Open Access Research article

Infraglenoidal scapular notching in reverse total shoulder replacement: a prospective series of 60 cases and systematic review of the literature

Patrick Sadoghi12*, Andreas Leithner2, Patrick Vavken34, Andreas Hölzer1, Josef Hochreiter5, Georg Weber5, Matthias F Pietschmann1 and Peter E Müller1

Author Affiliations

1 Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany

2 Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria

3 Department of Orthopedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston MA 02115, USA

4 Harvard Center for Population and Development Studies, Harvard School of Public Health, Boston, MA 02115, USA

5 Department of Orthopaedic Surgery, Krankenhaus Barmherzige Schwestern Linz, Seilerstätte 4, 4010 Linz, Österreich

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BMC Musculoskeletal Disorders 2011, 12:101  doi:10.1186/1471-2474-12-101

Published: 19 May 2011



The impact of infraglenoidal scapular notching in reversed total shoulder arthroplasty (RTSA) is still controversially discussed. Our goal was to evaluate its potential influence on subjective shoulder stability and clinical outcome. We hypothesized that subjective instability and clinical outcome after implantation of RTSA correlates with objective scapular notching.


Sixty shoulders were assessed preoperatively and at minimum 2-year follow-up for active range of motion and by use of the Oxford instability score, Rowe score for instability, Constant score for pain, Constant shoulder score, DASH score. All shoulders were evaluated on anterior-posterior and axillary lateral radiographic views. These X-ray scans were classified twice by two orthopaedic surgeons with respect to infraglenoidal scapular notching according to the classification of Nerot. Notching was tested for correlation with clinical outcome scores to the evaluated notching.


We found no significant correlation between infraglenoidal scapular notching and clinical outcomes after a mid-term follow-up from 24 to 60 months, but at the final follow-up of 60 months and more, we did see statistically significant, positive correlations between infraglenoidal scapular notching and the Constant pain score as well as active range of motion. At mean follow-up of 42 months (range from 24 to 96 months) we found no significant correlation between subjective instability and infraglenoidal scapular notching.


We conclude that patients' subjective impression on their shoulders' stability is not correlating with radiological signs of infraglenoidal scapular notching. Nevertheless clinical parameters are affected by infraglenoidal scapular notching, at least in the long term

Inverse shoulder prosthesis; notching; instability; clinical outcome