Stener Lesion: A Comprehensive Guide

A Stener lesion is a specific type of injury involving the ulnar collateral ligament (UCL) of the thumb. This ligament is located on the inside of the thumb’s metacarpophalangeal (MCP) joint and helps stabilise the thumb during gripping or pinching activities. When the UCL is torn, the ligament may get displaced, leading to a Stener lesion.

Key Characteristics of a Stener Lesion

• Displaced Ligament: The main defining feature is that the torn end of the UCL gets caught above the adductor aponeurosis, a layer of tissue that covers the UCL. This prevents the ligament from healing naturally, as it’s no longer in the correct position.
• Chronic Instability: Without intervention, the thumb joint may become chronically unstable, affecting grip strength and hand function.

How It Differs from Other Thumb Injuries

1. Unique Mechanism: Unlike a simple UCL tear (also known as “skier’s thumb” when caused by trauma), a Stener lesion involves the displacement of the ligament. This displacement is uncommon in other thumb injuries.
2. Healing Potential: Regular UCL injuries, like sprains or minor tears, can often heal with conservative treatments (such as splinting or physical therapy). A Stener lesion, however, usually requires surgical repair because the displaced ligament cannot reattach itself.
3. Symptoms and Diagnosis: While other thumb injuries may cause pain, swelling, and bruising, a Stener lesion can lead to persistent instability and weakened grip strength. It’s diagnosed through physical exams, and MRI imaging is often needed to confirm the displacement.

Due to the unique nature of a Stener lesion, early identification and proper treatment are crucial to restoring thumb function. It is important to get an assessment by medical staff trained in treating orthopaedic injuries. Access Ortho specialises in assessing and treating musculoskeletal/orthopaedic injuries such as fractures, sprains and dislocations. 

Anatomy and Mechanism

Understanding the Anatomy of the Thumb

The thumb’s structure is uniquely designed to allow complex movements like pinching, gripping, and rotating. The thumb consists of two small bones, the proximal and distal phalanges, and connects to the hand via the metacarpal bone at the metacarpophalangeal (MCP) joint. Several ligaments stabilise the thumb, including the ulnar collateral ligament (UCL) and radial collateral ligament (RCL). The UCL, on the inner side of the thumb’s MCP joint, is critical for preventing the thumb from bending outward during gripping. The adductor aponeurosis, a tissue layer over the UCL, supports the thumb’s powerful, precise movements.

Mechanism of Injury in Stener Lesions

A Stener lesion typically occurs when the thumb is forcefully bent outward or abducted, often during falls or high-impact sports. This excessive stress can tear the UCL, and in a Stener lesion, the torn ligament flips over and becomes trapped above the adductor aponeurosis. This displacement prevents the ligament from healing naturally, resulting in thumb instability and requiring surgical intervention for full recovery.

Types and Classification

Stener lesions don’t have an extensive classification system, as they are a specific type of ulnar collateral ligament (UCL) injury that involves displacement. However, clinicians and researchers sometimes categorise Stener lesions based on variations in the severity or location of the ligament displacement. Here are some common ways these lesions may be described:

Types of Stener Lesions

1. Partial Stener Lesion: The UCL is only partially torn and displaced. The ligament may still maintain some continuity with its attachment site, though it may still be caught above the adductor aponeurosis, preventing healing.
2. Complete Stener Lesion: The UCL is fully torn, and the entire ligament is displaced and entrapped above the adductor aponeurosis. This is the most common type and typically requires surgical repair.
3. Chronic Stener Lesion: If a Stener lesion goes untreated, the displaced ligament may remain entrapped long-term, leading to chronic instability and possible arthritis in the thumb joint. This type often requires reconstructive surgery, as the ligament’s tissue quality may have deteriorated.

