A Gamekeeper’s Thumb or Skier’s thumb is a tear of the ulnar collateral ligament of the thumb MCPJ. The tears can be graded reflecting the severity of the tear and the degree of retraction of the UCL the importance of which is that the more retraction there is, the less likely that the UCL will reattach to the proximal phalynx and heal. In a Stener lesion the UCL is severely retracted and has a “balled-up’ appearance and lies superficial to the adductor aponeurosis and thus cannot reattach and heal on it own and requires surgery. Go back to the last post on the normal appearance of the UCL and adductor aponeurosis before seeing this post on the appearance of UCL tears and Stener lesions.

Image Above: Coronal scans volar to dorsal. Insertion of adductor pollicis ( red arrow). Torn UCL ( blue arrow)  from its distal attachment with slight retraction( gap between ucl and bone). Adductor Pollicis  ( yellow arrow) overlies the UCL. 

Image Above: Same patient. Axial  scans proximal to distal.  Proximal UCL  intact ( blue arrow)  and torn from its distal attachment ( pink arrow). The adductor aponeurosis overlies the proximal UCL ( yellow arrow).

 

Image Above: Same patient. Coronal and axial scans Same patient.  Proximal UCL  intact ( blue arrow) . The adductor aponeurosis overlies the proximal UCL ( yellow arrow).

 

 

Image Above diagram of what happens to the UCL in a stener lesion.

Image Above:  Torn UCL ( blue arrow)  from its distal attachment with retraction( gap between ucl and phalynx) and a ” balled-up” appearance. The retracted UCL projects outwards from the metacarpal which is a good sign of a Stener lesion.  On the axial scans the UCL is more superficial than the Adductor Aponeurosis ( yellow arrow)