Consultant-led treatment for calcium deposits within the rotator cuff tendons

Pro Sports Medicine provides ultrasound-guided barbotage in Cardiff for selected patients with persistent calcific tendinopathy.

Barbotage—also known as ultrasound-guided tendon lavage or calcific deposit needling—is a minimally invasive procedure used to puncture, fragment and, where possible, draw calcium material from an affected tendon.

The procedure is delivered through our Consultant Musculoskeletal Radiology service, led by Dr Julian Chakraverty, a fellowship-trained Consultant Musculoskeletal Radiologist and Lead Doctor for Bath Rugby.

Treatment is recommended only after specialist assessment confirms that the calcium deposit is likely to be contributing to your symptoms and is suitable for intervention.

Book an assessment

Telephone: 02920 762000
Email: info@prosportsmedicine.co.uk

What is calcific tendinopathy?

Calcific tendinopathy occurs when calcium crystals accumulate within a tendon. It most commonly affects the rotator cuff of the shoulder, particularly the supraspinatus tendon.

Some calcium deposits cause no symptoms and are found incidentally on an X-ray or ultrasound scan. Others can irritate the tendon and surrounding bursa, producing significant shoulder pain, restricted movement and difficulty using the arm.

Calcific shoulder tendinopathy may cause:

• Pain when lifting or reaching
• Night pain or difficulty sleeping on the affected side
• Sudden episodes of severe shoulder pain
• Reduced shoulder movement
• Pain during gym, sport or overhead activity
• Persistent symptoms despite physiotherapy or medication

Many cases improve naturally or with conservative treatment. Persistent symptoms may require further investigation and consideration of treatments such as rehabilitation, shockwave therapy, injection treatment or barbotage. NICE identifies percutaneous lavage or barbotage as one of the treatment options that may be considered when calcific shoulder symptoms persist.

What is ultrasound-guided barbotage?

Ultrasound-guided barbotage is an outpatient procedure used to target a calcium deposit inside the tendon.

After the area has been cleaned and local anaesthetic administered, Dr Julian Chakraverty uses real-time ultrasound imaging to guide a needle accurately into the calcification. The deposit is punctured and fragmented before saline is introduced to help loosen and, where possible, aspirate some of the calcium material.

A steroid and local anaesthetic injection into the nearby subacromial bursa may sometimes be considered where there is associated inflammation. This is decided individually rather than being included automatically.

Ultrasound guidance allows the deposit, needle and surrounding tendon structures to be visualised throughout the procedure.

Who may benefit from tendon barbotage?

Barbotage may be considered when:

• Shoulder pain has persisted despite an appropriate period of rehabilitation
• Imaging has confirmed a significant rotator cuff calcium deposit
• The location and consistency of the deposit make it suitable for needling or lavage
• Symptoms and imaging findings correspond
• Pain is affecting sleep, work, exercise or normal daily activity
• Conservative treatments have not provided sufficient improvement

The presence of calcium on a scan does not automatically mean that barbotage is required.

Some deposits are asymptomatic, some are too hard to aspirate effectively and others may not be the main cause of the patient’s pain. Consultant assessment is therefore important before proceeding.

The best-established use of barbotage is for rotator cuff calcific tendinopathy of the shoulder. Treatment of calcium deposits in other tendons is less common and requires individual consultant review because the available clinical evidence is predominantly shoulder-based.

Assessment before treatment

Your appointment may include:

• Review of your symptoms and previous treatment
• Specialist shoulder assessment
• Review of previous X-rays, ultrasound or MRI scans
• Diagnostic musculoskeletal ultrasound
• Assessment of the calcium deposit’s size, position and consistency
• Evaluation of the surrounding tendon and bursa
• Discussion of treatment alternatives
• Planning of rehabilitation following the procedure

Barbotage may be performed at the same appointment when this has been arranged in advance and the procedure is considered clinically appropriate. In other cases, assessment and treatment may be separated.

Barbotage with Dr Julian Chakraverty

Dr Julian Chakraverty is a fellowship-trained Consultant Musculoskeletal and Sports Radiologist with specialist expertise in diagnostic ultrasound, sports injury imaging and image-guided intervention.

He is Lead Doctor for Bath Rugby and works extensively across professional rugby, football, cricket and elite athletics. He is also an Honorary Senior Lecturer in Anatomy at the University of Bristol and has published within musculoskeletal radiology, orthopaedics and sports medicine.

His role at Pro Sports Medicine allows patients in Cardiff and South Wales to access consultant-level imaging and advanced image-guided procedures within an integrated sports medicine and rehabilitation clinic.

