A Stener lesion is a type of traumatic injury to the

thumb The thumb is the first digit of the hand, next to the index finger. When a person is standing in the medical anatomical position (where the palm is facing to the front), the thumb is the outermost digit. The Medical Latin English noun for thumb ...

. It occurs when the

aponeurosis An aponeurosis (; : aponeuroses) is a flattened tendon by which muscle attaches to bone or fascia. Aponeuroses exhibit an ordered arrangement of collagen fibres, thus attaining high tensile strength in a particular direction while being vulnerable ...

of the

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. It is a fleshy, flat, triangular, and fan-shaped muscle deep in the thenar compartment benea ...

becomes interposed between the ruptured

ulnar collateral ligament Ulnar collateral ligament (or UCL) may refer to: * Ulnar carpal collateral ligament * Ulnar collateral ligament of elbow joint The ulnar collateral ligament (UCL) or internal lateral ligament is a thick triangular ligament at the medial aspec ...

(UCL) of the thumb and its site of insertion at the base of the

proximal Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...

phalanx The phalanx (: phalanxes or phalanges) was a rectangular mass military formation, usually composed entirely of heavy infantry armed with spears, pikes, sarissas, or similar polearms tightly packed together. The term is particularly used t ...

. No longer in contact with its insertion site, the UCL cannot spontaneously heal.

Mechanism

In 1962, Bertil Stener described a

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by injury or diseases. The term ''Lesion'' is derived from the Latin meaning "injury". Lesions may occur in both plants and animals. Types There is no de ...

which he observed to occur in a subset of patients suffering from gamekeeper's thumb. In these patients, the

distal Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position provi ...

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 A ligament is a type of fibrous connective tissue in the body that connects bones to other bones. It also connects flight feathers to bones, in dinosaurs and birds. All 30,000 species of amniotes (land animals with internal bones) have liga ...

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 A spica splint is a type of orthopedic splint used to immobilize the thumb and/or wrist while allowing the other digits freedom to move. It is used to provide support for thumb injuries (ligament instability, sprain or muscle strain), gamekeeper's ...

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.

History

CS Campbell, an orthopedic surgeon, originally coined the term "gamekeeper's thumb" in 1955, after he observed this condition in a number of Scottish

gamekeeper In the United Kingdom, a gamekeeper (often abbreviated to keeper) is a person who manages an area of countryside (e.g., areas of woodland, moorland, waterway or farmland) to make sure that there is enough Game (hunting), game for hunting, or fish ...

s. The injury appeared to occur as a result of the particular manner in which they killed small animals such as

rabbit Rabbits are small mammals in the family Leporidae (which also includes the hares), which is in the order Lagomorpha (which also includes pikas). They are familiar throughout the world as a small herbivore, a prey animal, a domesticated ...

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 The index finger (also referred to as forefinger, first finger, second finger, pointer finger, trigger finger, digitus secundus, digitus II, and many other terms) is the second digit of a human hand. It is located between the thumb and the m ...

s. This maneuver would place a valgus force upon the abducted

metacarpophalangeal The metacarpophalangeal joints (MCP) are situated between the metacarpal bones and the proximal phalanges of the fingers. These joints are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow ...

(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".

References

External links

{{Medical resources , DiseasesDB = , ICD10 = {{ICD10, S, 63, 4, s, 60 , ICD9 = {{ICD9, 719.94 , ICDO = , OMIM = , MedlinePlus = , eMedicineSubj = orthoped , eMedicineTopic = 19 , MeshID = D006227 Overuse injuries Injuries of wrist and hand Lesions