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Scapular Notching in Reverse Total Shoulder Arthroplasty

Friedman, Richard Joel, MD, FRCSC; Barcel, David Anthony, MD; Eichinger, Josef Karl, MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: March 15, 2019 - Volume 27 - Issue 6 - p 200–209
doi: 10.5435/JAAOS-D-17-00026
Review Article

Scapular notching is a common radiographic finding occurring after reverse total shoulder arthroplasty, and it refers to an erosive lesion of the inferior scapular neck because of the impingement of the humeral implant during adduction. The clinical importance of notching is unclear, and the optimal treatment of severe notching is unknown. The incidence and severity of scapular notching is related to prosthetic design and surgical technique. Implant design factors include size, shape, and position of the glenosphere, inclination of the humeral neck-shaft angle, implant offset, and native scapular anatomy. Scapular notching may lead to deterioration of functional outcomes and glenoid implant loosening and failure. Lateral offset, inferior glenosphere overhang, and careful consideration of the presurgical glenoid morphology may help prevent scapular notching. Currently, there is limited evidence to direct the management of scapular notching, and further research is needed to elucidate optimal prevention and treatment strategies.

From the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.

Dr. Friedman or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Exactech; serves as a paid consultant to Exactech and Johnson & Johnson; has received research or institutional support from Exactech; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, and the Association of Bone and Joint Surgeons. Dr. Eichinger or an immediate family member, serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Neither Dr. Barcel nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

© 2019 by American Academy of Orthopaedic Surgeons
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