Stener lesion

Changed by Daniel Haun, 16 Jan 2019

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Stener lesions are seen in the context of a torn ulnar collateral ligament of the thumb's metacarpophalangeal joint (gamekeeper's thumb).

Pathology

Normally, the ulnar collateral ligament lies deep to the adductor pollicis tendon. A Stener lesion is characterised by slippage of the torn end of the ulnar collateral ligament superficial to the adductor aponeurosis/adductor pollicis muscle such that now there is interposition of the adductor pollicis muscle between the ulnar collateral ligament and the MCP joint. This prevents healing and is an indication for surgical repair.

Radiographic features

evaluation for a Stener lesion requires MRI or high frequency ultrasound
- these studies are usually performed after a diagnosis of gamekeeper's thumb has been made on a hand radiograph
- a Stener lesion is proximal retraction of the ligament fibers which looks like a small mass displaced superficial to the adductor aponeurosis; this gives the yo-yo on a string appearance both on ultrasound and MRI images ⁵
passive flexion of the interphalangeal joint of the thumb during dynamic ultrasound imaging of the ulnar collateral ligament (UCL) allows for identification of a non-displaced UCL tear from a Stener lesion.^8,9
abduction stress views are no longer recommended as this itself can cause a Stener lesion in an otherwise ~~asymptomatic patient~~simple ulnar collateral ligament tear/avulsion.⁷

History and etymology

It was first described by B Stener in 1962 ^3,4.

~~-<li>abduction stress views are no longer recommended as this itself can cause a Stener lesion in an otherwise asymptomatic patient</li>~~
+<li>passive flexion of the interphalangeal joint of the thumb during dynamic ultrasound imaging of the ulnar collateral ligament (UCL) allows for identification of a non-displaced UCL tear from a Stener lesion.<sup>8,9</sup>
+</li>
+<li>abduction stress views are no longer recommended as this itself can cause a Stener lesion in an otherwise simple ulnar collateral ligament tear/avulsion.<sup>7</sup>
+</li>

References changed:

7. Noszian I, Dinkhauser L, Straub G, Orthner E. Ulnar Collateral Ligament Injuries of the Thumb: Dislocation Caused by Stress Radiography in 2 Cases. Acta Orthop Scand. 1995;66(2):156-7. <a href="https://doi.org/10.3109/17453679508995511">doi:10.3109/17453679508995511</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/7740947">Pubmed</a>
8. Melville D, Jacobson J, Haase S, Brandon C, Brigido M, Fessell D. Ultrasound of Displaced Ulnar Collateral Ligament Tears of the Thumb: The Stener Lesion Revisited. Skeletal Radiol. 2013;42(5):667-73. <a href="https://doi.org/10.1007/s00256-012-1519-x">doi:10.1007/s00256-012-1519-x</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23001117">Pubmed</a>
9. Melville D, Jacobson J, Fessell D. Ultrasound of the Thumb Ulnar Collateral Ligament: Technique and Pathology. AJR Am J Roentgenol. 2014;202(2):W168. <a href="https://doi.org/10.2214/AJR.13.11335">doi:10.2214/AJR.13.11335</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/24450699">Pubmed</a>

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Stener lesion

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