Paper 92: Outcomes of Percutaneous Barbotage for Calcific Tendonitis of the Shoulder
Authors: Goljan Peter , DeBottis Daniel , Grumet Robert , Kruse David , Rivadeneyra Adam , Shields Troy 
Published: July 2022

Objectives:

Calcific tendonitis is a painful shoulder condition that occurs secondary to deposition and resorption of calcium deposits within the tendinous insertions of the rotator cuff musculature. Its prevalence within the population ranges from 2.7 to 20% and it can be a cause of acute and debilitating pain. The treatment for calcific tendinitis is classically self-limited, as the natural history of the disease is for it to resolve with time. Anti-inflammatory medications and steroid use therefore are a common first line treatment option. In certain instances secondary measures such as extracorporeal shock wave therapy and percutaneous barbotage have been utilized when initial therapies have failed, but prior to pursuing surgical intervention Surgical intervention with removal of the calcium deposit and possible rotator cuff repair as needed is utilized only once all prior treatment options have been exhausted. Percutaneous needle barbotage of calcium deposits has been demonstrated to provide pain relief and improved symptoms in patients suffering from calcific tendonitis, but continued research is necessary to determine which patients might benefit most from this procedure as opposed to continued conservative approach. The purpose of our study is to assess the demographics and outcomes of those patients with a diagnosis of shoulder calcific tendonitis who underwent needle barbotage procedure. We evaluated those that had success with the procedure, including if any required surgery for their calcific tendonitis.

Methods:

This study was performed at a single institution. All patients were first seen and evaluated by an orthopedic surgeon fellowship trained in either sports medicine or shoulder and elbow surgery. Once calcific tendonitis was confirmed as the diagnosis and etiology of their symptoms they were referred to a single, family medicine physician with fellowship training in sports medicine. With this physician they underwent needle barbotage procedure of their calcific tendonitis with injection of local anesthetic, aspiration of the calcium deposit, and injection of corticosteroid all under ultrasound guidance. These patients were then retrospectively reviewed for demographic information and procedure details then prospectively contacted to evaluate the current status of their shoulder, as well as, if they ever had to undergo any further or operative treatment of their shoulder for calcific tendonitis.

Results:

Since 2018, twenty-two patients who had undergone needle barbotage for calcific tendonitis were able to be prospectively reached while 19 opted in to the study after informed consent. Of these patients, 14 were female (73%) vs. 5 male (27%), 13 of the 19 (68%) had at least one significant medical comorbidity, an average BMI of 26.3 (range 20-42), and average age was 56.8 years (range 31-76). The follow-up from time to procedure until they were prospectively contacted by phone was avg. 12.6 mo (range 2-30mo). The average Sane score for the affected extremity was 81.05 (range 25-100) vs. the unaffected extremity avg 91.6 (range 60-100) (P=0.054). Of these 19 patients zero went on the have surgical treatment of their calcific tendonitis at the time of follow up, only one patient had a subsequent corticosteroid injection into the affected shoulder.

Conclusions:

Calcific tendonitis remains a severe and idiopathic cause of acute shoulder pain. Though the disease is self-limiting this may take up to 6 months to resolve on its own. Previously, operative management for severe disease after corticosteroid injection failure was a mainstay. In our study cohort all patients were able to avoid surgical intervention by undergoing needle barbotage of the lesion after an average of 1 year follow up. Needle barbotage appears to be an effective way to treat symptomatic calcific tendonitis while allowing patients to avoid surgical debridement.