Gamekeeper’s Thumb—A Treatment-Oriented Magnetic Resonance Imaging Classification

Milner, Chris S.; Manon-Matos, Yorell; Thirkannad, Sunil M.

doi:10.1016/j.jhsa.2014.08.033

Cited by 25 publications

(28 citation statements)

References 16 publications

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“…Fluoroscopy, MRI and ultrasound are increasingly being used and evaluated as diagnostic tools. 3,6,[12][13][14] Our results confirm the findings of Mayer et al that pronation and supination play a role in stability of the thumb MCP joint. 15) We showed that supination and flexion of the thumb provided less stability when both components of the UCL were sectioned.…”

Section: Discussionsupporting

confidence: 90%

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Can Physical Examination Create a Stener Lesion?

Lankachandra

Eggers

Bogener

et al. 2017

J Hand Surg Asian-Pac Vol

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Background: The purpose of this study is to determine whether a Stener lesion can be created while testing stability of the ulnar collateral ligament (UCL) of the thumb. Testing was performed in a manner that reproduced clinical examination. Methods: Six fresh frozen hand and forearm specimens underwent sequential sectioning of the accessory UCL, the proper UCL, and the ulnar sagittal band. Measurements of radial deviation of the metacarpophalangeal (MCP) joint were taken with the thumb in neutral rotation, pronation and supination, both with 0 degrees and with 30 degrees of flexion of the MCP joint. Visual examination was performed to assess the presence of a Stener lesion. Results: No Stener lesion was created in any position as long as the fascial origin of the ulnar sagittal band at the adductor pollicis longus remained intact. After creating a defect in the ulnar sagittal band, a Stener lesion was created in two specimens, but only when the thumb was flexed and supinated. Pronation provided more stability, and supination provided less stability, with one or both components cut, especially when testing at 30° of flexion. Compared to both components cut without flexion or rotation, there was a statistically significant difference in angulation with the 30 degrees of MCP joint flexion in both neutral rotation in supination. Conclusions: Performing a physical examination to assess the amount of instability of an ulnar collateral ligament injury did not create a Stener lesion if the exam was performed in a controlled, gentle manner with the thumb held without rotation. If the thumb is held in neutral rotation during the exam, an iatrogenic Stener lesion should not be created.

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Section: Discussionsupporting

confidence: 90%

“…The authors discuss the potential dangers of clinical testing in increasing the displacement. 12) Further cadaveric and clinical studies will need to be performed to determine how clinical testing affects displacement and if clinical testing can convert a minimally displaced complete tear into a lesion that requires surgery.…”

Section: Discussionmentioning

confidence: 99%

Can Physical Examination Create a Stener Lesion?

Lankachandra

Eggers

Bogener

et al. 2017

J Hand Surg Asian-Pac Vol

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“…23,28 The accuracy of MRI has led to the development of a new classification guide for UCL management based on MRI scans displaying distance of UCL displacement in millimeters. 18 A recent treatment-oriented classification proposed by Milner 18 suggests surgery for all ruptured ligaments demonstrating displacement of 3 mm or greater (type 3) as well as those appearing to have a Stener lesion (type 4). Some consider MRI the best modality for UCL visualization, whereas others criticize its high cost and lagging availability, 16 frequently preferring ultrasound techniques to remedy these pitfalls.…”

Section: Late Years (1990s To Present)mentioning

confidence: 99%

The Stener Lesion: Historical Perspective and Evolution of Diagnostic Criteria

Lark

Maroukis

Chung

2016

Hand (New York, N,Y.)

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Background: In 1962, Bertil Stener first described the anatomy and treatment of the displaced ulnar collateral ligament of the metacarpophalangeal joint, later called the Stener lesion. Since Stener's publication, treatment algorithms for ulnar collateral ligament rupture have aided in preoperative diagnosis, yet the best diagnostic method to assess ligament displacement remains largely undefined. Methods: An extensive literature search was performed to explore the treatment evolution of the Stener lesion and explore how technical development has influenced Stener lesion diagnosis. We also sought to illuminate the life and work of Bertil Stener. Results: Studies evaluating the use of magnetic resonance imaging (MRI) and ultrasound (US) technology have suggested that these modalities have improved Stener lesion diagnosis. Conclusion: Despite the utility of developing MRI and US technology, consensus for one superior diagnostic tool for Stener lesions does not currently exist.

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“…Hergan and Romano and colleagues 60 used high-resolution MR imaging to characterize the detailed appearance of the thumb UCL after injury and suggested 5 distinct subclasses of ligament tear, including a partial tear, a Stener lesion, and avulsions fractures that were nondisplaced, minimally displaced ( 3 mm), and moderately displaced (!3 mm). Milner and colleagues 61 have proposed a modification of the Romano classification system, defining their groups as partial tears/sprains, undisplaced (<3 mm), displaced (>3 mm), and Stener lesion ( Table 1). This system, in their cohort, accurately identified the need for surgery (group 3 and 4) and those benefiting from conservative treatment (group 1 and 2).…”

Section: Pathogenesismentioning

confidence: 99%

“…This system, in their cohort, accurately identified the need for surgery (group 3 and 4) and those benefiting from conservative treatment (group 1 and 2). 61 Patients presenting with greater than 20% of the articular surface were treated as a fracture rather than a UCL injury and were, thus, excluded. Out of the 43 patients, 14 (33%) had a type 1 injury, 5 had a type 2 injury (12%), 10 had a type 3 injury (24%), and 14 had a type 4 injury (33%).…”

Section: Pathogenesismentioning

confidence: 99%