Stener-Like Lesion of the Radial Collateral Ligament of the Thumb Metacarpophalangeal Joint.

Abstract

Background: Stener lesions involve rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint with displacement of the ligament superficial to the adductor aponeurosis, preventing healing. Rarely, however, entrapment of the ligament by the overlying abductor pollicis brevis aponeurosis can lead to a Stener-like lesion. Few Stener-like lesions have been described, and surgical repair is recommended.

Case report: A 27-year-old female fell while skiing and hyperextended her right thumb. She presented with thumb pain, swelling, ecchymosis, and laxity. X-ray showed subluxation of the metacarpophalangeal joint. Magnetic resonance imaging demonstrated a complete radial collateral ligament tear with the proximal end displaced superficial to the abductor pollicis brevis aponeurosis (Stener-like), blocking reduction. An incision was made over the metacarpophalangeal joint. The radial collateral ligament fibers were interposed in the abductor pollicis brevis aponeurosis. Metacarpophalangeal joint arthrotomy revealed volar plate interposition that was removed to restore metacarpophalangeal joint reduction. The radial collateral ligament was repaired with a modified Kessler technique and augmented using an internal suture brace involving a suture anchor reinforced with suture tape for collateral metacarpophalangeal joint support. The abductor pollicis brevis aponeurosis was repaired, the joint was confirmed stable, and the wound was closed and dressed in a thumb spica splint.

Conclusion: This case describes a rare Stener-like lesion of the thumb radial collateral ligament, adding to the limited literature on this injury pattern. Such lesions are far less common than the classic Stener lesion. Early recognition is critical because interposed tissue will block reduction and healing.