Can clinical examination cause a Stener lesion in patients with skier's thumb?: A cadaveric study

Abstract

Approximately one-third of all injuries of the upper limb and 7% of all injuries in skiing affect the ulnar collateral ligaments of the thumb metacarpophalangeal joint (skier's thumb). In some patients the collateral ligaments are displaced proximally over the adductor aponeurosis, resulting in a so-called Stener lesion. In these cases surgical treatment is indicated. We hypothesized that a Stener lesion could be provoked by clinical stability testing in patients with a skiers thumb and performed a cadaveric study on 10 Thiel fixated cadaver hands. For clinical stability testing, the thumb was manually deviated in radial direction in both 308 flexion and extension of the MP-joint. It was performed with maximum strength by two hand surgeons after sequential detachment of the ulnar collateral ligaments. After every sequence, it was assessed if the clinical stability testing had caused a Stener lesion. All of the 10 cadavers showed identical results while testing the clinical stability. A decreased stability was only found after cutting both parts of the ulnar collateral ligaments. A Stener lesion could not be provoked in any of the cadavers at any time by clinical stability testing. Summarizing our findings we conclude that a proper performed clinical stability testing of the thumb MP joint is a safe maneuver, which does not lead to a Stener lesion in patients with skier's thumb. Clin. Anat. 25:762-766, 2012. V V C 2011 Wiley Periodicals, Inc.

Can Physical Examination Create a Stener Lesion?

“…The order of sectioning the tissues, pUCL, aUCL, and then the aponeurosis, reproduced the sequence of injury in traumatic events. 10,16) Similar to the finding of Adler et al, we were unable to create a Stener lesion after complete sectioning of the UCL at 0°and 30° of flexion with no rotation. 16) We also did not create a Stener lesion with supination or pronation with intact overlying fascia.…”

“…10,16) Similar to the finding of Adler et al, we were unable to create a Stener lesion after complete sectioning of the UCL at 0°and 30° of flexion with no rotation. 16) We also did not create a Stener lesion with supination or pronation with intact overlying fascia. Unlike the study by Adler, we used fresh frozen cadavers rather than preserved specimens.…”

Injury to Ulnar Collateral Ligament of Thumb

“…Other authors argue that, in the case of associated undisplaced fractures, the injury force is always greater than the force applied during clinical testing, thus allaying any fear of displacement. A recent cadaver study concluded that correctly performed stress test examinations do not cause Stener lesions. Thirkannad and Wolff described the “Two Fleck Sign”, wherein two bony fragments are present: one of them is usually obvious and denotes an undisplaced avulsion fracture whereas the other, which is frequently missed during initial X‐ray evaluation, denotes a Stener lesion.…”

Rupture of the ulnar collateral ligament of the thumb – a review

“…However, if the initial trauma was insufficient to cause a dislocation, the thought is that the strength used to test the thumb clinically is not enough to cause one [12]. Also, in a study with cadavers [13], a Stener lesion could not be caused by a correct clinical examination.…”