for a few days afterward.
- Barbotage or Tenex: which is better for calcific tendinitis?
- It depends on the deposit and the tendon. Soft deposits often respond well to barbotage, while harder deposits or a damaged tendon may do better with percutaneous tenotomy. Ultrasound at your visit helps decide.