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 ...
- 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
What are the diagnostic features of a Stener lesion?
Radiographic features 1 evaluation for a Stener lesion requires MRI or high frequency ultrasound. 2 passive flexion of the interphalangeal joint of the thumb during dynamic ultrasound imaging... 3 abduction stress views are no longer recommended as this itself can cause a Stener lesion in an otherwise...
What is a Stener lesion on the thumb?
Stener lesions are seen in the context of a torn ulnar collateral ligament of the thumb 's metacarpophalangeal joint ( gamekeeper's thumb ). Normally, the ulnar collateral ligament lies deep to the adductor pollicis tendon.
What is a Stener lesion on the ulnar collateral ligament?
Injury to the ulnar collateral ligament (UCL) of the thumb requires imaging for diagnosis of surgically important entities such as the Stener lesion. Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care.
What is a Stener lesion of the UCL?
The UCL lies deep to the adductor pollicies tendon. A Stener lesion occurs when a complete distal, thumb UCL tear results in the interposition of the aponeurosis of the adductor pollicis muscle between the MCP of the joint and torn ligament.
What is the significance of a Stener lesion?
With a Stener lesion, a situation exists in which the MCP joint of the thumb is rendered permanently unstable because the UCL is prevented from healing by the interposed adductor aponeurosis. The resultant chronic instability significantly impairs function in the injured hand.
What percentage of patients with a complete rupture are found to have a Stener lesion?
Stener lesions occur in 64% to 87% of all complete ruptures [6,7] and are usually treated by surgical repair. A Stener lesion.
How do you fix a Stener lesion?
Acute Stener lesions can be treated with repair of the UCL primarily through direct suture, suture anchor, or pull-out suture techniques.
How do you test for thumb UCL?
0:181:19Thumb Ulnar Collateral Ligament Test - YouTubeYouTubeStart of suggested clipEnd of suggested clipAnd is therefore referred to as skiers thumb. But have also heard it called gamekeepers thumbMoreAnd is therefore referred to as skiers thumb. But have also heard it called gamekeepers thumb medically it would be referred to as a first mCP UCL lesion in some cases the ligament may be prevented
Does stener lesion need surgery?
Treatment / Management Type 3: UCL tears that are displaced more than 3 mm will usually fail immobilization and most patients with require surgery. Type 4: Stener lesion will require surgery in all cases.
Does a torn UCL hurt all the time?
What You Need to Know. The most common UCL injury is a UCL tear that is usually gradual but may also happen in a single traumatic event. Pain on the inner side of the elbow is the most common symptom of a UCL injury. A UCL tear may sometimes feel like a “pop” after throwing followed by intense pain.
What does a stener lesion feel like?
Initially, people report pain and swelling directly at the site of the torn ligament. Once the swelling settles, people often say they have difficulty picking up or holding objects. Sometimes, people report instability or catching of their thumb in the pockets of their pants.
Can a UCL tear heal without surgery?
If the tear to the ulnar collateral ligament is minor, it may heal on its own. Non-surgical treatment for the ligament tear consists of medications, ice and rest to relieve pain and swelling. Rehabilitation would also be an extremely important component.
How long does it take to recover from UCL thumb surgery?
Grip and hand strength may come back as early as 3 - 4 months after surgery, but it can take up to 6 - 12 months to fully recover and obtain maximum improvement. In most cases, you will be transitioned to a cast at your follow up appointment and then a removable brace at approximately 6 weeks post-surgery.
Can you move your thumb with a torn UCL?
This injury is sometimes called “skier's thumb” because skiers are prone to this injury when they fall with their hand strapped to a ski pole. A thumb UCL injury can be very painful and make the thumb feel unstable. The injury can limit movements, such as squeezing and gripping, needed for many sports.
Does a torn thumb UCL require surgery?
UCL injures can be partial or complete tears and can present with varying degrees of instability. It is this degree of instability that usually dictates the treatment options. Some tears are treated with a cast and immobilization while other tears need to fixed surgically.
Can a thumb UCL tear heal without surgery?
UCL injuries can be treated surgically or non‐surgically. Non‐surgical or conservative options include plaster or splint immobilization (Sollerman 1991).
What happens when you tear your UCL?
When this ligament is torn or damaged, it can lead to pain, elbow instability and loss of function. A UCL tear occurs with overuse and wear and tear on the ligaments in the elbow and is most commonly associated with baseball pitchers and other athletes who perform frequent overarm movement.
How do you treat skier's thumb?
Skier's Thumb Treatment Self-Care at Home Apply ice to the thumb for 35 minutes at a time, up to 4 times per day. Do not apply ice directly to your skin. Continue to use ice until the pain stops. (You should see your doctor as soon as possible after the injury and then follow a doctor's directions for ice therapy.)
What is the volar plate?
The volar plate is a thick ligament that connects two bones in the finger. There are other ligaments to each side of the joint as well (collateral ligaments). When the finger is bent back too far, one or more of the collateral ligaments can also be torn.
How did gamekeeper's thumb get its name?
