Age / Sex : 41 / M

Chief complaint : right thumb pain after fall from bicycle


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 김선정, Seon-Jeong Kim, 명지병원 Myongji Hospital, Hanyang University Medical Center

Stener’s lesion

Discussion

Findings:

T1 and fat-saturated T2-weighted coronal images demonstrate the typical “yo-yo on a string” appearance of Stener’s lesion.

The torn, retracted UCL has mass-like appearance (yo-yo) and the adductor apponeurosis (string) becomes interposed between the torn UCL and the 1st MCP joint line.

Differential Diagnosis:(-)

Discussion:

• Gamekeeper’s thumb or skier’ thumb


• Sprain of tear of ulnar collateral ligament (UCL) of 1^st metacarpophalangeal (MCP) joint


• Related to hyperabduction injury with/without avulsion fracture


• Stener’s lesion


• Gamekeeper’s thumb with retraction of torn UCL with interposition of adductor pollicis apponeurosis between UCL and 1^st MCP joint line


• Indication for surgical repair (interposition of the apponeurosis prevents healing of the ligament and exposes the patient to permanent instability and degenerative changes of the MCP joint)

References:

David W. Stoller. Magnetic resonance imaging in orthopaedics and sports medicine. 3rd Ed. Lippincott Williams & Wilkins, 2007;1850-1851

Clavero et al. MR imaging of ligament and tendon injures of the fingers. RadioGraphics 2002; 22:237–256

Hinke DH et al. Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (gamekeeper's thumb). AJR Am J Roentgenol. 1994;163(6):1431-4.