Normally, the ulnar collateral ligament 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.
- 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 simple ulnar collateral ligament tear/avulsion 7
History and etymology
It was first described by the Swedish orthopedic surgeon Bertil Stener in 1962 3,4,10.
- 1. O'Callaghan B I, G Kohut and H M Hoogewoud. “Gamekeeper thumb: identification of the Stener lesion with US..” Radiology 192, no. 2 (1994): 477-480. doi:VL - 192.
- 2. Hinke DH, SJ Erickson, L Chamoy and ME Timins. “Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb).” Am. J. Roentgenol. 163, no. 6 (December 1, 1994): 1431-1434. [Link].
- 3. Lee Patrick, Tim B. Hunter and Mihra Taljanovic. “Musculoskeletal Colloquialisms: How Did We Come Up with These Names?1.” Radiographics 24, no. 4 (July 2004): 1009-1027. doi:10.1148/rg.244045015.
- 4. Stener B. "Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb: a clinical and anatomic study." J Bone Joint Surg Br 1962; 44: 869-879
- 5. Ebrahim FS, De Maeseneer M, Jager T et-al. 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 citation
- 6. Kundu N, Asfaw S, Polster J et-al. The stener lesion. Eplasty. 2012;12: ic11. Free text at pubmed - Pubmed citation
- 7. Irene M Noszian, Lienhard M Dinkhauser, Günther M Straub, Ernst Orthner. Ulnar collateral ligament injuries of the thumb: Dislocation caused by stress radiography in 2 cases. (2009) Acta Orthopaedica Scandinavica. doi:10.3109/17453679508995511
- 8. David Melville, Jon A. Jacobson, Steven Haase, Catherine Brandon, Monica Kalume Brigido, David Fessell. Ultrasound of displaced ulnar collateral ligament tears of the thumb: the Stener lesion revisited. (2013) Skeletal Radiology. 42 (5): 667. doi:10.1007/s00256-012-1519-x - Pubmed
- 9. David M. Melville, Jon A. Jacobson, David P. Fessell. Ultrasound of the Thumb Ulnar Collateral Ligament: Technique and Pathology. (2014) American Journal of Roentgenology. 202 (2): W168. doi:10.2214/AJR.13.11335 - Pubmed
- 10. Lark ME, Maroukis BL, Chung KC. The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria. (2017) Hand (New York, N.Y.). 12 (3): 283-289. doi:10.1177/1558944716661999 - Pubmed