Stener lesion
Encyclopedia
A Stener lesion is a type of traumatic injury to the thumb
. 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
. No longer in contact with its insertion site, the UCL cannot spontaneously heal.
in 1955, after he observed this condition in a number of Scottish gamekeeper
s. The injury appeared to occur as a result of the particular manner in which they killed small animals such as rabbit
s. Specifically, the animals were placed on the ground, and their necks were broken as the gamekeeper exerted downward pressure with the thumb and index finger
s. This maneuver would place a valgus force upon the abducted
metacarpophalangeal
(MCP) joint. Over time, this would lead to insufficiency of the ulnar collateral ligament of the thumb, a condition which Campbell referred to as gamekeeper's thumb.
In 1962, Bertil Stener described a lesion
which he observed to occur in a subset of patients suffering from gamekeeper's thumb. In these patients, the distal attachment of the UCL was traumatically avulsed
from its site of insertion at the base of the proximal phalanx of the thumb. The severed end of the ligament
would become trapped under the aponeurosis of the adductor pollicis muscle and therefore be unable to return to its proper anatomic position. Consequently, the severed ligament would fold on itself and thus be prevented from healing and restoring stability to the MCP joint.
For a Stener lesion to occur, both the proper and accessory collateral ligaments of the thumb must be completely ruptured. The Stener lesion is present in more than 80% of complete ruptures of the UCL of the thumb.
Most gamekeeper's thumb injuries are treated by simply immobilizing the joint in a thumb spica splint
or a modified wrist splint and allowing the ligament to heal. However, near total or total tears of the UCL may require surgery to achieve a satisfactory repair, especially if accompanied by a Stener lesion.
Thumb
The thumb is the first digit of the hand. When a person is standing in the medical anatomical position , the thumb is the lateral-most digit...
. It occurs when the aponeurosis
Aponeurosis
Aponeuroses are layers of flat broad tendons. They have a shiny, whitish-silvery color, are histologically similar to tendons, and are very sparingly supplied with blood vessels and nerves. When dissected, aponeuroses are papery, and peel off by sections...
of the adductor pollicis muscle
Adductor pollicis muscle
In human anatomy, the adductor pollicis muscle is a muscle in the hand that functions to adduct the thumb. It has two heads: transverse and oblique....
becomes interposed between the ruptured ulnar collateral ligament
Ulnar collateral ligament (thumb)
The ulnar collateral ligament of the thumb runs along the ulnar side of the metacarpo-phalangeal joint of the thumb.It is on the radial side of the wrist, but on the ulnar side of the thumb. It should not be confused with the ulnar collateral ligament of wrist joint.-Clinical significance:Injuries...
(UCL) of the thumb and its site of insertion at the base of the proximal phalanx
Phalanx bones
In anatomy, phalanx bones are those that form the fingers and toes. In primates such as humans and monkeys, the thumb and big toe have two phalanges, while the other fingers and toes consist of three. Phalanges are classified as long bones.The phalanges do not have individual names...
. No longer in contact with its insertion site, the UCL cannot spontaneously heal.
Gamekeeper's thumb: history and mechanism of injury
CS Campbell, an orthopedic surgeon, originally coined the term gamekeeper's thumbGamekeeper's thumb
Gamekeeper's thumb is a type of injury to the ulnar collateral ligament of the thumb. The UCL is torn at its insertion site into the proximal phalanx of the thumb in the vast majority of cases...
in 1955, after he observed this condition in a number of Scottish gamekeeper
Gamekeeper
A gamekeeper is a person who manages an area of countryside to make sure there is enough game for shooting, or fish for angling, and who actively manages areas of woodland, moorland, waterway or farmland for the benefit of game birds, deer, fish and wildlife in general.Typically, a gamekeeper is...
s. The injury appeared to occur as a result of the particular manner in which they killed small animals such as rabbit
Rabbit
Rabbits are small mammals in the family Leporidae of the order Lagomorpha, found in several parts of the world...
s. Specifically, the animals were placed on the ground, and their necks were broken as the gamekeeper exerted downward pressure with the thumb and index finger
Index finger
The index finger, , is the first finger and the second digit of a human hand. It is located between the first and third digits, between the thumb and the middle finger...
s. This maneuver would place a valgus force upon the abducted
Abduction (kinesiology)
Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist...
metacarpophalangeal
Metacarpophalangeal joint
The metacarpophalangeal joints are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges, with the exception of that of the thumb, which presents more of the characters of a ginglymoid joint...
(MCP) joint. Over time, this would lead to insufficiency of the ulnar collateral ligament of the thumb, a condition which Campbell referred to as gamekeeper's thumb.
In 1962, Bertil Stener described a lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
which he observed to occur in a subset of patients suffering from gamekeeper's thumb. In these patients, the distal attachment of the UCL was traumatically avulsed
Avulsion injury
In medicine, an avulsion is an injury in which a body structure is forcibly detached. It most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures...
from its site of insertion at the base of the proximal phalanx of the thumb. The severed end of the ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
would become trapped under the aponeurosis of the adductor pollicis muscle and therefore be unable to return to its proper anatomic position. Consequently, the severed ligament would fold on itself and thus be prevented from healing and restoring stability to the MCP joint.
For a Stener lesion to occur, both the proper and accessory collateral ligaments of the thumb must be completely ruptured. The Stener lesion is present in more than 80% of complete ruptures of the UCL of the thumb.
Treatment
The ulnar collateral ligament is an important stabilizer of the thumb. Thumb instability resulting from disruption of the UCL profoundly impairs the overall function of the involved hand. Because of this, it is critical that these injuries receive appropriate attention and treatment.Most gamekeeper's thumb injuries are treated by simply immobilizing the joint in a thumb spica splint
Spica splint
A spica splint is a type of orthopedic splint used to immobilize the thumb and/or wrist while allowing other digits freedom to move. It is used to provide support for thumb injuries , gamekeeper's thumb, osteoarthritis, de Quervain's syndrome, scaphoid fracture, thumb sprains, post-operative use,...
or a modified wrist splint and allowing the ligament to heal. However, near total or total tears of the UCL may require surgery to achieve a satisfactory repair, especially if accompanied by a Stener lesion.