Shoulder
Ultrasound-guided lavage of the calcification
Under ultrasound guidance, the calcification is aspirated and dissolved through a needle: pain often decreases within the following days.
How it is performed
The procedure, also called barbotage, is performed in an outpatient setting. After local anaesthesia of the skin, the ultrasound is used to locate the calcium deposit within the rotator cuff tendon. A thin needle is advanced into the calcification and, by alternating small injections of saline with aspiration, the calcific material is dissolved and removed. At the end, an anti-inflammatory medication can be administered into the subacromial bursa.
Who it is for
- Calcific tendinopathy documented on ultrasound or X-ray
- Pain disturbing sleep and overhead movements
- Lack of response to physiotherapy and medications
Recovery
You return home immediately afterwards. In the first 24-48 hours some transient pain may occur, manageable with ice and painkillers. Physiotherapy generally resumes after a few days.
Conditions treated in this area: calcific tendinopathy of the rotator cuff, frozen shoulder (adhesive capsulitis), subacromial bursitis.
Scientific evidence
Literature reviews on more than 900 patients show a significant and lasting improvement in shoulder pain and function after ultrasound-guided lavage, with a favourable safety profile. In direct comparisons between conservative treatment options, ultrasound-guided lavage combined with corticosteroid injection is among the most effective strategies. Prof. Ezio Lanza has worked on this procedure for years and is the author of dedicated scientific papers: a systematic review of the evidence on ultrasound-guided lavage (European Radiology, 2015), a study on outcomes also in patients previously treated with shockwave therapy (La Radiologia Medica, 2021), and a recent meta-analysis of randomised trials (European Journal of Physical and Rehabilitation Medicine, 2024).
References on PubMed
- Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting
Lanza E, Banfi G, Serafini G, et al. — Eur Radiol, 2015 · PMID 25583182
- US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy
Lanza E, Piccoli F, Intrieri C, et al. — Radiol Med, 2021 · PMID 32451885
- Ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a systematic review with meta-analysis of randomized controlled trials
Sconza C, Palloni V, Lorusso D, ... Lanza E, Brindisino F — Eur J Phys Rehabil Med, 2024 · PMID 39382530
- Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients
Gatt DL, Charalambous CP — Arthroscopy, 2014 · PMID 24813322
- Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for rotator cuff calcific tendinopathy: a network meta-analysis of RCTs
Arirachakaran A, Boonard M, et al. — Eur J Orthop Surg Traumatol, 2016 · PMID 27554465
- KALK study: ultrasound guided needling and lavage (barbotage) with steroid injection versus sham barbotage — randomized, double-blinded, controlled, multicenter study
Moosmayer S, Ekeberg OM, et al. — BMC Musculoskelet Disord, 2017 · PMID 28376756
Published data describe average results in groups of patients and are not a prediction of an individual outcome. The indication for treatment must always be assessed during a consultation.
Risks, costs and opinions
The three questions patients ask most often before deciding, with clear answers.
What are the risks of ultrasound-guided lavage of the calcification?
It is an outpatient procedure performed with a thin needle under local anaesthesia and continuous ultrasound guidance, which makes it possible to see the needle, the target and the structures to avoid in real time. The most common issues are transient: pain or swelling for 24-48 hours, a small bruise. Joint infection is a rare event, prevented by sterile technique. In treatments with cortisone, facial flushing or a temporary rise in blood sugar may occur in diabetic patients. Personal risks and contraindications are assessed during the consultation.
How much does the ultrasound-guided lavage of the calcification cost?
The cost depends on the setting in which the procedure is performed: some treatments are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment, and includes the assessment, the procedure and the planned follow-up. During the consultation I tell you which pathway is available in your case: you do not have to decide before knowing the cost.
Does it really work? What patients and the literature say
The most frequent questions are "how long does the benefit last?" and "can I repeat it?". The answer depends on the diagnosis and the stage: some injections resolve the painful episode, others serve to open a window in which rehabilitation becomes effective. Experiences read in forums concern cases different from yours. During the consultation we review your imaging and I tell you frankly what to expect, how many sessions may be needed and when another approach is better.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.