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241 - Ultrasound Guided Barbotage of Right Supraspinatus Calcific Tendinitis: A Case Report

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

SB

Sara Buckley, DO

Resident Physician
Charles Drew University
long, California, United States

Co-Author(s)

EP

Eric Poole, MD

Resident Physician, PGY-2
Charles Drew University of Medicine & Science
Long Beach, California, United States
SH

Sean Hendrix, MD

Physiatry Resident
Charles Drew University
Long Beach, California, United States
RT

Richard Thai, DO

Clinical Assistant Professor
Charles Drew University
Los Angeles, California, United States
CH

Calvin Ho, MD

Associate Program Director
Charles R. Drew University of Medicine and Science
Los angeles, California, United States
AW

Agnes Wallbom, MD

Professor
Charles R. Drew University
Los Angeles, California, United States

Case Diagnosis:

Ultrasound Guided Barbotage of Right Supraspinatus Calcific Tendinitis

Case Description:

A 67-year-old male with a past medical history of right shoulder arthritis and hypothyroidism was referred to pain clinic after failing six weeks of conservative management for right supraspinatus calcific tendinitis. Physical exam revealed normal strength, sensation, and reflexes bilaterally, with positive Empty Can and Hawkin’s sign. MRI of the right shoulder showed hydroxyapatite deposition in the supraspinatus tendon. Ultrasound showed a concordant hyperechoic structure within the right supraspinatus tendon. The patient was treated with ultrasound guided barbotage of the right supraspinatus tendon and subacromial bursa corticosteroid injection. Two weeks post-procedure, the patient reported 100% pain improvement and increased right shoulder range of motion. He has now returned to his favorite hobby of golf and is playing pain-free.

Discussions:

While the etiology calcific tendinitis is unclear, approximately 3-10% of the general population is affected by this condition. Initial treatment for calcific tendinitis includes non-steroidal anti-inflammatory drugs, physical therapy, and subacromial corticosteroid injection. Typically, barbotage is indicated for refractory cases in which conservative treatment fails for greater than 1 year. Recent studies have shown ultrasound barbotage alone provides short-term symptomatic relief, but data regarding long-term efficacy is mixed. Some patients may require additional sessions of barbotage, corticosteroid injections, or ultimately surgery. This specific case highlights the clinical benefits of ultrasound guided barbotage for calcific tendinitis and gives potential considerations for this treatment to be used early on in rehabilitation treatment plan if initial treatment fails.

Conclusions:

Given the strong evidence for short term relief from this treatment, and relatively high safety profile of ultrasound guided procedures, one must consider the utility of including ultrasound guided barbotage in the comprehensive rehabilitation treatment plan for patients with calcific tendinitis. Further research can be done regarding the timing and durability of ultrasound guided barbotage for calcific tendinitis.