What does the evidence say?

Research into ultrasound-guided lavage and barbotage has produced mixed findings.

Pro Sports Medicine does not present barbotage as a guaranteed solution. Treatment is considered through shared decision-making after reviewing:

• The characteristics of the calcium deposit
• The severity and duration of symptoms
• Previous rehabilitation and treatment
• Associated bursitis or tendon pathology
• Alternative non-surgical options
• The expected benefits and limitations of intervention

Recovery after barbotage

Most patients return home shortly after the procedure. Temporary discomfort or a flare in shoulder pain can occur once the local anaesthetic wears off.

You may be advised to arrange transport home and avoid driving until you can control the vehicle comfortably and safely. 

Heavy lifting, strenuous upper-body exercise and repetitive overhead activity are usually restricted initially. Exact advice will depend on the procedure performed, the condition of the tendon and your normal activities.

Gentle shoulder movement is generally encouraged, followed by progressive physiotherapy and strengthening. Rehabilitation is important because removing or disrupting the calcium deposit does not automatically restore tendon capacity, shoulder strength or movement.

At Pro Sports Medicine, treatment can connect directly with our physiotherapy and high-performance rehabilitation services through the complete PSM Pathway:

Diagnosis → Plan → Treatment → Rehabilitation → Return to Performance

Are there risks?

Barbotage is a minimally invasive procedure, but no intervention is risk-free.

Potential risks include:

• Temporary pain or post-procedure soreness
• Bruising or bleeding
• Infection
• Reaction to local anaesthetic or other medication
• Vasovagal symptoms such as dizziness or fainting
• Inability to aspirate a hard calcium deposit
• Incomplete removal of the calcification
• Persistent or recurrent symptoms
• No meaningful improvement despite treatment

Additional risks may apply when corticosteroid is used. These will be discussed during the consent process.

Why choose Pro Sports Medicine?

Consultant-led care

Assessment and treatment are delivered by a fellowship-trained Consultant Musculoskeletal Radiologist with extensive experience in image-guided intervention.

Diagnosis and treatment in one pathway

Diagnostic ultrasound findings are interpreted alongside your symptoms, clinical examination and previous imaging—not viewed in isolation.

Professional-sport expertise

Dr Julian Chakraverty’s work in elite rugby and professional sport brings high-level imaging and clinical decision-making into the Cardiff clinic.

Integrated rehabilitation

Patients can access specialist physiotherapy, shoulder rehabilitation, strength testing and progressive return-to-sport planning at the same clinic.

Alternatives considered

Barbotage is not recommended automatically. Shockwave therapy, injection treatment, rehabilitation, further imaging or surgical referral may be more appropriate in some cases.

Frequently asked questions

What is barbotage treatment?

Barbotage is an ultrasound-guided procedure used to puncture, fragment and sometimes wash calcium material from a tendon. It is most commonly used for calcific tendinopathy of the shoulder.

Is barbotage the same as a steroid injection?

No. Barbotage targets the calcium deposit itself. A steroid injection may occasionally be given into the surrounding bursa to manage inflammation, but it is a separate part of the procedure.

Does barbotage remove all the calcium?

Not always. Softer deposits may be easier to aspirate, while harder deposits may only be punctured and fragmented. Complete removal is not essential for every patient, but symptom improvement cannot be guaranteed.

Is the procedure painful?

Local anaesthetic is used, although pressure or discomfort may still be experienced. The shoulder can also feel sore after the anaesthetic wears off.

How long does barbotage take?

The exact appointment time varies because diagnostic assessment, preparation, imaging and the procedure itself are all required. The clinical team will explain the expected duration when arranging your appointment.

Will I need physiotherapy afterwards?

Rehabilitation is normally recommended to restore shoulder movement, progressively rebuild rotator cuff strength and prepare the tendon for work, exercise or sport.

Can barbotage treat calcium in tendons outside the shoulder?

The strongest clinical evidence relates to rotator cuff calcific tendinopathy. Calcium deposits in other tendons require individual specialist assessment, and barbotage may not be appropriate.

Can I refer a patient to Dr Julian Chakraverty?

Yes. Healthcare professionals can contact Pro Sports Medicine regarding Consultant Musculoskeletal Radiology assessment, diagnostic ultrasound and image-guided procedures.

Book an ultrasound-guided barbotage assessment

Persistent calcific shoulder pain should be assessed properly before deciding on treatment.

Book a Consultant Musculoskeletal Radiology appointment with Dr Julian Chakraverty at Pro Sports Medicine Cardiff.

Telephone: 02920 762000
Email: info@prosportsmedicine.co.uk