Stener Lesion
Other Names
- Stener Lesion
Background
- This page refers to the so-called Stener lesion, a complication of UCL of the Thumb Injury
History
- First described by the Swedish orthopedic surgeon Bertil Stener in 1962[1]
Epidemiology
- Estimated to occur in ~50% (range 14-88%) of UCL ruptures[2]
- Occurs in 64% to 87% of all complete UCL ruptures (need citation)
Introduction
General
- Interposition of the adductor pollicis aponeurosis between the ulnar collateral ligament and the MCP joint
- The injury can not heal properly in this position
- Typically considered a surgical problem
Pathoanatomy
- Ulnar Collateral Ligament of the Thumb runs along the ulnar side of the metacarpophalangeal joint
- Adductor Pollicis inserts on the base of the proximal phalanx with the UCL
- However, partly superficial and partly deep to the UCL ligament
- When a stener lesion occurs, the adductor aponeurosis is interposed between the UCL and the joint
- Male > Female [5]
- Sports
- Alpine Skiing
- Football
- Soccer
- Hockey
- Basketball
Differential Diagnosis
Differential Diagnosis Finger And Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Extensor Tendon Injuries of the Hand
- Central Slip Extensor Tendon Injury
- Flexor Tendon Injuries of the Hand
- Boutonniere Deformity
- Swan Neck Deformity
- Jersey Finger
- Mallet Finger
- Trigger Finger
- De Quervains Tenosynovitis
- Volar Plate Avulsion Injury
- Sagittal Band Injury
- Mannerfelt Lesion (FPL Rupture)
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
History
- Primarily a clinical diagnosis
- Patients will report pain at the 1st MCPJ
- Typically worse with abduction or extension
- Swelling, ecchymosis may be present acutely
- Fall on outstretched hand with abducted thumb
Physical Exam: Physical Examination Hand
- Minimal swelling, bruising
- No deformity
- Tenderness at site of UCL injury, typically on the phalanx
- If palpable mass, consider stener lesion
Special Tests
- UCL Stress Test (Thumb): Valgus stress causes pain, laxity (> 15-20° typically considered pathologic)
- Complete tears will lack an endpoint
- Important to compare to unaffected thumb
Evaluation
Radiographs
- Standard Radiographs Hand
- May be normal
- Evaluate for avulsion injury
- May see joint space widening
- Considered dislocated if
- Displaced more than 1 mm
- Malrotated
- Consider stress views
- Controversial, not widely used
- False negative rate as high as 25%[9]
Ultrasound
- Can be helpful to evaluate tear
- May identify stener lesion
- Appear as a round, heterogeneous tissue stump proximal to the metacarpophalangeal joint with non-visualization of UCL fibers
- Can dynamically stress the UCL
- Accuracy
- One study showed 100% accurate when diagnosing a complete UCL rupture[10]
MRI
- Findings for Stener lesion
- Disruption of the normal low signal linear UCL with proximal retraction with the adductor aponeurosis appearing as a low signal band underneath
- Chronic cases: carring may prevent the differentiating non-Stener UCL ruptures from Stener lesions
- Diagnostic accuracy[11]
- Sensitivity 96-100%
- Specificity 95-100%
Classification
- Not applicable
Management
Nonoperative
- Generally considered a surgical problem
- Nonoperative management can be considered in patients who are poor surgical candidates
Operative
- Indications
- Most patients
- Technique
- Open reduction, internal fixation
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Prognosis and Complications
Prognosis
- Needs to be updated
Complications
- Needs to be updated
See Also
Internal
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ Stener B. Displacement of the Ruptured Ulnar Collateral Ligament of the Metacarpo-Phalangeal Joint of the Thumb. The Journal of Bone and Joint Surgery British Volume. 1962;44-B(4):869-79. doi:10.1302/0301-620x.44b4.869
- ↑ Lark M, Maroukis B, Chung K. The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria. Hand (N Y). 2017;12(3):283-9. doi:10.1177/1558944716661999 - Pubmed
- ↑ McKeon, Kathleen E., Richard H. Gelberman, and Ryan P. Calfee. "Ulnar collateral ligament injuries of the thumb: phalangeal translation during valgus stress in human cadavera." JBJS 95.10 (2013): 881-887.
- ↑ Case courtesy of Frank Gaillard, Radiopaedia.org, rID: 7641
- ↑ Chuter GS, Muwanga CL, Irwin LR. Ulnar collateral ligament injuries of the thumb: 10 years of surgical experience. Injury. 2009 Jun;40(6):652-6
- ↑ Leggit JC et al. Acute finger injuries: Part II. Fractures, dislocations, and thumb injuries. Am Fam Physician. 2006;73(5):827-834
- ↑ Case courtesy of Henry Knipe, Radiopaedia.org, rID: 45734
- ↑ Case courtesy of Andrew Dixon, Radiopaedia.org, rID: 33700
- ↑ Harper, Michael T., et al. "Gamekeeper thumb: diagnosis of ulnar collateral ligament injury using magnetic resonance imaging, magnetic resonance arthrography and stress radiography." Journal of Magnetic Resonance Imaging 6.2 (1996): 322-328.
- ↑ Melville, David, et al. "Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited." Skeletal radiology 42 (2013): 667-673.
- ↑ Plancher, Kevin D., et al. "Role of MR imaging in the management of" skier's thumb" injuries." Magnetic resonance imaging clinics of North America 7.1 (1999): 73-84.
Created by:
John Kiel on 25 August 2019 12:32:49
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Last edited:
2 November 2024 15:31:09
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