Stener lesion

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

Epidemiology

Stener lesions are estimated to occur in ~50% (range 14-88%) of UCL ruptures ¹⁰.

Pathology

The UCL normally 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 ¹⁰.

Radiographic features

~~evaluation for a Stener lesion requires~~Both MRI orand high-frequency ultrasound
- ~~these~~ are accurate at diagnosing Stener's lesions ¹⁰. These studies are usually performed after a diagnosis of gamekeeper's thumb has been made on a hand radiograph^ref.
- a Stener ~~lesion is~~lesions are proximal retraction of the ligament fibres 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.
- Stener lesions appear as a round, heterogeneous tissue stump proximal to the metacarpal head and adductor aponeurosis; average defect length is 9 mm ¹⁰
- 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
MRI
- ~~abduction stress views are no longer recommended~~disruption of the normal low signal linear UCL with proximal retraction with the adductor aponeurosis appearing as ~~this itself can cause~~ a ~~Stener lesion in an otherwise simple ulnar collateral ligament tear/avulsion~~low signal band underneath ⁷¹⁰
History and etymology

It was first described by the Swedish orthopaedic surgeon Bertil Stener in 1962 ^3,4,10.

-<p><strong>Stener lesions</strong> are seen in the context of a torn <a href="/articles/ulnar-collateral-ligament-of-the-thumb">ulnar collateral ligament (UCL) of the thumb</a>'s metacarpophalangeal (MCP) joint (<a href="/articles/gamekeepers-thumb-2">gamekeeper's thumb</a>). </p><h4>Epidemiology</h4><p>Stener lesions are estimated to occur in ~50% (range 14-88%) of UCL ruptures <sup>10</sup>.</p><h4>Pathology</h4><p>The UCL normally lies deep to the <a href="/articles/adductor-pollicis-muscle">adductor pollicis</a> tendon. A Stener lesion is characterised by slippage of the torn end of the ulnar collateral ligament superficial to the adductor aponeurosis/<a href="/articles/adductor-pollicis-muscle">adductor pollicis muscle</a> 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 <sup>10</sup>.</p><h4>Radiographic features</h4><ul>
~~-<li>~~
~~-<p>evaluation for a Stener lesion requires MRI or high-frequency ultrasound</p>~~
~~-<ul>~~
~~-<li><p>these studies are usually performed after a diagnosis of <a href="/articles/gamekeepers-thumb-2">gamekeeper's thumb</a> has been made on a hand radiograph</p></li>~~
-<li><p>a Stener lesion is proximal retraction of the ligament fibres which looks like a small mass displaced superficial to the adductor aponeurosis; this gives the <a href="/articles/yo-yo-on-a-string-sign-stener-lesion-1">yo-yo on a string</a> appearance both on ultrasound and MRI images <sup>5</sup></p></li>
~~-</ul>~~
~~-</li>~~
+<p><strong>Stener lesions</strong> are seen in the context of a torn <a href="/articles/ulnar-collateral-ligament-of-the-thumb">ulnar collateral ligament (UCL) of the thumb</a>'s metacarpophalangeal (MCP) joint (<a href="/articles/gamekeepers-thumb-2">gamekeeper's thumb</a>). </p><h4>Epidemiology</h4><p>Stener lesions are estimated to occur in ~50% (range 14-88%) of UCL ruptures <sup>10</sup>.</p><h4>Pathology</h4><p>The UCL normally lies deep to the <a href="/articles/adductor-pollicis-muscle">adductor pollicis</a> tendon. A Stener lesion is characterised by slippage of the torn end of the ulnar collateral ligament superficial to the adductor aponeurosis/<a href="/articles/adductor-pollicis-muscle">adductor pollicis muscle</a> 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 <sup>10</sup>.</p><h4>Radiographic features</h4><p>Both MRI and high-frequency ultrasound are accurate at diagnosing Stener's lesions <sup>10</sup>. These studies are usually performed after a diagnosis of <a href="/articles/gamekeepers-thumb-2">gamekeeper's thumb</a> has been made on a hand radiograph <sup>ref</sup>.</p><p>Stener lesions are proximal retraction of the ligament fibres which looks like a small mass displaced superficial to the adductor aponeurosis; this gives the <a href="/articles/yo-yo-on-a-string-sign-stener-lesion-1">yo-yo on a string</a> appearance both on ultrasound and MRI images <sup>5</sup>.</p><h5>Plain radiograph</h5><p>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>.</p><h5>Ultrasound</h5><ul>
+<li><p>Stener lesions appear as a round, heterogeneous tissue stump proximal to the metacarpal head and adductor aponeurosis; average defect length is 9 mm <sup>10</sup></p></li>
~~-<li><p>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></p></li>~~
~~-</ul><h4>History and etymology</h4><p>It was first described by the Swedish orthopaedic surgeon <strong>Bertil Stener</strong> in 1962 <sup>3,4,10</sup>.</p>~~
+</ul><h5>MRI</h5><ul><li><p>disruption of the normal low signal linear UCL with proximal retraction with the adductor aponeurosis appearing as a low signal band underneath <sup>10</sup></p></li></ul><h4>History and etymology</h4><p>It was first described by the Swedish orthopaedic surgeon <strong>Bertil Stener</strong> in 1962 <sup>3,4,10</sup>.</p>

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