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Stener lesion

A Stener lesion is 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
    • on ultrasound a stener lesion may be seen as a retracted proximal lobulated nodule 5
  • abduction stress views are no longer recommended as this itself can cause a Stener lesion in an otherwise asymptomatic patient

History and etymology

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

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