The term "Gamekeeper's thumb" was first coined in 1955 by Campbell who identified UCL injuries as an occupational disease in Scottish gamekeepers. The gamekeepers strangled rabbits using their thumb and index finger, and the repeated valgus stresses resulted in UCL injury and chronic instability of the MCP joint.
What is a Stener lesions?
Stener lesions are seen in the context of a torn ulnar collateral ligament of the thumb 's metacarpophalangeal joint ( gamekeeper's thumb ).
What ligament is the Stener lesion?
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 ...
Why is it important to identify a Stener lesion?
Identification of a Stener lesion is important as the surgical correction is required to avoid chronic instability, pain, and osteoarthritis. [4] [5] When patients with skin injuries to the thumb present in the emergency department, the primary care physician or nurse practitioner, should seek early consultation with an orthopedic specialist. Plain films, dynamic ultrasound, and MRI are often needed if the physical exam is unrevealing, yet the suspicion for a UCL tear and a Stener lesion is high. [5]
What is the Stener lesion on ultrasound?
The appearance of a Stener lesion on the ultrasound has been called the “tadpole sign” or “yo-yo on a string sign.” Ridley et al. note “ The head of the tadpole is formed by the retracted proximal fragment of the UCL which displaces to be adjacent to the head of the metacarpal. The tail of the tadpole is formed by the adductor aponeurosis which is often thickened and lies deep to the retracted UCL fibers.” [13] The “yoyo on a string sign” appearance presents by the small mass displaced superficial to the adductor pollicis from the torn ligament fibers that retracted proximally. The “yoyo on a string sign” can also be seen in an MRI. [6]
What is the most common initial imaging modality to evaluate hand injuries and associated fractures and MCP joint instabilities?
Plain film X-ray is the most common initial imaging modality to evaluate hand injuries and associated fractures and MCP joint instabilities. UCL distal end injury is suspected if an avulsed bony fragment in the proximal phalanx is present. A displacement greater than 1 mm indicates a displaced UCL tear. [3] Plain radiographs, however, can be normal despite the presence of gamekeeper injury. Further imaging, therefore, is often indicated if the clinical suspicion is high especially if a Stener lesion is also under consideration.
What is a Stener lesion?
A Stener lesion occurs when a complete distal, thumb ulnar collateral ligament tear results in the interposition of the aponeurosis of the adductor pollicis muscle between the metacarpophalangeal joint and torn ligament. Patients with this lesion present with ecchymosis, soft tissue swelling, and focal tenderness of the ulnar aspect of the thumb metacarpophalangeal joint. This activity outlines the evaluation and management of the Stener lesion and explains the role of the interprofessional team in improving care for those with this condition.
Can a UCL be treated with a thumb splint?
[5] A majority of patients with gamekeepers' thumb are managed non-surgically with the use of long arm thumb spica splint. Immobilization may span several weeks. However, if a Stener lesion is present, operative treatment is indicated as healing will not occur due to the separation between the ruptured ends of the ligaments from the Stener lesion. A bone anchor is utilized to reinsert the torn ligament. [4]
Can ultrasound show UCL tear?
[1] Dynamic ultrasound imaging with the interphalangeal joint of the thumb in passive flexion can distinguish between a non-displaced UCL tear and a Stener lesion. [11] [12] Ultrasound also affords quick comparative imaging of the uninjured side. [1]
Can a torn UCL be caught?
A torn UCL can get caught over the aponeurosis of adductor pollicis creating a “lesion” initially described by Stener. [6]
How to detect cartilaginous manifestations?
These include loss of sharpness of the outer margin, loss of clarity of the cartilaginous layer, cartilage thinning, and subchondral bone profile irregularities. Any early erosions can also be sought, which may allow differentiation between erosive and degenerative disease. The effect of multiple osseous fragments can be determined in relation to surrounding structures. More specifically, in the setting of decreased range of movement or instability, one can differentiate between intraarticular loose bodies (, Fig 21) and osseous spurs or heterotopic bone. Any impingement on tendons, ligaments, and blood vessels can be identified. An example of this is tenosynovitis around the flexor carpi radialis tendon in the setting of first carpometacarpal joint osteoarthrosis (, 19 ).
What is a UCL tear?
UCL tears are also referred to as gamekeeper’s thumb or skier’s thumb (, 1 ). Campbell and colleagues described the occupational hazard of ligamentous insufficiency of the UCL of the thumb in Scottish gamekeepers in 1955 (, 2 ).
Why is MR less reliable?
MR imaging is considered less reliable in evaluation of the extensor pollicis longus because of its susceptibility to the magic angle artifact. At the wrist level, the extensor pollicis longus crosses to the thumb at a 55° angle (, 21 ).
Is stress view radiography safe?
Historically, routine radiography including stress views does not allow such diagnosis and is potentially detrimental to patient care. Both magnetic resonance imaging and ultrasonography (US) are currently used for direct evaluation of the UCL of the thumb and are safe and accurate.
Can a radiograph be used to determine ligament displacement?
However, avulsion fragments are uncommonly seen on radiographs (12% of injuries) (, 4 ). Therefore, in most patients, plain radiographs cannot provide a landmark for evaluating ligament displacement. The most extreme example of this shortcoming is in cases of Stener lesion.
