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Stener lesion

Last revised by Sonam Vadera on 3 Aug 2024

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Vadera S, Elfeky M, et al. Stener lesion. Reference article, Radiopaedia.org (Accessed on 06 Oct 2024) https://radiopaedia.org/articles/7614

DOI:

Permalink:

https://radiopaedia.org/articles/7614

rID:

7614

Article created:

12 Nov 2009, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

3 Aug 2024, Sonam Vadera ◉

Disclosures:

At the time the article was last revised Sonam Vadera had no financial relationships to ineligible companies to disclose.

View Sonam Vadera's current disclosures

Revisions:

34 times, by 22 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Tags:

thumb, lesion

Synonyms:

Stener's lesion
Stener lesions

Stener lesions are seen in the context of a torn ulnar collateral ligament (UCL) of the thumb's metacarpophalangeal (MCP) joint (gamekeeper's thumb) resulting in an interposition of the adductor pollicis aponeurosis between the ulnar collateral ligament and the MCP joint.

The UCL normally lies deep to the adductor pollicis tendon. A Stener lesion is characterized 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

Both MRI and high-frequency ultrasound are accurate at diagnosing Stener lesions ¹⁰. These studies are usually performed after a diagnosis of gamekeeper's thumb has been made on a hand radiograph ^ref.

Stener lesions are 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 ⁵.

Plain radiograph

Abduction stress views can cause a Stener lesion in an otherwise simple ulnar collateral ligament tear/avulsion ⁷ although this view is not shared by all authors ¹².

Ultrasound

Stener lesions appear as a round, heterogeneous tissue stump proximal to the metacarpophalangeal joint with non-visulation of UCL fibers ^10,12
passive flexion of the interphalangeal joint of the thumb during dynamic ultrasound imaging of the UCL allows for identification of a non-displaced UCL tear from a Stener lesion ^8,9

MRI

disruption of the normal low signal linear UCL with proximal retraction with the adductor aponeurosis appearing as a low signal band underneath ¹⁰
with chronic cases, scarring may prevent the differentiating non-Stener UCL ruptures from Stener lesions ¹²

History and etymology

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

Quiz questions

References

1. O'Callaghan B, Kohut G, Hoogewoud H. Gamekeeper Thumb: Identification of the Stener Lesion with US. Radiology. 1994;192(2):477-80. doi:10.1148/radiology.192.2.8029418 - Pubmed
2. Hinke D, Erickson S, Chamoy L, Timins M. Ulnar Collateral Ligament of the Thumb: MR Findings in Cadavers, Volunteers, and Patients with Ligamentous Injury (Gamekeeper's Thumb). AJR Am J Roentgenol. 1994;163(6):1431-4. doi:10.2214/ajr.163.6.7992741 - Pubmed
3. Lee P, Hunter T, Taljanovic M. Musculoskeletal Colloquialisms: How Did We Come Up with These Names? Radiographics. 2004;24(4):1009-27. doi:10.1148/rg.244045015 - Pubmed
4. 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
5. Ebrahim F, De Maeseneer M, Jager T, Marcelis S, Jamadar D, Jacobson J. US Diagnosis of UCL Tears of the Thumb and Stener Lesions: Technique, Pattern-Based Approach, and Differential Diagnosis. Radiographics. 2006;26(4):1007-20. doi:10.1148/rg.264055117 - Pubmed
6. Kundu N, Asfaw S, Polster J, Lohman R. The Stener Lesion. Eplasty. 2012;12:ic11. PMC3406613 - Pubmed
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. doi:10.3109/17453679508995511 - Pubmed
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. doi:10.1007/s00256-012-1519-x - Pubmed
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. doi:10.2214/AJR.13.11335 - Pubmed
10. 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
11. Hirschmann A, Sutter R, Schweizer A, Pfirrmann C. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers. AJR Am J Roentgenol. 2014;202(4):819-27. doi:10.2214/ajr.13.11397 - Pubmed
12. Madan S, Pai D, Kaur A, Dixit R. Injury to Ulnar Collateral Ligament of Thumb. Orthop Surg. 2014;6(1):1-7. doi:10.1111/os.12084 - Pubmed

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Stener lesion

Citation, DOI, disclosures and article data

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