Barbotage of the shoulder with image-intensified fluoroscopic control of needle placement for calcific tendinitis.

In 9 patients with symptomatic calcific deposits in the rotator cuff, followed for an average of 9 years, good to excellent results were obtained by barbotage (needle irrigation and aspiration). The deposit was localized with a needle using an image intensifier. Postbarbotage X-rays show residual deposits, but films taken on follow-up show complete disappearance of the lesion except in one instance where a small density was seen. One patient had early recurrence of symptoms out of the 3 who had postbarbotage cortisone injection. Barbotage is simple, effective, with virtually no complications. Failures of the method were apparently due to difficulty in locating the deposit with the needle. Barbotage is most indicated in the acute phase of the disease but may be used in cases with chronic symptoms to remove dry granular deposits. It is not essential, however, to completely remove the deposits because the resorption process continues. Local cortisone injection either as a primary procedure of after barbotage is not recommended because it aborts the natural course of the disease and promotes recurrences.