Ultrasound-Guided Percutaneous Needle Barbotage and Ultrasonic Tenotomy for Rotator Cuff Calcific Tendinopathy

Rotator cuff calcific tendinopathy (RCCT) is a common source of shoulder pain caused by calcium deposits within the rotator cuff tendons. Ultrasound-guided interventions have emerged as effective, minimally invasive alternatives to surgery for symptomatic cases unresponsive to conservative treatments. This review summarizes two primary techniques: percutaneous needle barbotage and percutaneous ultrasonic tenotomy. In needle barbotage, one or two needles are inserted under ultrasound guidance to inject and aspirate saline, thereby fragmenting and removing the calcific deposit. This method yields rapid pain relief and improved shoulder function, with follow-up imaging often demonstrating near-complete deposit resolution. For particularly hard or recalcitrant deposits, ultrasonic tenotomy uses an oscillating, suction-assisted handpiece to emulsify and aspirate the calcification in a single session. Both procedures are typically performed under local anesthesia in an outpatient setting, offering the benefits of precise targeting, low complication rates, and a swift return to normal activity. Imaging with plain radiographs and ultrasound is integral throughout the process, from diagnosis to post-procedural evaluation. The evidence indicates that these ultrasound-guided techniques not only alleviate pain but also reduce the need for more invasive surgical approaches, supporting their role as first-line interventions in the management of RCCT.