Ultrasound guided barbotage of calcific tendinitis of the rotator cuff

The results of this 5-year follow-up RCT done by De Witte et al. (2017) showed that there are no statistically significant differences in the clinical and radiological midterm outcomes of ultrasound (US)-guided barbotage combined with a corticosteroid injection in the subacromial bursa (SAIC) (5 mL of bupivacaine [5 mg/mL] and 1 mL of Depo-Medrol [40 mg/mL]) compared with an isolated US-guided SAIC in patients with calcific tendinitis of the rotator cuff. There was a statistically significant and clinically relevant improvement in both groups in terms of clinical scores and radiological resorption rates compared with baseline. This is in contrast to the authors previous publication of the 1-year results of this RCT, showing significantly superior results for barbotage compared with a SAIC.
In case of persisting or severe symptoms and no signs of spontaneous resorption, barbotage and a SAIC might both lead to significant improvement in the long term, but based on the author's results, faster improvement can be expected with barbotage, with a lower chance of needing additional treatment during the follow-up period.