Barbotage in the Ring: Ultrasound-Guided Treatment for Elbow Calcific Tendonitis in a Jiu Jitsu Athlete

Case Diagnosis: Triceps Calcific Tendinitis treated with Ultrasound-Guided Needle Barbotage

Case Description or Program Description: 36-year-old male presented with right posterior elbow pain after one month of jiu-jitsu. Examination showed tenderness worsened by resisted extension and flexion at end range, with right elbow flexion ⅘ on manual testing. Conservative treatments, including non-steroidal anti-inflammatory medication and activity modification failed to provide relief and negatively impacted his quality of life and ability to perform jiu-jitsu. X-rays revealed olecranon spurs with triceps tendinous calcifications. Focused real-time ultrasound imaging of the right posterior elbow revealed tendinous calcification, scar tissue, and tendinosis of common extensor tendon.

Setting: Private practice clinic

Assessment/Results: Patient was diagnosed with common extensor calcific tendinitis. Patient then elected for ultrasound guided needle barbotage. After 2 weeks, he reported 97% improved pain relief, full range of motion, and functional recovery. Patient continued rehabilitation after needle tenotomy to improve tendon strength with isometrics, then isotonics, and finally eccentrics. At 4 weeks , he was able to return to jiu-jitsu without pain.

Discussion (relevance): Calcific tendinitis is most commonly diagnosed in the shoulder, particularly in the rotator cuff, and less frequently in the elbow. Both conditions present with pain, limited range of motion, and functional impairment. While ultrasound-guided barbotage has demonstrated excellent results for shoulder calcific tendinitis, its use in the elbow is less well-documented. This case highlights the promising potential of ultrasound-guided barbotage as an effective, minimally invasive treatment for elbow calcific tendinitis, offering significant pain relief and improved function.

Conclusions: Ultrasound-guided barbotage is a promising, minimally invasive treatment for calcific tendinitis. This case highlights the use of real time image guided needle tenotomy in the application of calcium barbotage has potential in effectively treating persistent or refractory elbow pain. Further studies are needed to confirm its broader applicability and establish it as a viable alternative to more invasive treatments.