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 (; plural: ''aponeuroses'') is a type or a variant of the deep fascia, in the form of a sheet of pearly-white fibrous tissue that attaches sheet-like muscles needing a wide area of attachment. Their primary function is to join musc ...

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 * Ulnar collateral ligament of thumb The ulnar collateral ligament of the thumb runs along the ulnar side of the met ...

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

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

phalanx The phalanx ( grc, φάλαγξ; plural phalanxes or phalanges, , ) was a rectangular mass military formation, usually composed entirely of heavy infantry armed with spears, pikes, sarissas, or similar pole weapons. The term is particularly use ...

. 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 disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

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 unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

attachment of the UCL was traumatically

avulsed Avulsed is a Spanish death metal band, formed in August 1991 in Madrid by Dave Rotten (who also manages the Xtreem Music record label). Biography The band developed its musical style through various demos: ''Embalmed in Blood'' (1992), ''Def ...

from its site of insertion at the base of the proximal phalanx of the thumb. The severed end of the

ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal li ...

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 A gamekeeper (often abbreviated to keeper), or in case of those dealing with deer (deer-)stalker, is a person who manages an area of countryside (e.g. areas of woodland, moorland, waterway or farmland) to make sure there is enough game for shoo ...

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

rabbit Rabbits, also known as bunnies or bunny rabbits, are small mammals in the family Leporidae (which also contains the hares) of the order Lagomorpha (which also contains the pikas). ''Oryctolagus cuniculus'' includes the European rabbit speci ...

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 mid ...

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 cav ...

(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 Lesion