IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Scapular notching in reverse shoulder arthroplasty

Case contributed by Domenico Nicoletti
Diagnosis certain

Presentation

Incidental finding with normal ROM and without pain.

Patient Data

Age: 70 years
Gender: Male

Post-operative

x-ray

Normal post-operative control of reverse prosthesis.

5 months later

x-ray

After five months evidence of scapular notching along the posteroinferior scapular neck, Grade 1 of Nerot-Sirveaux grading system for postoperative scapular notching after reverse total shoulder arthroplasty. Bony erosion of the inferior scapular pillar is evident to the level of the inferior stabilization screw of the glenosphere.

Scapular notching along the posteroinferior scapular neck marked by the yellow line. 

Case Discussion

Scapular notching after reverse shoulder arthroplasty is the erosion of bone of the scapular neck due to mechanical abutment of the humeral implant with adduction of the upper extremity. Repetitive mechanical contact between the polyethylene cup of the humeral component and the inferior scapular neck, wear of the polyethylene may compound a notch leading to chronic inflammation of the joint capsule, local osteolysis, and the prosthesis loosening. Scapular notching tends to first appear in the early postoperative period, between 6 weeks and 14 months postoperatively.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.