Classification System for Stener Lesions

While there isn’t a widely accepted formal classification system specifically for Stener lesions, some clinicians classify these injuries based on timing and severity:

• Acute vs. Chronic: Acute lesions are newly formed injuries, while chronic Stener lesions develop if the injury is not treated promptly and leads to long-term instability.
• Grade of Injury: In some cases, the UCL tear itself may be graded similarly to other ligament injuries (Grades I to III):
  • Grade I: Mild sprain without significant displacement.
  • Grade II: Partial tear with possible minor displacement.
  • Grade III: Complete tear with significant displacement, resulting in a Stener lesion.

Overall, Stener lesions are primarily classified by the degree of displacement and chronicity, which informs the treatment approach, typically involving surgical intervention.

Prevalence and Epidemiology

How Common Are Stener Lesions?

Stener lesions are relatively uncommon injuries but are significant when they occur due to their impact on thumb stability. They account for a small percentage of all ulnar collateral ligament (UCL) injuries in the thumb. UCL injuries are more common in sports-related incidents, particularly skiing, where this type of injury is sometimes called “skier’s thumb.” Among all thumb UCL tears, only a portion result in a Stener lesion, but these cases are unique due to the ligament displacement that requires surgical intervention.

Who Is Most at Risk for Stener Lesions?

Individuals most at risk for Stener lesions include:

• Athletes in High-Impact Sports: Especially skiers, who often fall with their thumb extended, leading to excessive force on the UCL. Other athletes in contact sports like football and rugby are also at risk.
• Workers in Manual or High-Risk Occupations: Jobs that involve repetitive strain or risk of falls (such as construction work) increase susceptibility to this type of injury.
• Older Adults: With age, ligaments may lose flexibility and strength, making them more prone to tears and displacement during accidental falls.

These risk factors highlight the importance of prompt assessment and treatment for thumb injuries in individuals who are more exposed to forceful thumb impacts.

Symptoms and Causes

What Causes Stener Lesions?

A Stener lesion occurs when the thumb’s ulnar collateral ligament (UCL) is torn and displaced. This injury typically results from forceful abduction (pulling away) or hyperextension of the thumb, such as when landing on an outstretched hand. Sports and activities with high-impact falls or force on the thumb—like skiing, rugby, and football—are common causes, as well as any incidents where the thumb is bent forcefully away from the hand.

Risk Factors for Stener Lesions

Several factors increase the likelihood of sustaining a Stener lesion:

1. Participation in High-Risk Sports: Activities that involve falling or direct impact on the hand (e.g., skiing, football, basketball) increase the risk of UCL injuries, including Stener lesions.
2. Manual Labour or Physical Jobs: Jobs involving repetitive thumb use, heavy lifting, or risk of falls can lead to ligament injuries.
3. Age and Ligament Health: Older individuals may have weaker ligaments, making them more prone to ligament tears.
4. Previous UCL Injuries: Those with a prior UCL sprain or tear are at higher risk of recurrent injuries and complications, including Stener lesions.

Symptoms of a Stener Lesion

A Stener lesion often presents with symptoms similar to other UCL injuries but can have distinctive signs of persistent instability due to the displaced ligament. Common symptoms are:

• Pain and Swelling: This is noted around the base of the thumb, especially on the inner side of the MCP joint.
• Thumb Weakness: Difficulty with pinching or gripping objects, leading to reduced hand function.
• Instability or Laxity: The thumb may feel loose or unstable, particularly when pinched against the index finger.
• Visible Lump: In some cases, a small, palpable lump may be felt at the base of the thumb due to the displaced ligament trapped above the adductor aponeurosis.

Potential Complications of Untreated Stener Lesions

If left untreated, Stener lesions can lead to several long-term complications:

1. Chronic Thumb Instability: Without repair, the thumb may continue to feel weak and unstable, affecting grip strength and hand function.
2. Early-Onset Arthritis: The instability in the joint can accelerate wear, increasing the risk of developing osteoarthritis in the MCP joint.
3. Persistent Pain and Dysfunction: Patients may experience ongoing pain, decreased movement, and an inability to perform certain tasks.
4. Decreased Quality of Life: With chronic pain and limited thumb function, daily activities can become challenging, impacting work and recreational activities.

