Stener lesion

Last revised by Henry Knipe on 12 Sep 2023

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.

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

Stener lesions may present as a tender swelling on the ulnar side of the thumb 12.

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.

Both MRI and high-frequency ultrasound 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.

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.

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.

  • 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

  • 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

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

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