Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients.

PURPOSE: A systematic review was performed to assess the outcomes and complications of ultrasound-guided barbotage (repeated injection and aspiration) for calcific tendonitis of the shoulder.

METHODS: A literature search of the Medline, Embase, and Cochrane databases using all relevant keywords found 1,454 original articles. After removal of duplicates and application of inclusion criteria, 13 original articles were selected for review. Articles that used fluoroscopic guidance rather than ultrasound guidance were excluded from the review. All studies analyzed except 1 were case series, with no comparative studies being available.

RESULTS: Thirteen articles with a total of 908 patients were analyzed. In all articles reviewed, the authors reported a good clinical outcome, with many achieving marked improvement in clinical scores or overall satisfaction with the treatment.

CONCLUSIONS: Ultrasound-guided barbotage is a safe technique, with a high success rate and low complication rate. There is no evidence assessing its effectiveness compared with other major treatment modalities; a randomized trial comparing ultrasound-guided barbotage, extracorporeal shock wave therapy, and arthroscopic calcific deposit excision would be of great value. However, while awaiting such a trial, on the basis of the results of this systematic review, we can recommend ultrasound-guided barbotage.

LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.