Evaluating Scapular Notching after Reverse Total Shoulder Arthroplasty

Abstract

Background: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. Methods: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. Results: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. Conclusions: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck. (Clin Shoulder Elbow 2015;18(4):248-253)

Deltoid muscle volume affects clinical outcome of reverse total shoulder arthroplasty in patients with cuff tear arthropathy or irreparable cuff tears

“…Age [12], obesity [13], status of the remained rotator cuff muscle [14,15], scapular notching [16,17], and lengthening of the lever arm[18] have been considered essential factors for clinical consequences subsequent to RTSA.…”

Complications of Reverse Shoulder Arthroplasty: A Concise Review

“…The clinical course of scapular notching is debated [ 60 ]. Many studies have reported that patients without scapular notching showed better range of motion and functional outcomes than patients with scapular notching [ 57 , 60 ].…”

“…The clinical course of scapular notching is debated [ 60 ]. Many studies have reported that patients without scapular notching showed better range of motion and functional outcomes than patients with scapular notching [ 57 , 60 ]. Mollon et al [ 58 ] observed scapular notching with a single implant (medial glenoid/lateral humerus design) in 10% of 476 cases and found that patients with scapular notching showed poor functional scores, low degree of shoulder elevation, and reduced muscle strength [ 58 ].…”

SPECT/CT for Early Detection of Stress Reactions After Reverse Shoulder Arthroplasty

“…On the AP (A), glenohumeral AP (B), and axillary lateral (C) views of x-rays performed 3-year after the surgery, scapular notching (arrow) is observed in the inferior and posterior aspects of the scapular neck. [1][2][3][4][5] On the axial (D), coronal (E), and 3D reconstruction (F) CT images performed 2 months after the surgery, it is evident that the lower 3 screws used for baseplate fixation are positioned closely within the narrow scapular vault, protruding through the far cortex (arrowhead). Such screw placement and scapular notching can potentially serve as stress risers.…”

“…Although she initially experienced significant pain relief and had a favorable outcome for 2 years, she gradually complained of increasing pain from the third year onward. On the AP ( A ), glenohumeral AP ( B ), and axillary lateral ( C ) views of x-rays performed 3-year after the surgery, scapular notching (arrow) is observed in the inferior and posterior aspects of the scapular neck 1–5 . On the axial ( D ), coronal ( E ), and 3D reconstruction ( F ) CT images performed 2 months after the surgery, it is evident that the lower 3 screws used for baseplate fixation are positioned closely within the narrow scapular vault, protruding through the far cortex (arrowhead).…”