Scapular Notching in Reverse Shoulder Arthroplasty

  • Giulia NicolaciEmail author
  • Andrea Pautasso
  • Michel Calò
  • Filippo Castoldi


The complication rate associated with reverse shoulder arthroplasty has been decreasing since its introduction but still remains significant and includes scapular notching. It is actually considered one of the most frequent complications after reverse total shoulder arthroplasty. Scapular notching has been defined as the glenoid neck erosion resulting from the repeated contact of the humeral stem with the inferior scapular neck during the adduction of the arm and also as the effect of a rotational friction during internal and external rotation. The clinical consequences of scapular notching still appear controversial: for some authors, the radiographic image does not have any significant clinical effect; for others, it is related to reduced strength, reduced range of motion, implant loosening, and possible joint instability.

Some risk factors have been described in literature such as an E2 glenoid morphology (Favard’s classification), a shorter scapular neck, a higher grade of infraspinatus muscle atrophy, or an eccentric osteoarthritis with cuff tear arthropathy which has been related to a higher risk of scapular notching. Finally, the anterolateral approach also has been demonstrated to lead to a higher risk of notching.

In this chapter, we review the literature and deliver our personal experience for technical procedures used in order to avoid scapular notching. Biomechanical analysis has demonstrated that both humeral neck-shaft angle and glenosphere placement play the most important role in the reduction of scapular notching incidence and the increase of the range of motion in adduction.


