Stener Lesion Workup

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

Imaging Studies

Radiography

Anteroposterior (AP) and lateral radiographs are used to classify the ligamentous injury into one of five types in accordance with the schema developed by Louis et al (see Presentation).

Other imaging modalities

Other methods of diagnosis, such as stress radiography, magnetic resonance imaging (MRI), [8] arthrography, and ultrasonography (US), [9] also have been used to aid in diagnosing Stener lesions, with varying accuracy. Further research is needed to delineate the accuracy of these modalities. [10, 11, 12, 13, 14, 15, 16]

Melville et al, in a retrospective study aimed at characterizing the  appearance of surgery-proven displaced UCL tears on US, determined that two US findings—the absence of UCL fibers and the presence of a heterogeneous masslike abnormality proximal to the first MCP joint—were 100% accurate in differentiating displaced from nondisplaced full-thickness tears of the thumb UCL. [17]

The so-called tadpole sign on US has been described as representing a Stener lesion. [18]

Milner et al used extremity MRI to assess UCL injury and measure the degree of ligament displacement, which they then correlated with clinical outcome; planned surgical intervention was reserved for patients with a Stener lesion. [19] They were able to generate a four-stage treatment-oriented classification of these injuries, as follows:

  • Type 1 (partial and minimally displaced UCL tears (type 1) - Typically healed with immobilization alone
  • Type 2 (tears displaced < 3 mm) - Typically healed by immobilization alone
  • Type 3 (tears displaced >3 mm) - Failed immobilization and required surgery in 90% of cases
  • Type 4 (Stener lesion) - Failed immobilization and required surgery in all cases