Due to these potential complications, early diagnosis and intervention are crucial to restore thumb stability and prevent long-term damage.

Access Ortho specialises in the care of orthopaedic injuries. If you are concerned about a thumb injury contact us today for a rapid appointment. Early orthopaedic advice will help minimise the risk of complications.

Diagnosis and Tests

How Are Stener Lesions Diagnosed?

Stener lesions are diagnosed through a combination of clinical evaluation and imaging studies. The medical provider typically starts by taking a detailed history about the injury and doing a physical examination, often followed by imaging to confirm ligament displacement. Accurate and timely diagnosis is essential to differentiate a Stener lesion from other thumb injuries and to determine appropriate treatment. Access Ortho is an urgent injuries clinic offering rapid appointments for orthopaedic concerns. 

Physical Examination Techniques for Stener Lesions

Physical examination techniques focus on assessing thumb stability and identifying potential displacement of the ulnar collateral ligament. Common techniques include:

1. Palpation: The healthcare provider palpates the base of the thumb near the MCP joint. In cases of a Stener lesion, a small lump or bulge may be felt due to the displaced ligament above the adductor aponeurosis.
2. Valgus Stress Test: The examiner applies gentle outward pressure to the thumb to test for instability in the UCL. Increased laxity or pain during this maneuver can suggest a UCL tear.
3. Pinch Grip Test: The patient is instructed to pinch their thumb and index finger together, assessing for pain, weakness, or instability. Difficulty performing this action is common with a compromised UCL.

Imaging Studies Used to Confirm Stener Lesions

Imaging is crucial in confirming a Stener lesion diagnosis by visualising the ligament displacement. The most common imaging studies include:

1. X-Ray: Though an X-ray does not show soft tissues like ligaments, it is often used to rule out fractures or bone avulsion injuries at the MCP joint, which can accompany a UCL tear.
2. Ultrasound: A non-invasive method that allows direct visualisation of the UCL. Ultrasound can often show the ligament’s position and displacement above the adductor aponeurosis, indicating a Stener lesion.
3. MRI (Magnetic Resonance Imaging): MRI is used for diagnosing soft tissue injuries, including Stener lesions. It provides a detailed view of the ligament and surrounding structures, confirming if the UCL is torn and displaced.

Differential Diagnosis: Distinguishing Stener Lesions from Other Thumb Injuries

Stener lesions share symptoms with other thumb injuries, making differential diagnosis important to avoid misdiagnosis. Conditions that may be considered include:

1. Simple UCL Sprain or Partial Tear: Unlike Stener lesions, a simple UCL injury does not involve ligament displacement above the adductor aponeurosis and often responds well to conservative treatment.
2. Gamekeeper’s Thumb: Refers to a chronic UCL injury due to repetitive stress, often presenting without displacement.
3. Fractures of the Thumb: Fractures around the MCP joint can cause similar pain and swelling but typically appear on X-rays.
4. Radial Collateral Ligament (RCL) Injury: Injury to the RCL, located on the outer side of the thumb, can cause similar instability but will present with tenderness on the opposite side of the thumb.

By combining physical examination findings with imaging studies, skilled orthopaedic healthcare providers can accurately diagnose Stener lesions and distinguish them from other thumb injuries. Early identification ensures appropriate treatment and minimises the risk of long-term complications. 

Management and Treatment

Conservative treatments, like splinting or immobilisation, are generally ineffective for Stener lesions because the displaced ligament cannot heal on its own due to its position above the adductor aponeurosis. For this reason, most cases require surgical intervention to restore thumb stability. However, conservative management may be considered in rare cases where there is only a partial ligament tear without full displacement, or if the patient is unable to undergo surgery.

In cases where conservative treatment is attempted:

• Splinting: Immobilising the thumb with a splint or cast for 4–6 weeks may help stabilise the ligament, though this approach has limited success with displaced lesions.
• Rest and Anti-Inflammatory Medications: Rest, ice, and NSAIDs may help manage pain and swelling but do not address the underlying ligament displacement.

