Stener Lesion Workup

  • Author: Joseph Rectenwald, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Aug 19, 2011
 

Imaging Studies

  • Radiographs: AP and lateral views are used to classify the ligamentous injury into 1 of 5 categories (see Introduction, Clinical).
  • Other modalities have been utilized to aid in diagnosing Stener lesions, with varying accuracy. Further research is needed to delineate the accuracy of these techniques, which include the following:
    • Stress radiography
    • MRI
    • Arthrography
    • Ultrasound scanning[11, 12]
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Joseph Rectenwald, MD  Staff Physician, Department of Orthopedic Surgery, Palmetto Richland Memorial Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

John J Walsh IV, MD  Professor and Chairman, Department of Orthopedic Surgery, University of South Carolina School of Medicine

John J Walsh IV, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Specialty Editor Board

A Lee Osterman, MD  Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Yaszemski, MD, PhD  Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint. J Bone Joint Surg Am. Nov 1962;44B(4):869-79.

  2. Campbell CS. Gamekeeper's thumb. J Bone Joint Surg Br. Feb 1955;37-B(1):148-9. [Medline].

  3. Heyman P, Gelberman RH, Duncan K, et al. Injuries of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Biomechanical and prospective clinical studies on the usefulness of valgus stress testing. Clin Orthop Relat Res. Jul 1993;165-71. [Medline].

  4. Louis DS, Huebner JJ, Hankin FM. Rupture and displacement of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Preoperative diagnosis. J Bone Joint Surg Am. Dec 1986;68(9):1320-6. [Medline].

  5. Lohman M, Vasenius J, Kivisaari A, et al. MR imaging in chronic rupture of the ulnar collateral ligament of the thumb. Acta Radiol. Jan 2001;42(1):10-14.

  6. Shinohara T, Horii E, Majima M, Nakao E, Suzuki M, Nakamura R, et al. Sonographic diagnosis of acute injuries of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Clin Ultrasound. Feb 2007;35(2):73-7. [Medline].

  7. Gherissi A, Moussaoui A, Liverneaux P. [Is the diagnosis of Stener's lesion echograph-dependent? About a series of 25 gamekeeper's thumb.]. Chir Main. Sep 29 2008;[Medline].

  8. Heyman P. Injuries to the ulnar collateral ligament of the thumb metacarpophalangeal joint. J Am Acad Orthop Surg. Jul 1997;5(4):224-9. [Medline].

  9. Thirkannad S, Wolff TW. The 'two fleck sign' for an occult Stener lesion. J Hand Surg Eur Vol. Apr 2008;33(2):208-11. [Medline].

  10. Glickel SZ, Malerich M, Pearce SM, et al. Ligament replacement for chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. J Hand Surg [Am]. Sep 1993;18(5):930-41. [Medline].

  11. Rochet S, Gallinet D, Garbuio P, Tropet Y, Obert L. [Rupture of the thumb ulnar collateral ligament of the metacarpophalangeal joint: is it possible to operate according to the position of sesamoides on dynamic Xray]. Chir Main. Aug-Oct 2007;26(4-5):200-5. [Medline].

  12. Ebrahim FS, De Maeseneer M, Jager T, et al. US diagnosis of UCL tears of the thumb and Stener lesions: technique, pattern-based approach, and differential diagnosis. Radiographics. Jul-Aug 2006;26(4):1007-20.

  13. Gerber C, Senn E, Matter P. Skier's thumb. Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb's metacarpophalangeal joint. Am J Sports Med. May-Jun 1981;9(3):171-7. [Medline].

  14. Kozin SH, Bishop AT. Gamekeeper's thumb. Early diagnosis and treatment. Orthop Rev. Oct 1994;23(10):797-804. [Medline].

  15. Neviaser RJ, Wilson JN, Lievano A. Rupture of the ulnar collateral ligament of the thumb (gamekeeper's thumb). Correction by dynamic repair. J Bone Joint Surg Am. Oct 1971;53(7):1357-64. [Medline].

  16. Puhaindran ME, Cheah AE, Yong FC. Re: "Stener lesion" after collateral ligament rupture of the proximal interphalangeal joint of the index finger. J Hand Surg Eur Vol. Oct 2008;33(5):678-9. [Medline].

 
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Displacement of the ulnar collateral ligament by the adductor aponeurosis during hyperabduction of the thumb.
Stress view of ulnar collateral ligament.
Ruptured ulnar collateral ligament.
Completed repair using suture anchors for fixation.
 
 
 
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