Determining the efficacy of barbotage for pain relief in calcific tendinitis

Abstract

Background: Rotator cuff calcific tendinitis is a common cause of shoulder discomfort. Ultrasound-guided barbotage consists of needle aspiration and a subsequent lavage of calcium deposits in the shoulder. While barbotage has proven benefit, other options have also shown similar symptom improvement. This study aims to examine pain outcomes of patients following barbotage of calcific tendinitis. We hypothesize that barbotage will improve shoulder pain scores compared to preprocedure scores.

Methods: This is a retrospective chart review of 179 ultrasound-guided barbotage interventions for calcific tendinitis of the rotator at a New England urban medical center. Patient pain scores were analyzed using a Friedman's analysis of variance at a significance level of α = 0.05, and statistical significance between groups was elucidated using nonparametric post-hoc tests of significance between groups.

Results: Pain scores at preprocedure, 2-month, 6-month, and 12-month follow-ups yielded significant differences. Post-hoc nonparametric analysis revealed pain scores at 2 months were significantly lower than preprocedure and at 6 months. Additionally, 47.5% of cases in this study went on to require a secondary procedure of the respective shoulder after their barbotage treatment.

Conclusion: Upon analysis, utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation. Additionally, a large portion of patients required further interventions of their shoulder, including corticosteroid injections, more barbotage, or surgery, raising further concerns over its long-term benefit.

Keywords: Aspiration and lavage; Barbotage; Calcific tendinitis; Corticosteroids; Pain management; Patient-reported outcomes.

Figure 1

The percentage of barbotage patients who went on to undergo further treatment modalities for their calcific tendinitis. Total amount of cases that required further treatment to create these percentages included 26 cases involved subsequent barbotage treatment, 50 cases required corticosteroid, and 29 required surgery. The total number of cases that required any form of subsequent treatment modality was 85 of the 179 cases included in this study.

Figure 2

Mean pain scores at various intervals prior to and following barbotage. Of note using Friedman's analysis of variance with post-hoc analysis, pain scores at 2-month follow-up (0-10, with 10 being most severe pain) were found to be significantly lower than pain scores prebarbotage and at 6-month follow-up (follow-up shortened to F/U). A comparison between 2-month follow-up and 12-month follow-up was found to not be statistically significant when incorporating a Bonferroni correction. Overall, pain scores at evaluations further from the date of barbotage (at 6 months and 12 months) appear to be more similar to those at initial evaluation. The pain scores displayed omitted pain scores obtained following a secondary procedure.

Figure 3

Mean pain scores with and without pain score omissions. Scores collected following a secondary procedure (including corticosteroid injection, subsequent barbotage, or surgery) of the ipsilateral shoulder were omitted in the omission groups (due to concern of confounding). These are presented in grey. Means without omissions are present in black. Paired student’s t-test showed no significant differences between the means of omitted vs. not omitted at each time point (2-month, 6-month, and 12-month follow-up). F/U is used as an abbreviation for “follow-up” in the display, and pain score refers to a 0-10 scale with 10 being the most severe pain.