Surgical Interventions for Stener Lesions

Surgery is the recommended treatment for Stener lesions, as it is necessary to reposition and secure the ligament to restore thumb stability and function. Surgical options include:

1. Direct Repair of the UCL: In most cases, the surgeon repositions the displaced UCL and sutures it back to its attachment site on the bone. This technique is effective for recent injuries with intact ligament tissue.
2. Ligament Reconstruction: A ligament reconstruction may be necessary if the injury is chronic or the ligament tissue is compromised. In this procedure, a graft is used, often from a tendon elsewhere in the hand, to reconstruct the UCL.
3. Internal Brace Augmentation: In some cases, an additional support (internal brace) is added to reinforce the ligament repair, providing extra stability during healing and potentially allowing for quicker rehabilitation.

Surgery is typically performed as an outpatient procedure, allowing the patient to go home the same day. After surgery, the thumb is usually immobilised in a splint or cast to protect the repair while it heals.

The medical team at Access Ortho can advise on the need for surgery and help find a suitable surgeon if necessary. Early, accurate diagnosis is the most important step to ensure this injury is not missed and that treatment is not delayed. 

Rehabilitation and Physical Therapy for Stener Lesions

Rehabilitation is essential after surgical repair to restore full range of movement, strength, and function to the thumb. All rehabilitation must be done under the guidance of your surgeon. This is an example of a rehabilitation plan includes:

1. Immobilisation Period: Post-surgery, the thumb is immobilised in a cast or splint for 4–6 weeks to allow the ligament to heal. During this period, the patient should avoid any activity that stresses the thumb.
2. Early Range of Motion Exercises: Once the immobilisation period ends, the patient begins gentle exercises to increase range of motion under the guidance of a physiotherapist. These exercises help improve flexibility in the MCP joint without over-stressing the healing ligament.
3. Strengthening Exercises: As healing progresses, the patient can begin thumb and hand strengthening exercises, typically around 6–8 weeks post-surgery. These exercises focus on grip strength, pinch strength, and overall hand coordination.
4. Gradual Return to Activity: Full return to normal activities, including sports, may be allowed 3–4 months after surgery, once the thumb is fully stable and strong. The timeline may vary based on the individual’s progress and the extent of the original injury.

Physiotherapy helps ensure the ligament heals properly and minimises the risk of re-injury, allowing patients to regain full use of their thumb and hand.

Prevention

While not all Stener lesions are preventable, protective techniques and appropriate equipment can reduce the risk during high-risk activities. Preventive strategies are especially important for athletes and individuals in jobs that place strain on the thumbs.

How Can I Prevent Stener Lesions?

To help prevent Stener lesions:

• Use Protective Gear: Wear padded gloves or thumb braces, especially during sports like skiing, football, or other activities with a high risk of falls.
• Practice Proper Techniques: Learning and using correct hand positioning in sports and activities that involve gripping or handling can minimise thumb stress.
• Strength and Flexibility Training: Regular exercises to strengthen the hand and thumb muscles improve joint stability and reduce the risk of ligament injuries.

Protective Equipment and Techniques for High-Risk Activities

1. Thumb Braces: For sports like skiing, consider using thumb-specific braces or supports that provide extra stability.
2. Taping Techniques: Athletes can tape their thumbs for added support during high-impact activities to limit excessive thumb abduction.
3. Skill Training: Working with a coach to learn safe falling techniques and proper hand positioning reduces the risk of thumb injuries in sports.

By incorporating these preventive measures, individuals can lower their risk of Stener lesions and other thumb injuries.

Outlook / Prognosis

Outlook / Prognosis for Stener Lesions

The prognosis for a Stener lesion is generally favourable with prompt surgical treatment. Most patients regain full function, strength, and range of motion in the thumb after surgery and rehabilitation. However, untreated Stener lesions can lead to chronic instability, pain, and an increased risk of arthritis in the MCP joint, so early intervention is key.

What Can I Expect if I Have a Stener Lesion?

