Wednesday, January 25, 2017

Scapular notching, it's not about the scapula!

Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders

These authors reviewed 476 shoulders at a minimum of 2 years after reverse total shoulder arthroplasty.

Scapular notching was observed in 10.1% (48 of 476) of rTSAs and was associated with a longer clinical follow-up, lower body weight, lower body mass index, and when the operative side was the non-dominant extremity. 

Patients with scapular notching had significantly lower postoperative scores on the Shoulder Pain and Disability Index, Constant, Simple Shoulder Test, and University of California, Los Angeles, Shoulder Rating Scale compared with patients without scapular notching. 

Patients with scapular notching also had significantly lower active abduction and significantly less strength

Patients with scapular notching had a significantly higher complication rate.

Comment: This is a welcome study, because scapular notching after a reverse total shoulder has often been written of has having 'no clinical consequence'.

The concern is not so much about the loss of bone at the scapular neck

but rather the concern is what's causing the bone erosion.

In most cases, scapular notching is caused by unwanted contact between the polyethylene of the humeral cup and the bone of the scapula. While the effect on the scapular bone is evident on radiographs, the effect on the humeral polyethylene is only seen at the time of revision surgery.

Particles of polyethylene wear are known to cause inflammation, pain, stiffness and loosening.

A number of strategies can be used to avoid unwanted contract between the humeral polyethylene cup and the scapula. One is to use a glenoid component with lateral offset as shown on the right below.

Our technique reverse total shoulder arthroplasty is shown here:  Reverse total shoulder technique


To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'