Scapular Notching in Reverse Total Shoulder Arthroplasty

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.