Shoulder Barbotage/Lavage/Steroid Injection/Shockwave Therapy
Calcific Tendinitis is a condition where calcium deposits form within a tendon. It is most commonly found in the rotator cuff tendons in the shoulder. The condition goes through various phases and initially, as the calcium is forming, it can be painless, however as the calcium is reabsorbed it can be at its most painful. At this stage it is commonly misdiagnosed as it can present as other types of shoulder problems. Ultrasound scanning is very good at assisting in this early diagnosis. At this point a simple steroid injection can provide effective pain relief which is maximised with a period of physiotherapy. The body can then go through a period of re-absorbing the calcium and the condition resolves in time.
For some people, the condition does not resolve at this stage at which point another procedure called barbotage (also known as lavage and incorporating dry needling) can be considered. Barbotage involves using ultrasound to guide a needle towards the calcification which in turn is used to gently break it up. Prior to this, the area is numbed using local anaesthetic and generally the procedure is comfortable and well-tolerated. After gently breaking the calcium up, the region is flushed with saline (salt water) and is then aspirated (withdrawn) back out bringing with it the calcium fragments into a syringe. Following this process, typically a small steroid injection is provided around the area to give pain-relief following the procedure.
Barbotage has been shown to be safe and effective in the treatment of resistant calcific tendinitis. Once again, the effects are maximised with a period of physiotherapy following the procedure.
Another evidence-based treatment for calcific tendinitis is Shockwave Therapy. This is a non-invasive treatment which involves targeting a sigh energy pressure wave at the site of the calcification via specialised equipment. This is a good option for those who cannot undergo injection treatment or who have resistant cases of calcific tendinitis.