Stener Lesion Clinical Presentation

Updated: Aug 22, 2019
  • Author: Joseph P Rectenwald, MD; Chief Editor: Harris Gellman, MD  more...
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Presentation

History

A patient with an acute injury to the ulnar collateral ligament (UCL) presents with a painful, swollen, ecchymotic thumb metacarpophalangeal (MCP) joint. The physician must differentiate between an incomplete rupture or sprain and a complete rupture of the UCL. If a complete rupture is suspected, the physician must differentiate between a complete rupture with adductor aponeurosis interposition (Stener lesion) and a complete rupture with anatomic or near-anatomic positioning of the severed end of the UCL.

Next:

Physical Examination

Before the stress-testing part of the physical examination, plain anteroposterior (AP) and lateral radiographs are obtained. Valgus stress testing prior to radiographic evaluation may be contraindicated in the case of a nondisplaced ligamentous or avulsed bone fragment. [5] Such a maneuver theoretically could turn a nondisplaced disruption into a displaced Stener-type lesion.

A protocol and classification system developed by Louis et al in 1986 [6] provides a systematic method of evaluation for the acute UCL injury. In this system, radiographs are used to classify the ligamentous injury into one of the following five categories:

  • Type I (nondisplaced avulsion injury)
  • Type II (displaced fracture of the ulnar aspect of the base of the proximal phalanx)
  • Type III (ligament strain)
  • Type IV (complete UCL tear)
  • Type V (avulsion of the volar plate, with no UCL injury)

If no fracture fragment is seen on initial radiographs, assessment of MCP stability to passive radial deviation is attempted. The MCP joint should be in a flexed position for testing, with the examiner firmly grasping the metacarpal head with one hand and passively applying a radial force to the proximal phalanx with the other hand (see the image below). If pain precludes examination, a local anesthetic may be used.

Stress view of ulnar collateral ligament. Stress view of ulnar collateral ligament.

If resistance is felt as the thumb is radially deviated less than 35°, the patient most likely has a type III ligament injury. In a type IV injury, the thumb deviates radially more than 35° as it is stressed. A type IV injury should be treated surgically, in that it may reflect the presence of a Stener-type lesion. A type V injury easily may be mistaken for a type II injury when it is associated with an avulsion fracture. A type V injury is stable in flexion and is treated with a thumb spica splint or cast for 4 weeks

Palpation of a lump (the distal end of the ruptured UCL) on the ulnar aspect of the thumb MCP joint is strongly suggestive of a Stener lesion; however, the absence of a mass does not exclude a Stener lesion.

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