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Can a Stener Lesion be Created During Physical Examination?
Manesha Lankachandra, MD1; Richard L. Hutchison, MD2
1University of Missouri-Kansas City, Kansas City, MO; 2Children's Mercy Hospital / University of Missouri - Kansas City, Kansas City, MO

Introduction: The purpose of this study was to discover if a Stener lesion could be created by clinical examination in a thumb with nondisplaced transection of the distal components of the ulnar collateral ligament.

Materials and Methods: Six thawed fresh frozen hand and forearm specimens were used. Measurements of radial deviation of the metacarpophalangeal (MCP) joint were taken with the thumb in neutral rotation, pronation and supination, both in full extension and in 30 degrees of flexion of the MCP. Pronation and supination force was achieved through manual stress by one the investigators reproducing a clinical examination. Measurements were obtained using a hand-held goniometer. The proper UCL and the accessory UCL were serially sectioned and radial deviation measurements were repeated. The adductor pollicis aponeurosis was initially left intact, and visual examination was performed to assess the presence of a Stener lesion. After measurements were obtained with both UCL components sectioned, an opening was made in the fascia connecting the proximal adductor tendon to the underlying joint capsule and thumb extensor mechanism. Testing was repeated to visualize if a Stener lesion could be created.

Results: A Stener lesion was not created by testing in neutral rotation or in pronation. After creating a defect in the fascia, a Stener lesion could be created in two thumbs. Clinical testing measurements were evaluated. Pronation provided more stability, and supination provided less stability, with one or both components cut, especially with testing at 30 of flexion. There was a statistically significant different in angulation when tested with the thumb supinated at 30 degrees of MCP joint flexion.

Conclusions: New findings in our study show that a Stener lesion can be created from a non-displaced complete UCL tear if the testing is done with the thumb supinated and flexed. Care needs to be taken during examination to prevent rotation of the thumb.

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