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Author Affiliation Disclosures Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. Abstract The ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint is a static stabilizer that may rupture from a hyperabduction injury. Although some UCL tears may heal with immobilization, outcomes are worse for Stener lesions, in which the proximal ligament stump slips out from beneath the adductor pollicis aponeurosis and is entrapped proximal and superficial to the aponeurosis, preventing primary healing. We report the case of a patient with a Stener lesion with radiographic, ultrasound, and magnetic resonance imaging correlation, subsequently confirmed with intraoperative photographs. Physicians must be familiar with the regional anatomy to understand the injury pathogenesis and the need for surgical intervention to optimize patient outcomes. Take-Home Points • Torn, displaced, and entrapped UCL is a Stener lesion.
• Hyperabduction injury with pain and joint laxity on examination. • MRI and ultrasound are useful in evaluating UCL tears. • Ultrasound offers dynamic evaluation. • Must be treated appropriately to avoid pain, instability, and osteoarthritis. In the literature, hyperabduction injuries to the thumb metacarpophalangeal (MCP) joint have been referred to interchangeably as gamekeeper’s thumb and skier’s thumb. Historically, though, gamekeeper’s thumb was initially described in hunters with chronic injury to the ulnar collateral ligament (UCL), 1 and skier’s thumb typically has been described as an acute hyperabduction injury of the UCL.
2-5 The proximal portion of a torn UCL may retract with further abduction and displace dorsally, becoming entrapped by the adductor pollicis aponeurosis insertion, known as a Stener lesion. 6 The first MCP joint is stabilized by static and dynamic structures that contribute in varying degrees in flexion and extension of the joint.
The static stabilizers include the proper and accessory radial and UCLs, the palmar plate, and the dorsal capsule. The UCL originates at the dorsal ulnar aspect of the first metacarpal head at the metacarpal tubercle about 5 mm proximal to the articular surface. 
The UCL courses distally in the palmar direction to insert volar and proximal to the medial tubercle of the proximal phalanx about 3 mm distal to the articular surface. 7 In flexion, the proper collateral ligament is taut and is the primary static stabilizer. In extension, the accessory collateral ligament, which inserts on the palmar plate, is taut and is the primary static stabilizer. 8-11 The dynamic stabilizers include the extrinsic muscles (flexor pollicis longus, extensor pollicis longus and brevis) and the intrinsic muscles (abductor pollicis brevis, adductor pollicis, flexor pollicis brevis) inserting on the thumb at the distal phalanx and proximal phalanx and at the base of the first metacarpal. There is also a broad aponeurosis that inserts onto the extensor hood expansion, dorsal to the insertion of the UCL ( Figures 1A-1C and 2A, 2B).