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Hand Trauma – Fractures and Dislocations
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Ulnar collateral ligament (UCL) injuries of the MCP joint of the thumb can occur in the context of a dislocation or as an isolated injury. Known as ‘Skier’s thumb’ or ‘Gamekeeper’s thumb’ the injury occurs from forced radial deviation of the thumb. If the UCL is completely ruptured then the patient is very likely to develop a Stener lesion, which is the spontaneous interposition of the adductor pollicis aponeurosis between the ruptured UCL stump and its insertion, meaning that the UCL will not heal with conservative management (Figure 5.19).
Extremity trauma
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Injury to the thumb metacarpal ulnar collateral ligament is a unique injury often termed ‘game keepers' thumb or ‘skiers' thumb. Due to the unique anatomical arrangement of adductor policis, if the ligament undergoes complete rupture the aponeurosis may become interposed, inhibiting ligament to bone healing. A rupture of the ulnar collateral ligament should be suspected when an ulnar directed force is directed across the metacarpophalangeal (MCP) joint. A tender swelling on the ulna side of the MCP joint may signify the ‘Stener' lesion. Increased laxity may be clinically evident, and if there is uncertainty, stress radiographs can demonstrate the degree of injury. Complete ruptures with a Stener lesion (interposed aponeurosis) require open reduction of the ligament to restore bone contact, with a suture anchor repair of the associated ulnar collateral ligament.
Forearm and hand
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
In a Stener lesion, a distal rupture of the thumb ulnar collateral ligament occurs at the thumb metacarpophalangeal joint, with interposition of the adductor pollicis aponeurosis between the distal site of attachment of the ruptured ligament and the detached ligament. The interposed adductor aponeurosis maintains separation between the ruptured ends of the ligament, and thus prevents ligamentous healing and restoration of joint stability.
The role of ultrasonography in the assessment of ulnar collateral ligament injury of the thumb – a diagnostic test accuracy meta-analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Firas J. Raheman, Djamila M. Rojoa, Mohit Dhingra, Saad Siddiqui, Christopher R. Macdonald
The ulnar collateral ligament (UCL) is an important static stabiliser of the thumb [1]. With an incidence of 200,000 cases, injury to this structure is common and accounts for 86% of all thumb injuries [2–4]. Stener lesion is the most severe form of UCL injury comprising 64–87% of all complete UCL ruptures [5,6]. It is described as the adductor pollicis aponeurosis being interposed between the ruptured UCL tear and its insertion to the proximal phalanx [3,5].