With appropriate surgical treatment, you can expect a structured recovery process involving immobilisation, followed by gradual rehabilitation. Most people are able to resume normal activities after healing, although recovery may take several months.

Recovery Time and Milestones After Stener Lesion Treatment

1. Immediate Post-Surgery: To protect the repair, the thumb is typically immobilised in a cast or splint for 4–6 weeks.
2. 4–6 Weeks Post-Surgery: Gentle range-of-motion exercises begin under the guidance of a physiotherapist to restore flexibility.
3. 6–8 Weeks Post-Surgery: Gradual strengthening exercises are introduced to rebuild thumb and hand strength.
4. 3–4 Months Post-Surgery: Depending on progress and stability, most patients start to return to normal activities and sports.

Long-Term Outcomes and Potential Complications

With successful treatment, long-term outcomes are usually excellent, with a full return of thumb stability and function. Potential complications, although uncommon, include:

• Thumb Instability or Weakness: In cases where the ligament does not heal properly.
• Arthritis in the MCP Joint: Risk increases if the injury is not treated early.
• Re-Injury: As with any ligament injury, there is a slight risk of re-injury in high-impact activities.

Overall, with appropriate care, most patients recover well and can return to their usual activities with minimal long-term effects.

When to Seek Medical Attention

If you suspect a Stener lesion or have a thumb injury with significant pain, swelling, or instability, it’s essential to seek medical attention promptly. Early diagnosis and treatment are required for a successful recovery, as Stener lesions typically require surgical intervention.

When Should I Go to a Fracture Clinic?

Consider going to a fracture clinic such as Access Ortho if you experience:

• Persistent Thumb Pain: If pain doesn’t improve with rest, ice, or over-the-counter pain relief after a few days.
• Thumb Instability or Weakness: If you feel that your thumb is loose or unstable, especially during gripping or pinching.
• Difficulty Using Your Thumb: Limited range of motion or inability to perform everyday tasks without pain could indicate a serious injury.

Red Flags: When Immediate Medical Attention is Necessary

Seek immediate medical care if you note any of these red flags:

• Visible Deformity or Lump: A lump near the base of the thumb can indicate a displaced ligament, a hallmark sign of a Stener lesion.
• Severe Pain and Swelling: Especially if swelling and bruising develop rapidly around the MCP joint.
• Numbness or Tingling: This could signal nerve involvement or damage.
• Inability to Move the Thumb: Complete loss of movement may suggest a severe injury requiring urgent intervention.

Prompt assessment by a specialist can lead to early treatment, minimising the risk of long-term complications like chronic instability or arthritis.

Access Ortho is an orthopaedic clinic offering emergency and follow-up care for orthopaedic injuries such as thumb injuries and potential Stener lesions. 

What is a Fracture Clinic?

A fracture clinic is a specialised medical facility that assesses, diagnoses and treats bone and soft tissue injuries. Access Ortho is a private yet affordable fracture clinic staffed by orthopaedic specialists, emergency specialists and orthopaedic / emergency nurse practitioners. Not all fracture clinics are staffed by specialists in orthopaedics, so it is important to check this. These clinics treat a range of injuries, including fractures, sprains, ligament tears, and tendon injuries. For complex cases like Stener lesions, fracture clinics provide a comprehensive approach to managing bone and ligament injuries and ensuring a rapid, accurate diagnosis. 

Role of Fracture Clinics in Stener Lesion Management

Fracture clinics play a crucial role in diagnosing and treating Stener lesions, which often require surgical repair and structured rehabilitation:

1. Diagnosis: Fracture clinics can refer to specialised imaging (X-rays, ultrasounds, and MRIs) to confirm ligament displacement and assess associated fractures.
2. Surgical Referral: Since Stener lesions usually need surgery, the clinic can refer patients directly to an orthopaedic surgeon or hand specialist for repair. A direct referral from Access Ortho means your wait time for surgery can be shorter.

