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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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The role of Magnetic Resonance Imaging (MRI) and Ultrasound (US) in the diagnosis of the thumb Stener lesion

Meeting Abstract

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  • presenting/speaker Juan Manuel Breyer - Clínica Alemana, Hospital del Trabajador, Santiago, Chile
  • Diego Junqueras - Clínica Alemana, Santiago, Chile
  • Nicolas Zilleruelo - Clínica Alemana, Santiago, Chile
  • Alejandro Bifani - Clínica Alemana, Santiago, Chile
  • Felipe Saxton - Clínica Alemana, Santiago, Chile
  • Sebastian Undurraga - Clínica Alemana, Mutual de Seguridad, Santiago, Chile
  • Rodolfo Ide - Clínica Alemana, Hospital del Trabajador, Santiago, Chile
  • Robinson Gonzalez - Clínica Alemana, Mutual de Seguridad, Santiago, Chile

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1022

doi: 10.3205/19ifssh0624, urn:nbn:de:0183-19ifssh06243

Published: February 6, 2020

© 2020 Breyer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The interposition of the fascia of the adductor pollicis muscle in the ulnar metacarpophalangeal (MCP) ligament injury of the thumb (Stener lesion), is a pathology that requires surgical treatment. The ability to accurately diagnose Stener lesion has proven to be difficult and unreliable; the most common imaging methods used to diagnose this injury are US and MRI, however, their utility is not clearly established.

The purpose of this study is to evaluate the diagnostic accuracy of US and MRI for the Stener lesion.

Methods: A descriptive study was carried out in 14 adult patients, operated on suspicion of a Stener lesion of the thumb, with joint instability (more than 30º) after an acute trauma (less than 10 days). Patients with open injuries and fractures were excluded.

After the surgery was indicated, an ultrasound study (evaluated by one observer) and an MRI (evaluated by four observers) were performed, with emphasis on the presence of a Stener lesion. Both exams were blind to the surgeon, patient and observers.

Results: All patients presented complete rupture of the ulnar collateral ligament in the surgery, but only eight of them (57,1%) had the Stener lesion.

For the identification of Stener, the MRI presented a sensitivity of 87.5%, specificity of 66.6%, PPV 77.7% and NPV of 80%. The US had a sensitivity of 100%, specificity of 50%, PPV 72% and NPV of 100%. Moderate to considerable values were obtained in interobserver and intraobserver concordance for MRI.

Conclusions: In the suspicion of a Stener lesion, US and MRI are complementary studies that would help improve the diagnosis. However, the values of specificity and negative predictive value are insufficient to confirm the Stener lesion and reduce the false positive diagnosis, so their use would not yet fully resolve this situation.