Scapular notching RSA Complications 


  1. 1.
    Sirveaux F, Favard L, Oudet D, et al. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff—results of a multicentre study of 80 shoulders. J Bone Joint Surg. 2004;86-B:388–95.CrossRefGoogle Scholar
  2. 2.
    Nicholson GP, Strauss EJ, Sherman SL. Scapular notching recognition and strategies to minimize clinical impact. Clin Orthop Relat Res. 2011;469:2521–30.CrossRefGoogle Scholar
  3. 3.
    Li X, Dines J, Warren R, et al. Inferior glenosphere placement reduces scapular notching in Reverse Total Shoulder Arthroplasty. Orthopedics. 2015;38(2):e88–93.CrossRefGoogle Scholar
  4. 4.
    Ladermann A, Gueorguiev B, Charbonnier C, et al. Scapular notching on kinematic simulated range of motion after Reverse Shoulder Arthroplasty is not the result of impingement in adduction. Medicine. 2015;94(38):e1615.CrossRefGoogle Scholar
  5. 5.
    Nyffeler RW, Werner CML, Simmen BR, et al. Analysis of a retrieved Delta III total shoulder prosthesis. J Bone Joint Surg. 2004;86-B:1187–91.CrossRefGoogle Scholar
  6. 6.
    Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–86.PubMedGoogle Scholar
  7. 7.
    Simovitch RW, Zumstein MA, Lohri E, et al. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588–600.CrossRefGoogle Scholar
  8. 8.
    Mollon B, Mahure SA, Roche CP, Zuckermann JD. Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders. J Shoulder Elb Surg. 2007;26:1253–61.CrossRefGoogle Scholar
  9. 9.
    Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics. 2002;25(2):129–33.PubMedGoogle Scholar
  10. 10.
    Boileau P, Gonzalez JF, Chuinard C, et al. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elb Surg. 2009;18(4):600–6.CrossRefGoogle Scholar
  11. 11.
    Levigne C, Garret J, Boileau P, et al. Scapular notching in reverse shoulder arthroplasty:is it important to avoid it and how? Clin Orthop Relat Res. 2011;469:2512–20.CrossRefGoogle Scholar
  12. 12.
    Delloye C, Joris D, Colette A, et al. Mechanical complications of total shoulder inverted prosthesis. Rev Chir Orthop Reparatrice Appar Mot. 2002;88(4):410–4.PubMedGoogle Scholar
  13. 13.
    Levigne C, Boileau P, Favard L, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2008;17:925–35.CrossRefGoogle Scholar
  14. 14.
    Grassi FA, Murena L, Valli F, Alberio R. Six-year experience with the Delta III reverse shoulder prosthesis. J Orthop Surg. 2009;17(2):151–6.CrossRefGoogle Scholar
  15. 15.
    Taliaferro JP, Crosby LA. Scapular notching in reverse total shoulder arthroplasty: now what? Semin Arthroplast. 2014;25:44–7.CrossRefGoogle Scholar
  16. 16.
    Paisley KC, Kraeutler MJ, Lazarus MD, et al. Relationship of scapular neck length to scapular notching after reverse total shoulder arthroplasty by use of plain radiographs. J Shoulder Elb Surg. 2014;23:882–7.CrossRefGoogle Scholar
  17. 17.
    Nyffeler RW, Werner CML, Gerber C. Biomechanical relevance of glenoid component positioning in the reverse Delta III total shoulder prosthesis. J Shoulder Elb Surg. 2005;14:524–8.CrossRefGoogle Scholar
  18. 18.
    Kelly JD, Humphrey CS, Norris TR. Optimizing glenosphere position and fixation in reverse shoulder arthroplasty, Part One: The twelve-mm rule. J Shoulder Elb Surg. 2008;17:589–94.CrossRefGoogle Scholar
  19. 19.
    Humphrey CS, Kelly JD, Norris TR. Optimizing glenosphere position and fixation in reverse shoulder arthroplasty, Part Two: The three-column concept. J Shoulder Elb Surg. 2008;17(4):595–601.CrossRefGoogle Scholar
  20. 20.
    Gutierrez S, Walker M, Willis M, et al. Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty. J Shoulder Elb Surg. 2011;20:732–9.CrossRefGoogle Scholar
  21. 21.
    Huri G, Familiari F, Salari N, et al. Prosthetic design of reverse shoulder arthroplasty contributes to scapular notching and instability. World J Orthop. 2016;7(11):738–45.CrossRefGoogle Scholar
  22. 22.
    Kempton LB, Balasubramaniam M, Ankerson E, Wiater JM. A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2011;20:968–74.CrossRefGoogle Scholar
  23. 23.
    Edwards TB, Trappey GJ, Riley C, et al. Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study. J Shoulder Elb Surg. 2012;21:641–6.CrossRefGoogle Scholar
  24. 24.
    Berliner JL, Regalado-Magdos A, Ma CB, Feeley BT. Biomechanics of reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2015;24:150–60.CrossRefGoogle Scholar
  25. 25.
    Chae SW, Leeb J, Hanc SH, Kimd SY. Inferior tilt fixation of the glenoid component in reverse total shoulder arthroplasty: a biomechanical study. Orthop Traumatol Surg Res. 2015;101:421–5.CrossRefGoogle Scholar
  26. 26.
    Ackland DC, Patel M, Knox D. Prosthesis design and placement in reversetotal shoulder arthroplasty. J Orthop Surg Res. 2015;10:101.CrossRefGoogle Scholar
  27. 27.
    Frankle M, Siegal S, Pupello D, et al. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87(8):1697–705.PubMedGoogle Scholar
  28. 28.
    Cuff D, Pupello D, Virani N, et al. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am. 2008;90(6):1244–51.CrossRefGoogle Scholar
  29. 29.
    Lawrence C, Williams GR, Namdari S. Influence of glenosphere design on outcomes and complications of reverse arthroplasty: a systematic review. Clin Orthop Surg. 2016;8:288–97.CrossRefGoogle Scholar
  30. 30.
    Boileau P, Moineau G, Roussanne Y, O’Shea K. Bony increased-offset reversed shoulder arthroplasty minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011;469:2558–67.CrossRefGoogle Scholar
  31. 31.
    Ladermann A, Denard PJ, Boileau P, et al. Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty. Int Orthop. 2015;39:2205–13.CrossRefGoogle Scholar
  32. 32.
    Kowalsky MS, Galatz LM, Shia DS, et al. The relationship between scapular notching and reverse shoulder arthroplasty prosthesis design. J Shoulder Elb Surg. 2012;21:1430–41.CrossRefGoogle Scholar
  33. 33.
    Gutierrez S, Comiskey CA, Luo Z, et al. Range of impingement-free abduction and adduction deficit after Reverse Shoulder Arthroplasty : hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am. 2008;90:2606–15.CrossRefGoogle Scholar
  34. 34.
    Erickson BJ, Frank RM, Harris JD, et al. The influence of humeral head inclination in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2015;24(6):988–93.CrossRefGoogle Scholar
  35. 35.
    Gutierrez S, Keller TS, Levy JC, et al. Hierarchy of stability factors in reverse shoulder arthroplasty. Clin Orthop Relat Res. 2008;466:670–6.CrossRefGoogle Scholar
  36. 36.
    Virani NA, Cabezas A, Gutierrez S, et al. Reverse shoulder arthroplasty components and surgical techniques that restore glenohumeral motion. J Shoulder Elb Surg. 2013;22:179–87.CrossRefGoogle Scholar
  37. 37.
    Samitier G, Alentorn-Geli E, Torrens C, Wright TW. Reverse shoulder arthroplasty. Part 1: Systematic review of clinical and functional outcomes. Int J Shoulder Surg. 2015;9(1):24–31.CrossRefGoogle Scholar
  38. 38.
    Samitier G, Alentorn-Geli E, Torrens C, Wright TW. Reverse shoulder arthroplasty. Part 2: Systematic review of reoperations, revisions, problems, and complications. Int J Shoulder Surg. 2015;9(2):60–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giulia Nicolaci
    • 1
    Email author
  • Andrea Pautasso
    • 1
  • Michel Calò
    • 1
  • Filippo Castoldi
    • 1
  1. 1.Orthopaedics and Traumatology UnitSan Luigi Gonzaga HospitalOrbassanoItaly

Personalised recommendations