Us diagnosis of ucl tears of the thumb and stener lesions. However, presence of a stener lesion is a distinct, anatomic lesion that requires surgical correction. Stenerlike lesions due to radial collateral ligament rupture. Ultrasound is helpful in identifying not only the tear but also whether or not a stener lesion is present. Coronal us scan of the thumb shows a proximally retracted nodule with an irregular lobulated outline arrows, an appearance diagnostic of a stener lesion. An animated description of stener lesions that can occur in ulnar collateral ligament injuries of the thumb gamekeepers thumb or skiers thumb. It is held in this position by the broad tendon of the adductor pollicus muscle. Nelle lesioni recenti lintervento consiste nella sutura del legamento oppure nella reinserzione del legamento sullosso con luso di miniancore. Any information contained in this pdf file is automatically generated from digital material. A stener lesion is characterized by slippage of the torn end of the ulnar collateral ligament superficial to the adductor aponeurosisadductor pollicis muscle such that now there is interposition of the adductor pollicis muscle between the ulnar collateral ligament and the mcp joint. Mri is increasingly used to asses xray occult injuries to the ulnar collateral or to attempt to identify a stener lesion.
No longer in contact with its insertion site, the ucl cannot spontaneously heal. A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Cs campbell first coined the term gamekeepers thumb in 1955, when he described insufficiency in the ulnar collateral ligament ucl of t.
It occurs when the aponeurosis of the adductor pollicis muscle becomes interposed between the ruptured ulnar collateral ligament ucl of the thumb and its site of insertion at the base of the proximal phalanx. We also sought to illuminate the life and work of bertil stener. The most likely reason is that the stir slice thickness of 3 mm limits resolution of small ucls. This prevents healing and is an indication for surgical repair. Oct 16, 2017 displaced ulnar collateral ligament injuries of the metacarpophalangeal joint of the thumb, also known as stener lesions, are a wellrecognized clinical entity, requiring surgical intervention because of the trapped location of the torn lateral collateral ligament superficial to the adductor aponeurosis of the thumb. At the time of injury the thumb deviates away from the fingers and the ligament tears off the base of the proximal phalanx the adductor tendon shifts also at the time of injury and shifts down the thumb. Stenerlike lesion of the lateral collateral ligament of the. Abduccion extrema hiperextension subdiagnostico dolorrigidez. The incidence of stener lesions in complete ruptures is highly variable in the reported literature but may occur in up to 80% of complete. This report evaluates the level of evidence currently available to support the effectiveness and safety of using recombinant activated coagulation factor vii rfviia for clinical indications not approved by the u. Diagnostic ultrasound revealed a torn ulnar collateral ligament of the. Stener lesion is a complication of traumatism in the first mcp joint. Detecting such dislocations isimportant because they require surgical repair. Clearly, this requires a knowledge of local anatomy and use of a highfrequency probe.
Aug 22, 2019 stener s original article was a significant contribution to the treatment of acute disruptions of the ucl of the thumb mcp joint. A stener lesion is where the ulnar collateral ligament completely tears and folds back upon itself. A stener lesion is a type of traumatic injury to the thumb. The full text of this article is available in pdf format. It is important to state out that in stener lesion that the ulnar collateral ligament is transpositioned superficial to the adductor aponeurosis, therefore the ligament ends are no longer in contact and will not heal conservatively. Stenerlike lesions of the superficial medial collateral. The poor sensitivity and specificity of grass as well as poor interobserver agreement suggest that mr may not be sufficiently accurate for stener lesion evaluation. Displacement of the ruptured ulnar collateral ligament of the metacarpophalangeal joint. It was first described by the swedish orthopedic surgeon bertil stener in 1962 3,4,10. Jul 18, 2012 most patients presenting with gamekeepers thumbs can be managed nonoperatively with immobilization in the form of a longarm thumb spica splint for several weeks. The nodule represents the retracted proximal segment of the ucl and is consistent with a fullthickness tear.
Sham lesion is the name given to a control procedure during a lesion experiment. Describe the basic techniques used to perform us of the ucl of the thumb. Identify the us features of ucl injury of the thumb with emphasis on the stener. Lesione del legamento collaterale ulnare della mf del pollice 2.
This case report describes the use of diagnostic ultrasound to diagnose a stener lesion in a patient who presented for conservative care of thumb pain following a fall on an outstretched hand. In his now classic 1962 article, bertil stener described a distinct, surgically correctable anatomic lesion that could account for the chronic instability found in the thumbs of some gamekeepers and skiers. An extensive literature search was performed to explore the treatment evolution of the stener lesion and explore how technical development has influenced stener lesion diagnosis. Jacobson, md the thumb is a central component supporting the intricate movements. The purpose of our study, therefore, is to report the mri features of stener like lesions of the smcl of the knee, including the classically described pattern, where the ligament is displaced superficial to the pes anserinus, as well as any distal tear in which interposition of soft tissue or osseous structures between the smcl and its attachment would prevent ligamenttobone healing. Stener lesion after ulnar collateral ligament rupture posterng. Medlineplus en espanol tambien contiene enlaces a sitios web no gubernamentales. Conventional radiographic images demonstrated an avulsion fracture at the ulnar aspect of the base of the first proximal phalanx. Pdf on jul 18, 2012, neilendu kundu and others published the stener lesion find, read and cite all the research you need on researchgate. A stener lesion is a displaced fullthickness tear of the ulnar collateral ligament ucl of the 1st mcp joint and has a tadpole appearance on ultrasound. Download as pdf print show related cases notify admin. Apr 30, 2014 tear can lead to pain with pinching grip. B, intraoperative photograph from subsequent openknee surgery confirms presence of stener lesion, with isolation of retracted ligament stump asterisk. Normally, the ulnar collateral ligament lies deep to the adductor pollicis tendon.
In a sham lesion, an animal may be placed in a stereotaxic apparatus and electrodes inserted as in the experimental condition, but no current is passed, and therefore damage to the tissue should be minimal. Acute injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Aspect normal et lesions du ligament collateral ulnaire du. If a stener lesion is recognized early, the ucl may be reduced operatively and secured in its anatomic position. When the superficial fibers of the medial collateral ligament of the knee are torn without tearing of the deep fibers, the anterior superficial fibers may displace over the pes anserinus tendons, so that healing back to the tibial insertion site may be jeopardized. Descargue como pdf, txt o lea en linea desde scribd. Neglection of these lesions may lead to articular instability with decreased. List the us features of other common acute conditions affecting the base of the thumb. Technique, patternbased approach, and differential diagnosis1 learning objectives for test 2 after reading this article and taking the test, the reader will be able to. The interposition of the adductor pollicis aponeurosis between the retracted ulnar collateral ligament and the joint prevents healing unless surgical repair is performed. Stenerlike lesions due to radial collateral ligament rupture in the metacarpophalangeal joints of two adjacent fingers.