Barbotage for Calcific Tendinopathy
Barbotage is an ultrasound-guided procedure that breaks down and removes the calcium deposits behind calcific tendinopathy, often called calcific tendonitis, most commonly in the shoulder.
Calcific shoulder pain can be severe. It can stop you sleeping on that side, lifting your arm above your head or getting through a day’s work, and it can arrive suddenly with no injury to explain it. Where the deposit is the problem and rehabilitation has not settled it, barbotage treats the calcium directly rather than working around it.
We provide barbotage at Meyer Physio in Weybridge, Surrey. You can come to us directly — you do not usually need a GP or consultant referral, and there is no waiting list. Your shoulder is assessed and scanned first, because whether barbotage will help depends on what the deposit actually looks like.
What is a barbotage procedure?
Barbotage is a minimally invasive procedure used to break down and remove calcium deposits in tendons, commonly in the shoulder. Using ultrasound guidance, a fine needle is inserted into the affected area to aspirate (remove) the calcium and flush the area with a saline solution.
The scan comes first: it shows where the deposit sits, how large it is and what it looks like, which is what determines whether barbotage is likely to help you.
Why is barbotage recommended?
Barbotage is recommended for patients with calcific tendinopathy who have persistent pain and reduced mobility despite other treatments like pain relief medications and physiotherapy. The procedure aims to:
- Reduce pain and inflammation
- Improve shoulder function
- Avoid the need for surgery
Your barbotage is carried out by the same clinician who assessed your shoulder and scanned the deposit, and who then guides your rehabilitation afterwards. Because the procedure is planned as one step in getting the shoulder moving again, what follows it is decided before it is done. See more on ultrasound-guided injections.
What happens during the barbotage procedure?
- You will be positioned comfortably, and the skin over the affected area will be cleaned.
- A local anaesthetic will be injected to numb the area.
- Using ultrasound guidance, a thin needle will be inserted into the tendon to break up and remove the calcium deposit.
- The area will be flushed with saline, and a small amount of steroid medication is injected to reduce inflammation.
- A small dressing will be applied, and you will be monitored for a short period before going home.
What are the benefits of barbotage?
- Minimally invasive, avoiding surgery
- Short recovery time
- Can reduce pain and improve function in appropriately selected patients
What are the risks of barbotage?
As with any procedure, there are some risks, including:
- Mild pain or discomfort at the injection site
- Temporary swelling or bruising
- Infection (rare)
- Incomplete removal of calcium, requiring further treatment
- Temporary worsening of symptoms before improvement
Barbotage recovery time and aftercare
Most patients begin to notice improvement over the following three to four weeks. The shoulder can be uncomfortable for a short period immediately afterwards, so relative rest is advised at first, followed by a gradual return to movement.
- Rest the treated area for 24–48 hours.
- Apply an ice pack if needed to reduce swelling.
- Avoid strenuous activity for 1–2 weeks.
- You may be advised to do specific physiotherapy exercises.
- Pain relief medications like paracetamol or ibuprofen can be taken as needed.
How much does barbotage cost?
The fee covers the medication, the sterile consumables and delivery of the procedure under ultrasound guidance. Current fees are listed on our prices page.
When to seek medical attention
Seek medical advice if you develop increasing pain that does not begin to settle, increasing redness, warmth or swelling around the injection site, discharge from the injection site, fever, or if you feel systemically unwell. Contact Meyer Physio, your GP or NHS 111 for advice. If you become acutely unwell, seek urgent medical attention.
Informed Consent Form
If barbotage has been recommended for you, please read this page carefully and ask us any questions before giving your consent. To proceed with the treatment you must complete the form: Informed Consent Barbotage
Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].
Last reviewed: 10 September 2026.