A 48-year-old female presents complaining of thumb pain since a fall which occurred two weeks ago. Take a look at the first three images without arrows first, then look at the same three images with arrows.
A. What do you think is the cause of the patient’s pain?
B. What are the more common names for this condition?
C. What additional complication has occurred?
D. What is the significance of this complication?
Coronal PD Fat Sat
Coronal 3D Gradient
Coronal T1
Coronal PD Fat Sat
Coronal 3D Gradient
Coronal T1
A. Torn ulnar collateral ligament at the first metacarpophalangeal (MCP) joint.
B. Gamekeeper’s or skier’s thumb
C. Stener lesion. The torn ulnar collateral ligament is retracted proximally and superficially to the adductor aponeurosis (yellow arrows on images 4 and 5 points to adductor aponeurosis).The red arrows on image 4 and 5 point to the torn and contracted ulnar collateral ligament (UCL) of the first MCP joint. The orange arrow in image 6 points to the intact radial collateral ligament, while the pink arrow again makes note of the torn UCL.
D. The lesion requires surgery to heal properly. Since the UCL (red arrow) is prevented by the adductor aponeurosis (yellow arrow) from finding its way back to its attachment, and therefore healing, only surgical repair will do.
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Dr. Stephen Pomeranz
Dr. David Downs
