Age / Sex : 46 / F

Age / Sex : 46/F
Chief complaint : Lt. thumb pain

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

* Send Application Answers to In Sook Lee, MD (lis@pusan.ac.kr)

Courtesy : Kim Na Ra, Konkuk University School of Medicine

Gamekeeper’s thumb with Stener’s lesion

Discussion

Findings:

Plain radiograph:

ulnar Instability on radial stress view compared with the contralateral thumb

MRI:

 On fat-saturated T2-weighted coronal images, the ulnar collateral ligament of the first MCP joint is completely torn at its distal insertion. The swollen avulsed ligament stump retracts proximally and superficially above the adductor aponeurosis; this is called a Sterner’s lesion.

Black arrow: avulsed ulnar collateral ligament

White arrow: adductor aponeurosis

Arrowhead: completely distal avulsed site of UCL

Diagnosis:  

Gamekeeper’s thumb with Stener’s lesion

Discussion:

Gamekeeper’s thumb (=skier’s thumb)

 - injury of UCL of first MCP joint

 - avulsion of distal insertion during forced valgus mechanism

Stener’s lesion

 - torn UCL retract proximally and superficially above adductor aponeurosis

 - need to be repaired surgically because of the interposition of the aponeurosis and the risk of chronic instability

References:

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