Six month X-ray letter after my reverse says "grade 1 inferior scapular notching". What does that mean and should I be worried?

Some of you will remember me from the behind the back saga. Reverse on the left, about seven months ago now, and genuinely going well. Overhead is great, I am back on the allotment, the lot.

Had the six month review with an X-ray a couple of weeks back and the surgeon was cheerful, said it all looked good, and I went home happy. Then the clinic letter arrived this morning, copied to my GP, and one line in the X-ray bit says "grade 1 inferior scapular notching, components well fixed." Nobody said the word notching to me in the room. Googled it and now I have read that it is "bone erosion" and can lead to "loosening" and I am sat here at 6pm feeling like the shoulder is being eaten.

Is this a known thing with reverses? Is grade 1 bad? Should I be ringing someone tomorrow or is it one of those lines that means nothing?

Never had that word on any of my letters, either the total or the reverse, so no help there. But "components well fixed" in the same sentence reads to me like the important half. I would not ring in a panic over a letter where the surgeon was cheerful in the room. I would write it down for the next review though.

Derek, I have it. Mine was mentioned at my one year X-ray and it was grade 1 then and still grade 1 at two years. The way it was put to me was that the plastic bit on the arm bone rubs on the edge of the shoulder blade when your arm is down by your side, and it wears a small dip in the bone, and with reverses it is very common. My surgeon called it something to keep an eye on, not something to do anything about. My shoulder has been the same throughout.

The clinic letters are written for the GP, not for us, which is the whole problem. Mine said "mild AC joint arthropathy" once and I thought something new had gone wrong. It had been there for twenty years. Worth asking the surgeon to translate any line you do not understand at the next one.

deltoid_derek said:

one line in the X-ray bit says "grade 1 inferior scapular notching, components well fixed."

Derek, reverse-at-68 has described it accurately, and for what it is worth that combination of words on a report is a reassuring one. I cannot comment on your own films, so this is general.

Scapular notching is a defect worn into the bottom of the scapular neck, just below the baseplate of a reverse replacement. It happens because, with the arm by the side, the rim of the humeral cup can contact the bone there, and repeated contact over months and years wears a notch that shows on X-ray. It is specific to the reverse design and very common: studies report it in anywhere from about 10% to over 90% of reverses, depending on implant design and how long people are followed. It is graded I to IV by how far it extends. Grade I is the smallest, a defect limited to the lower edge of the neck, well short of the screws.

Does it matter? On average, across groups of patients, shoulders with notching score slightly lower and lift a few degrees less, and in some series that difference only appears after around five years. Many people with notching have an excellent shoulder. Surgeons follow it because extensive notching that reaches the screws or the baseplate may, over years, be associated with loosening, which is why the "components well fixed" half of your sentence is the important one. What we watch is the trend: a grade I that is still grade I at the next film is the usual and unremarkable course.

There is nothing you need to do about it. No exercise or restriction reverses it, and the usual advice for a reverse is unchanged. What would justify an earlier review is change in the shoulder rather than a word on a report: new pain in a shoulder that had settled, a loss of lift or strength, or a clunk. Otherwise, keep the routine X-rays and ask at the next one whether it has changed. The site has just published a full explanation in scapular notching after reverse shoulder replacement, and the long-term picture of how these joints last is in how long does a shoulder replacement last.

Thank you. "A word on a report versus a change in the shoulder" is exactly the line I needed. Shoulder unchanged, allotment unchanged, panic cancelled.

Rang the secretary just to be sure I had read it right and the surgeon's reply came back through her: grade 1, expected, he will compare it at the one year film. Writing it on the calendar and leaving it there.