Barbotage, Procedure (Shoulder, Knee & TUSS), Meaning, Definition, Injection, Recovery Time, Pain, Calcific Tendinitis Treatment

Barbotage:

• What is Barbotage?
• Procedure (Shoulder, Knee & TUSS)
• Meaning and Definition
• Barbotage Injection
• Recovery Time
• Pain During and After
• Calcific Tendinitis Treatment

What is Barbotage?

Barbotage is a minimally invasive medical procedure used to break down and remove calcium deposits that form inside tendons and joints. It is most commonly performed in the shoulder for treating calcific tendinitis, but it can also be applied to the knee, hip, and other joints. The goal is to reduce pain, restore movement, and speed up recovery without requiring open surgery.

The technique involves using a fine needle under ultrasound guidance to repeatedly aspirate and flush out calcium deposits. By washing out the affected area, barbotage helps relieve inflammation and improve tendon function. It is widely practiced in orthopedic and sports medicine, especially for patients who have persistent pain and limited mobility despite conservative treatments such as physiotherapy, rest, and medications.

Procedure (Shoulder, Knee & TUSS)

The barbotage procedure is typically performed under ultrasound guidance (TUSS – Therapeutic Ultrasound-Guided Shoulder Barbotage). For shoulder barbotage, the patient is positioned comfortably, and a local anesthetic is given. A needle is then inserted into the calcium deposit, and saline is injected to break it apart. The fluid and dissolved calcium are aspirated back using the syringe, which helps wash out the deposit. Sometimes a corticosteroid injection is added to reduce post-procedure inflammation.

In the knee, the same principle is applied to aspirate calcific or crystal deposits from tendons or soft tissue around the joint. Ultrasound ensures accuracy and minimizes risk. The procedure usually takes 15–30 minutes and is performed on an outpatient basis. Since it avoids open surgery, patients experience a much faster recovery and can often resume normal activities within days to weeks, depending on the severity of the condition and size of the calcium deposits.

Meaning and Definition

The term Barbotage comes from the French word "barboter," meaning to stir or agitate. In medicine, it refers to the repeated movement of a syringe plunger to mix, inject, and aspirate fluid. This agitation breaks down calcific deposits in tendons and joints, helping them dissolve more easily.

Clinically, the definition of barbotage is a needle-based lavage procedure used under ultrasound or X-ray guidance to mechanically disrupt and aspirate calcium crystals in tendons or joints. Unlike surgery, it is minimally invasive, quick, and safe, making it a preferred first-line treatment for calcific tendinitis when conservative methods fail.

Barbotage Injection

A barbotage injection involves the use of a fine needle, saline solution, and sometimes corticosteroids. The saline solution flushes out the calcium, while the corticosteroid reduces local inflammation and pain after the procedure. The injection is carefully guided using ultrasound to ensure accurate targeting of the calcium deposit and surrounding inflamed tissue.

The needle is inserted multiple times into the calcific area to fragment the deposit, allowing for better aspiration. Patients typically feel some pressure or mild discomfort during the procedure, but local anesthesia helps minimize pain. Since barbotage injection is done under sterile conditions and imaging guidance, the risk of infection or damage is very low.

Recovery Time

Recovery after barbotage is generally quick compared to surgical treatments. Most patients experience immediate relief from pain, although mild soreness may persist for a few days. Rest and ice packs are often recommended during the first 24–48 hours.

Full recovery depends on the size of the calcium deposits and the affected tendon. Many patients return to light activities within a week, while more strenuous activities or sports may take 2–6 weeks. Physical therapy is often advised after the procedure to restore strength and flexibility, ensuring long-term improvement and reducing the chance of recurrence.

Pain During and After

During the barbotage procedure, local anesthesia helps reduce pain, but patients may still feel some pressure or mild discomfort as the needle fragments the calcific deposit. The flushing of saline may also cause a temporary stretching sensation in the tendon or joint. Most patients tolerate the procedure well and do not require sedation.

After the procedure, mild pain, swelling, or stiffness may occur for a few days. These symptoms usually resolve with rest, over-the-counter pain relievers, and ice therapy. The corticosteroid injection, when used, further reduces inflammation and speeds up recovery. Long-term pain relief is generally excellent, with studies showing significant improvement in shoulder and knee function within weeks.

Calcific Tendinitis Treatment

Calcific tendinitis occurs when calcium deposits form in the tendons, most commonly in the shoulder (rotator cuff). It causes intense pain, stiffness, and limited mobility. Conservative management includes physiotherapy, anti-inflammatory medications, and rest. However, in persistent cases, barbotage is a highly effective option before considering surgery.

Barbotage treatment removes the calcium deposits that cause irritation and inflammation. By breaking down and aspirating the crystals, the procedure reduces pain and restores joint function. Studies have shown barbotage to be one of the most effective nonsurgical treatments for calcific tendinitis, with high patient satisfaction and low recurrence rates. When combined with physiotherapy, it offers lasting relief and functional recovery for most patients.