Type:
Educational Exhibit
Keywords:
Athletic injuries, Perception image, Imaging sequences, Diagnostic procedure, Ultrasound, Conventional radiography, MR, Musculoskeletal system, Musculoskeletal joint, Anatomy
Authors:
A. M. Marrero, E. Rombola, D. KALLSTEN, A. Beresnak; Buenos Aires/AR
DOI:
10.1594/ecr2011/C-1269
Background
Stener lesion is a complication of traumatism in the first MCP joint.
It occurs after a violent hyperabduction of the thumb associated with damage of the ulnar collateral ligament (UCL).
Rupture of the UCL may be total or partial and usually takes place at its distal point of insertion.
It may be accompanied by bone avulsion.
In total rupture of the UCL,
retraction can be mild or severe.
Severe retraction may also be associated with interposition of the adductor muscle aponeurosis,
which is called as Stener lesion.
Anatomy
The thumb is a central component supporting the intricate movements of the hand.
The MCP joint of the thumb is a condylar type articulation that allows motion primarily in the flexion- extension axis and also some degree of rotation.
Similarly to the interphalangeal and MCP joints of the finger,
the MCP joint of the thumb is stabilized by the volar plate,
collateral ligaments,
and musculotendinous structures.
The volar plate is an important stabilizer of this joint and is interconnected with the adjacent MCP joint by the deep transverse metacarpal (interglenoid) ligament.
The collateral ligaments of the MCP joint are taut in flexion and lax in extension,
allowing abduction and adduction.
The extensor hood (particularly its sagittal bands),
which stabilizes the extensor tendon at this level,
also contributes to the stability of the joint.
The adductor pollicis has a strong tendinous point of insertion into the proximal phalanx and volar plate- sesamoid complex.
Some of its fibers also contribute to the adductor aponeurosis,
which covers the UCL.
The UCL together with the base of the first proximal phalanx form a bone-ligament complex that resists valgus stress at the metacarpophalangeal joint.
Theoretically,
integrity should be simple to confirm by clinical examination.
However,
pain,
swelling,
and concern about exacerbation of the injury can hamper physical examination.
This creates two pitfalls: the first is the incorrect classification of a UCL injury and the second is a wrong diagnosis.