Scapular notching

Last revised by Arlene Campos on 11 Mar 2024

Scapular notching is a radiologic finding post reverse total shoulder arthroplasty that correlates to erosion of the scapular neck.

The erosion occurs due to the repetitive contact between the polyethylene of the humeral component and the inferior scapular neck during adduction and progressive loosening of the glenosphere.

Scapular notching after reverse total shoulder arthroplasty is a common finding, occurring in ~70% of cases (44-96%) 2,3.

The clinical significance of scapular notching is debatable. Patients may present with no impact to their range of motion or pain 4. While some studies note a correlation between notching and a decreased range of motion and inferior shoulder strength 5.

Scapular notches are associated with elevated baseplate position 7. The scapular notching usually appears between 6 weeks and 14 months after surgery.

The reduction of the peg glenoid rim distance (PGRD) or the distance between the central peg and the inferior border of the glenoid (target position 12 mm above the inferior border of the glenoid), reduces the impingement and therefore scapular notching 7.

The sphere bone overhang distance (SBOD) is the distance from a line at the inferolateral edge of the glenoid drawn parallel to the peg, to a parallel line at the most inferior glenosphere border. When the glenosphere translates inferiorly in relation to the scapular neck, the sphere bone overhang distance becomes more positive (increases sphere bone overhang distance) and the scapular notching decreases.

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