Hand iSAWE 15

Question

A 29 year old skier falls with a pole in her hand. She has pain and swelling on the ulnar side of the thumb MCP joint.

Hand iSAWE 15, radiograph of the thumb
Radiograph of the thumb. Image by Fluffy89502, Wikimedia Commons, CC BY-SA 4.0.
  1. What is the injury and how is it examined?
  2. What is a Stener lesion?
  3. Outline management.

Answer

Injury and examination

  • Ulnar collateral ligament injury of the thumb MCP joint (skier’s thumb, gamekeeper’s thumb when chronic)
  • Radiograph first to exclude a displaced avulsion fracture before stress testing
  • Stress in 30 degrees of flexion tests the proper collateral
  • Stress in full extension tests the accessory collateral and volar plate
  • Laxity over 30 to 35 degrees or 15 degrees more than the other side, or no firm end point, means complete rupture
  • Local anaesthetic helps if pain limits examination

Stener lesion

  • Torn distal UCL displaced superficial to the adductor pollicis aponeurosis
  • Aponeurosis blocks ligament healing
  • Present in most complete ruptures
  • Palpable lump proximal to the adductor aponeurosis
  • Ultrasound or MRI if uncertain

Management

  • Partial tears, hand based thumb spica for 4 to 6 weeks
  • Complete tears and Stener lesions, early repair with a suture anchor into the base of the proximal phalanx
  • Displaced or rotated avulsion fractures over 2 mm, fixation
  • Chronic instability, free tendon graft reconstruction
  • MCP fusion for arthritis

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.