What to Expect During Your Fracture Clinic Visit

Here’s what a typical visit to a fracture clinic, such as Access Ortho, might involve if you have a potential Stener lesion or other orthopaedic injury:

1. Initial Evaluation: A doctor or nurse practitioner will take a history of your injury, asking about symptoms like pain, instability, or difficulty moving the thumb.
2. Imaging Studies: X-rays may be arranged to rule out fractures, and if a ligament injury is suspected, an ultrasound or MRI may be ordered to assess the UCL.
3. Specialist Assessment: An orthopaedic specialist will review the findings to determine if the ligament is displaced, indicating a Stener lesion.
4. Treatment Planning: If a Stener lesion is confirmed, the medical team will discuss surgical options, including whether the patient wishes to be referred to a public hospital or have surgery privately.

Fracture clinics streamline care for injuries like Stener lesions, ensuring patients receive prompt, specialised treatment and a clear recovery plan for the best outcomes. Access Ortho is a fracture clinic that specialises in assessing and diagnosing orthopaedic injuries and provides specialist orthopaedic follow-up care. Unlike Urgent Care centres or Emergency Departments, Access Ortho can provide follow-up care with an orthopaedic surgeon in Access Ortho clinics. This ensures streamlined care, minimal wait times and expert assistance from the first presentation until a full recovery is made. You do not need a referral to visit Access Ortho; urgent appointments are available.

Commonly Asked Questions

 Can a Stener Lesion heal on its own?

No, Stener lesions typically do not heal on their own. The ulnar collateral ligament (UCL) becomes displaced above the adductor aponeurosis, which prevents it from reconnecting and healing naturally. Surgical intervention is generally required to reposition and repair the ligament.

How is a Stener Lesion different from a simple thumb sprain?

A simple thumb sprain involves a mild to moderate strain or partial tear of the UCL without displacement, which can often heal with rest and immobilisation. In a Stener lesion, however, the UCL is fully torn and displaced above the adductor aponeurosis, necessitating surgical repair for proper healing.

Will I need surgery for my Stener Lesion?

Surgery is usually necessary to reposition and reattach the displaced UCL in Stener lesions. Without surgery, the ligament cannot heal properly, leading to ongoing thumb instability and potentially long-term complications. It is important to get orthopaedic advice regarding the need for surgery.

How long does it take to recover from Stener Lesion surgery?

Recovery from Stener lesion surgery generally takes around 3–4 months. Initial healing requires immobilisation for 4–6 weeks, followed by physiotherapy to regain movement and strength. Depending on progress, most patients can resume normal activities, including sports, within 3–4 months.

Can I still use my hand while recovering from a Stener Lesion?

Yes, you can typically use your hand for light tasks, but the thumb will be immobilised to protect the healing ligament. Avoid activities that stress the thumb until your doctor clears you to do so during the later stages of rehabilitation.

Are there any long-term effects of a Stener Lesion?

With proper treatment, most people recover fully. However, untreated or improperly healed Stener lesions can lead to chronic thumb instability, weakness, pain, and an increased risk of early arthritis in the MCP joint.

How can I prevent re-injury after recovering from a Stener Lesion?

After recovery, you can prevent re-injury by strengthening the muscles around the thumb, wearing protective gear (like braces) during high-risk activities, and practising proper techniques in sports to avoid excessive force on the thumb.

What activities put me at risk for a Stener Lesion?

Activities with a high risk of falls or force on the thumb increase the likelihood of a Stener lesion. This includes skiing, football, basketball, other contact sports, and jobs involving repetitive thumb strain or exposure to falls.

How soon after injury should I seek medical attention for a potential Stener Lesion?

If you suspect a Stener lesion, seek medical attention as soon as possible. Immediate evaluation helps confirm the injury and allows for treatment to start as soon as possible, reducing the risk of complications from delayed repair.

Will physiotherapy be necessary after Stener Lesion treatment?

Yes, physiotherapy is an essential part of recovery. Therapy helps restore thumb mobility, strength, and function, ensuring a smooth return to daily activities and reducing the risk of re-injury.