Ultrasound-Guided Needle Treatment to Break Down Calcium Deposits
Calcific tendonitis is one of the more acutely painful shoulder conditions a person can experience. Calcium deposits can build to a point where they cause intense, often debilitating shoulder pain that does not respond well to rest, anti-inflammatories, or standard physiotherapy alone. They develop in a lot of different areas but most often in the supraspinatus tendon of the rotator cuff, or the gluteal tendons of the hip.
Barbotage is a minimally invasive, ultrasound-guided procedure in which one or two needles are used to puncture, break up, and aspirate (wash out) the calcium deposit. It does not require surgery or a general anaesthetic. Evidence from clinical trials, including research published in peer-reviewed musculoskeletal imaging journals, supports barbotage as an effective treatment for significant calcific deposits that have failed conservative management, with the majority of patients experiencing meaningful improvement at three to six months.
Motherwell Physio provides barbotage as part of an integrated injection and physiotherapy service. The procedure is performed under continuous ultrasound guidance, allowing the clinician to target the calcium accurately and monitor the aspiration in real time.
Who This Is For
Barbotage is typically considered when:
- You have confirmed calcific tendonitis on ultrasound or X-ray
- Pain has persisted for three months or more despite conservative management
- Shoulder function is significantly restricted
- You have not responded adequately to physiotherapy, NSAIDs, or a previous steroid injection
Not all calcium deposits are suitable for barbotage. The consistency of the deposit (formative vs. resorptive phase), its size, and your overall clinical picture will all influence whether the procedure is appropriate. This is assessed at your consultation under ultrasound to see if it is appropriate or if a straight forward cortisone /steroid injection is more appropriate.
How the Procedure Works
Consultation and Assessment
A thorough clinical assessment is carried out first, including a review of any existing imaging. The nature, location, and phase of the calcium deposit will be assessed under ultrasound at this appointment. If barbotage is appropriate we will carry it out within the appointment. The procedure, expected outcomes, and post-treatment plan will be explained in full.
The Barbotage Procedure
You will be positioned with your shoulder accessible, usually lying. The skin is cleaned with antiseptic. Under continuous ultrasound guidance, a fine needle (or two needles using a double-needle technique) is advanced into the calcium deposit. Saline is used to irrigate and break up the calcium, which is then aspirated back through the needle. A corticosteroid is commonly injected at the end of the procedure to reduce post-procedural inflammation. The procedure takes approximately 30 to 45 minutes.
Recovery and Follow-Up
It is normal to experience a flare of pain in the 24 to 72 hours following barbotage. This is a predictable response as the disrupted calcium causes a local inflammatory reaction, and paradoxically, this reaction is often associated with better long-term outcomes as the body clears the residual deposit. Ice, rest, and over-the-counter analgesia typically manage this period well.
Most patients begin to notice significant improvement within a few days up to six weeks. A structured physiotherapy programme to restore rotator cuff strength and shoulder function follows the procedure.
What to Expect at Your First Appointment
Your first appointment lasts approximately 45 to 60 minutes. Wear clothing that allows easy access to the shoulder; a short-sleeved top or vest is ideal. Bring any imaging reports and a list of current medications. A referral is not required, but if your GP or specialist has provided one, please bring it along.
You should not drive immediately after the procedure. Arrange transport for the appointment day.
Your Treatment Team
Shane Ryan, Director, Advanced Practice Physiotherapist
BSc Physiotherapy, PG Cert in Musculoskeletal Ultrasound, Clinical Specialist in Ultrasound guided injections, Independent Prescriber
CSP No. 098175
HCPC No, PH107655
BSc Physiotherapy, PG Cert in Musculoskeletal Ultrasound, Clinical Specialist in Ultrasound guided injections, Independent Prescriber
CSP No. 098175
HCPC No, PH107655
Pricing and Appointments
Book online at motherwellphysio.co.uk or call the clinic directly.
Conveniently Located in Motherwell
- Motherwell Physio, 406 Brandon Street, Motherwell, ML1 1XA
- Mon - Fri 8am - 6pm
- 01698 692086
- info@motherwellphysio.co.uk
- Free car park across the road
Frequently Asked Questions
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A steroid injection reduces inflammation but does not remove the calcium deposit. Barbotage physically punctures, breaks up, and aspirates the calcium using a needle under ultrasound guidance. A corticosteroid is often combined at the end, but the primary mechanism is mechanical disruption and removal of the deposit itself.
The procedure itself causes discomfort, and a local anaesthetic is used to reduce this. A significant post-procedural flare lasting 24 to 72 hours is common and expected. Patients are advised to arrange for a quiet day or two after the procedure and to have appropriate analgesia at home.
Existing imaging is helpful but not always required before your first appointment. The clinician will perform a diagnostic ultrasound at assessment to confirm the diagnosis and evaluate the deposit before planning the procedure.
Most patients require a single procedure. If the deposit is large or particularly dense, a second session may occasionally be recommended. This will be discussed at your follow-up review, typically four to six weeks after the first treatment.
Yes. Physiotherapy following barbotage is important to restore rotator cuff strength, shoulder mobility, and functional movement patterns. The combination of barbotage and rehabilitation produces better outcomes than either alone.
Following the initial 48 to 72 hour flare, most patients notice gradual improvement over two to six weeks. Full recovery and return to sport or overhead activity varies, but most people are significantly improved by three months. Some residual calcium may remain on imaging even when symptoms have resolved. This is normal and does not necessarily indicate treatment failure.
Yes but there can be a very long waiting time at present as it is not routinely commissioned on the NHS in most areas and is typically accessed through self-funding or private health insurance.
Yes, in most cases. A previous steroid injection does not exclude you from barbotage. The full history of prior treatments will be reviewed at your assessment.
If the procedure does not produce sufficient improvement, alternative options including further physiotherapy, a repeat procedure, or surgical consultation will be discussed. The clinician will review your progress at follow-up and guide next steps based on your response to treatment.
Ready to Book?
To arrange an assessment for calcific tendonitis, call or book online at motherwellphysio.co.uk. 01698 692086