- 023-8218-2416
- info@physio-soton.co.uk
- 297 High Street, Eastleigh, SO50 5NB
- Opening hours: Mon - Fri 10:00 - 20:00, Sat 10:00-15:00
Barbotage breaks up and washes out calcium deposits in the rotator cuff under live ultrasound guidance. At Physio Soton in Eastleigh the procedure costs £460, is carried out in the clinic by the same clinician who scans you, and no GP referral is needed.
A barbotage procedure is a minimally invasive treatment for calcific tendonitis of the shoulder. Under local anaesthetic and live ultrasound, a needle is guided into the calcium deposit inside the tendon. Fluid is pushed in and drawn back out repeatedly, which breaks the deposit up and washes the calcium out through the needle.
The procedure is also called needling and lavage, ultrasound guided lavage, or calcific needling. Lavage simply means washing. It is sometimes misspelled barbatage.
A small steroid injection is placed into the bursa above the tendon at the end to settle the inflammation the procedure causes. The same word is used for unrelated procedures in spinal anaesthesia and bladder testing. This page is only about the shoulder treatment.
Calcific tendonitis in the shoulder is a buildup of calcium inside one of the rotator cuff tendons, most often the supraspinatus at the top of the shoulder. It commonly affects people between 30 and 60.
The deposit often sits in the tendon for months or years without causing any pain at all. Trouble usually starts when the body begins to break the calcium down, known as the resorptive phase. That process triggers intense inflammation.
That is why the pain is so distinctive. People commonly describe:
Others have a longer, niggling version. A shoulder that aches after the gym or a round of golf, and slowly gets worse over years.
Calcific tendonitis is confirmed with imaging. The calcium shows clearly as a bright white area on an ultrasound scan and on an X-ray. It can be missed on MRI, which is one reason some people go months without a diagnosis.
Several shoulder conditions cause similar pain, and the main symptom helps tell them apart:
| Condition | Main symptom | Typical pattern |
|---|---|---|
| Calcific tendonitis | Pain | Often sudden and severe, worse at night |
| Frozen shoulder | Stiffness | Gradual loss of movement, even when someone else moves your arm |
| Rotator cuff tear | Weakness | Difficulty lifting the arm, often after a fall or strain |
| Subacromial bursitis | Pain on lifting | Pain in the middle of the lifting arc |
An ultrasound scan of the shoulder shows the deposit, measures it, and shows whether it is hard or soft. That matters for treatment. If your shoulder is stiff rather than painful, our page on frozen shoulder may be more relevant.
Often, yes. Many calcium deposits are eventually reabsorbed by the body, and symptoms can settle without any procedure. The problem is time. The painful resorptive phase can last weeks to months, and some deposits stay put and keep causing trouble for years.
There is no diet, supplement or home remedy proven to dissolve shoulder calcium. What treatment can do is shorten the painful period and help the deposits that are not clearing by themselves.
That is the honest framing for everything below. The question is rarely “will it ever get better?” It is “how long are you prepared to wait, and how much is it affecting your sleep, work and life in the meantime?”
There are five main options for calcific tendonitis treatment, and they are not mutually exclusive. Most people start with the simplest and step up if the pain does not settle.
| Treatment | What it does | Removes calcium? | Price at our clinic |
|---|---|---|---|
| Physiotherapy and exercise | Restores movement and strength | No | Physio assessment £90 |
| Steroid injection | Settles inflammation and pain | No | £250 |
| Shockwave therapy | Pressure waves to stimulate breakdown | Partly, over several sessions | £70 per session |
| Barbotage | Breaks up and washes out the deposit | Yes, directly | £460 |
| Keyhole surgery | Surgical removal of the deposit | Yes | Referral to a surgeon |
A network meta-analysis of randomised trials found that needling combined with a subacromial steroid injection gave significant improvements in pain, function and deposit size. You can read the published analysis on PubMed.
Both work, and they have been compared head to head. In a randomised trial of 82 patients, both groups had similar improvements in pain and function at one year. The needling group saw its deposits shrink by 13mm on average, against 6.7mm with shockwave.
The same trial found the barbotage group needed further treatment, compared with 41 percent of the shockwave group. You can read the trial summary on PubMed.
In practice, the choice often comes down to preference and the deposit itself. Shockwave therapy is non-invasive, costs £70 a session and usually needs three to five sessions. Barbotage is a single procedure that removes calcium directly. We offer both, so the recommendation is based on your scan rather than on what we happen to provide.
The procedure is effective for most suitable patients, but the evidence shows its main benefit is speed rather than a better long-term outcome.
A randomised trial from Leiden University Medical Center compared needling plus steroid injection with steroid injection alone. At one year, the barbotage group had significantly better shoulder function and smaller deposits. You can read the one year results on PubMed.
At five years, however, the same trial found no significant differences between the two groups. Both had improved. In other words, calcific tendonitis tends to get better eventually, and the procedure gets you there faster.
Results are not universal. A 2024 study of 179 procedures found good short-term relief, but a meaningful number of patients needed further treatment. Large or very hard deposits are harder to remove fully.
We tell patients this plainly. If you are sleeping badly, struggling at work or unable to use your arm, getting better in weeks rather than a year or more is a genuine benefit.
It suits people with a confirmed calcium deposit that is causing significant pain, particularly when rest, physiotherapy or a steroid injection have not been enough. The research trials generally included deposits larger than 5mm with symptoms lasting several months.
