Radial Collateral Ligament Injury of the Thumb with a Stener-Like Lesion

Abstract

The original Stener lesion, described in 1962, refers to an ulnar collateral ligament tear of the thumb metacarpophalangeal joint with adductor aponeurosis interposition. The adductor aponeurosis serves as a mechanical block to healing by preventing apposition of the torn ends of the ulnar collateral ligament. This article presents a case of a 27-year-old woman with painful swelling of the thumb metacarpophalangeal joint following a car accident. Complete tear of the radial collateral ligament was diagnosed based on physical and radiographic examinations. Radial collateral ligament injuries are reported to be less common than ulnar collateral ligament injuries, and, in the past, radial collateral ligament tears were thought to be innocuous, requiring little intervention. More recently, the significance of these injuries has been well documented, and there is support for acute surgical management of complete radial collateral ligament tears. During surgical intervention in our case, we found an intrasubstance tear of the radial collateral ligament with the proximal portion of the ligament retracted and lying superficial to the abductor aponeurosis, thereby producing a Stener-like lesion on the radial side of the joint. The incidence of a Stener-like lesion to the radial collateral ligament is unknown, but it has only been reported once in the literature. Although a primary radial collateral ligament tear may heal by soft tissue apposition, we felt that conservative management in our patient would unlikely lead to healing due to interposition of the abductor aponeurosis. This case supports current recommendations for surgical intervention of complete radial collateral ligament injuries due to the possibility of a Stener-like lesion with soft tissue interposition recurring in the future.