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Scapular notching in reverse shoulder arthroplasty

Case contributed by Dr Domenico Nicoletti

Presentation

Incidental finding with normal ROM and without pain.

Patient Data

Age: 70
Gender: Male
X-ray

Post-operative

Normal post-operative control of reverse prosthesis.

X-ray

5 months later

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.

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Case information

rID: 86140
Published: 21st Jan 2021
Last edited: 27th Jan 2021
Inclusion in quiz mode: Included

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