Background:
The accurate diagnosis of Stener lesions in ulnar collateral ligament (UCL) injuries of the thumb is critical for determining the need for surgical intervention. While international literature1 reports high ultrasound (USS) sensitivity (95%) for detecting Stener lesions, clinical experience at Christchurch Hospital suggests a high false positive rate.
Methods:
A retrospective analysis was conducted on all UCL repair operations performed at Christchurch Hospital between January 2022 - January 2025. Patient demographics, ultrasound results, Intra-operative findings were recorded. Cases with incomplete data and non UCL-repair operations were excluded.
Results:
There were 95 UCL repairs performed over a 36 month period. 31 were excluded due to incomplete data or complex injuries. There were 41 males and 23 females. The median age was 42.5 (range 12 to 82) and 56% had their UCL repaired on their dominant hand. 51 (80%) of the 64 patients were true Stener lesions intra-operatively. This was only 60% in patients aged 60 or greater.
Conclusion:
A positive predictive value of 80% suggests that up to 20% of patients may undergo unnecessary surgical intervention. This study highlights the limitations of USS in diagnosing Stener lesions in our clinical setting and presents a new diagnostic pathway incorporating MRI (sensitivity 96-100%) for select patients. We propose a stratified approach: patients under 60 years of age with USS-proven Stener lesions should proceed directly to surgery, while those aged 60 and above should undergo MRI confirmation before surgical intervention. This approach may reduce surgical morbidity and healthcare costs.