It may not be the right choice if:
The scan answers most of these questions. If the procedure is unlikely to help, we will say so and suggest what will.
A helpful way to picture the deposit: it often behaves like a sweet with a hard shell and a soft, paste like centre. Once the needle reaches the centre, the paste can be washed out.
You may wish to arrange a lift home, as the shoulder can feel numb or weak for a few hours afterwards.
Most people describe the procedure as uncomfortable rather than very painful. The local anaesthetic numbs the area, so the main sensation is pressure as the needle works on the deposit, rather than sharp pain.
The part most people find hardest comes later, when the anaesthetic wears off. Pain commonly peaks that evening or overnight and eases noticeably over the following two or three days. Have your usual painkillers ready at home before your appointment, and follow the advice given on the day.
Recovery usually follows a clear pattern. The first one to three days are the most painful. Most people then notice a steady improvement over the next one to two weeks, and the original deep pain often settles within that window.
A typical course looks like this:
| Time after the procedure | What is common |
|---|---|
| First evening | Pain peaks as the anaesthetic wears off |
| Days 1 to 3 | Soreness easing, dressing and reaching still awkward |
| First 2 weeks | Relative rest, no heavy lifting, pushing or pulling |
| Weeks 2 to 6 | Gradual return of movement and strength with exercises |
| Around 6 weeks | Most people back to normal activity, including sport |
Some people have a flare of bursitis after the procedure, which can make the shoulder more painful for a few weeks before it improves. It is uncomfortable but usually settles.
How long you need off work depends on your job. Desk-based work is often manageable within a few days. Manual work, lifting or overhead work needs longer, and you will be advised based on your role.
Removing the calcium does not fix the weakness and stiffness that months of pain leave behind. Most people have been protecting the shoulder, and the rotator cuff has lost strength. Rehabilitation rebuilds it.
It also protects against a secondary problem. A shoulder that is kept still for too long after the procedure can stiffen. Gentle, guided movement early on prevents that, followed by strengthening once the pain allows.
Our shoulder physiotherapy team can take you through the programme, or you can follow it at home.
This is considered a low risk procedure, and most side effects are mild and short lived.
Seek medical advice promptly if your pain becomes much worse than before, you develop a fever, or the shoulder becomes hot, red and swollen.
Surgery is usually reserved for deposits that do not respond to other treatments. The keyhole operation, called arthroscopy, removes the calcium directly. Recovery typically involves around a week in a sling, physiotherapy afterwards, and two to three months before full recovery.
Barbotage avoids an operation, a general anaesthetic and a hospital stay, and is done in clinic. For most people, it is worth trying first. If it does not work, surgery remains an option, and we can help arrange a referral.
Barbotage costs £460 at Physio Soton in Eastleigh. An injection consultation costs £60. You will know the full cost before anything is agreed, and if the procedure is not appropriate for you, you will not be charged for it.
Full pricing for every procedure is on our injection prices page. If you have private medical insurance, check your policy, as some insurers cover image-guided procedures. We can provide a report for your insurer.
It is available on the NHS in some areas, usually through a hospital radiology or orthopaedic department after a GP referral. Availability and waiting times vary widely.
Privately, you can book directly with no referral. Many people choose this when the pain is severe and waiting is not realistic.
Your procedure is carried out by Marek Czeladzki MSc, PGCert (Ultrasound), HCPC (PH83097), MCSP, IP. He is a Chartered Physiotherapist, musculoskeletal sonographer and Independent Prescriber, which means the same clinician scans your shoulder, performs the procedure and plans your rehabilitation.
He trained in ultrasound guided injections at the University of Essex and completed advanced cadaveric injection training. He trained in musculoskeletal ultrasound under Professor Saulius Rutkauskas MD PhD of the European Society of Musculoskeletal Radiology. He is a member of the British Medical Ultrasound Society.
For other injection options, see our ultrasound guided injections page.
Physio Soton is at 297 High Street, Eastleigh, SO50 5NB, just off Junction 12 of the M3 with free parking nearby. Patients travel to us for shoulder barbotage from across Hampshire.
We regularly see patients from:
Opening hours are Monday to Friday 10:00 to 20:00 and Saturday 10:00 to 15:00.
The two terms are used for the same shoulder procedure. Lavage means washing the deposit with fluid. The name describes the repeated pushing in and drawing out of fluid that breaks the calcium up.
They are not dangerous, and many people have them without symptoms. They become a problem when they cause pain, which can be severe. They do not spread or damage other parts of the body.
It can, although many people remain pain-free once the deposit has cleared. New deposits can form in the same or the other shoulder, particularly if the underlying tendon is weak.
Acupuncture may ease pain and muscle tension for some people, but there is no good evidence that it removes calcium. It is best seen as a pain relief option alongside other treatment.
It is safer to arrange a lift. Your shoulder may feel numb or weak for a few hours after the local anaesthetic.
Most people notice a clear change within one to two weeks, once the early soreness settles. A follow up scan can show how much of the deposit has cleared.
No. You can book a consultation directly online or by phone.
If calcific tendonitis is wrecking your sleep and nothing is shifting it, barbotage may help you recover in weeks rather than waiting months for the calcium to clear on its own. Start with a scan and an honest assessment of whether it is right for you.
Call 023 8218 2416 or book online. Physio Soton, 297 High Street, Eastleigh, SO50 5NB.
