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Stener-like Lesion of the Radial Collateral Ligament of the Thumb MCP Joint: A Case Report
Alexander T Crowley, MD, Jakob Oury, B.S., Katherine Fisher, SMA; Carol Meyer, M.D.
Ochsner Clinic Foundation, Jefferson, LA
Stener-like Lesion of the Radial Collateral Ligament of the Thumb MCP Joint: a Case Report
Background:
Stener lesions classically involve rupture of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint (MCPJ) with displacement of the ligament superior to the adductor aponeurosis, preventing natural healing. By contrast, in complete tears of the thumb's radial collateral ligament (RCL), non-operative treatment often leads to successful outcomes. However, the abductor pollicis brevis (APB) aponeurosis overlies the RCL and in rare cases, entrapment of the ligament within the APB aponeurosis can lead to a Stener-like lesion. Few of these lesions have been described in the literature, but prompt surgical repair of complete RCL tears with soft-tissue interposition, is recommended.
Case Report:
We present a 27-year-old who fell onto a hyperextended right thumb while skiing. She presented with radial-sided thumb pain, swelling, ecchymosis and laxity. X-ray showed subluxation of the MCPJ (
Figure 1). MRI demonstrated complete proximal RCL tear, dorsal capsular fraying, and volar plate rupture (
Figure 2). The proximal end was displaced superficial to the ABP aponeurosis (Stener-like), blocking reduction.
Surgical management was undertaken. A curvilinear incision was made over the right MCPJ to expose the RCL, found frayed with fibers interposed in the ABP aponeurosis. MCP arthrotomy revealed volar plate interposition which was removed to restore MCP reduction. RCL was repaired with a modified Kessler technique and augmented using internal suture brace then fixed using a suture anchor. The ABP aponeurosis was repaired, the joint was confirmed stable under fluoroscopy, the wound was closed and dressed with a thumb spica splint.
Conclusion:
This case highlights a rare Stener-like lesion of the thumb RCL, adding to the limited body of literature on this injury pattern. Such lesions are far less common than the classic Stener lesion. Early recognition is critical since interposed tissue will block reduction and healing as opposed to standard RCL injuries without interposition, which are often treated non-operatively.
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