Stener-like lesions of collateral ligament ruptures of the metacarpophalangeal joint of the finger.

BACKGROUND: The Stener lesion of the ulnar collateral ligament of the metacarpophalangeal (MP) joint of the thumb is characterized by an interposition of the adductor aponeurosis between a distally avulsed ligament and its insertion into the base of the proximal phalanx. Stener-like lesions of the MP joint of the finger have been previously reported in only a few cases. METHODS: The authors experienced 38 cases of collateral ligament injuries of the MP joint of the finger. The two most frequently affected sites were the radial side of the little finger (21 cases) and the radial side of the ring finger (8 cases). We have previously reported some of these cases (22 cases), as well as clinical features and arthrographic findings. One Stener-like lesion in a collateral ligament injury of the MP joint of the ring finger was also reported earlier (Ishizuki, 1988). Additionally, Stener-like lesions were found postoperatively in six of eight cases surgically treated for collateral ligament injuries of the MP joint of the finger (little finger involvement in 5 cases and long finger involvement in 1 case). RESULTS: We experienced six cases of a Stener-like lesion of the MP joint of the finger. In five of these cases the distally avulsed collateral ligament was trapped by the opened window of the injured sagittal band. In the other case the ligament was avulsed at a proximal site, and the ruptured end was trapped by the sagittal band. All of the little fingers involving Stener-like lesions were abducted and unable to adduct. Therefore, an abducted little finger is an important sign of this lesion and is considered to warrant surgical treatment. Arthrograms provided information useful for identifying the lesions. In the radial three fingers, palpation of the tumor at the level of the collateral ligament may also be an important examining tool for identifying a displaced ruptured collateral ligament of the MP joint of the finger. CONCLUSION: We experienced six cases of Stener-like lesions of the MP joint of the finger. In all cases, the avulsed collateral ligament was trapped by the ruptured sagittal band. Surgical treatment was thought to be indicated in these cases. Therefore, it is important to avoid overlooking Stener-like lesions of the MP joint of the finger.

Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging.

We studied magnetic resonance images of rotator cuff tears to determine whether it was possible to establish preoperatively the feasibility or infeasibility of primary repair. The study comprised 27 shoulders in 26 patients who underwent magnetic resonance imaging before surgery because of complete tears of the rotator cuff and who were treated with primary repair or by the patch graft technique because primary repair was not feasible. The length and width of each tear, the thickness of the supraspinatus muscle at the superior margin of the glenoid, and the presence or absence of a high signal intensity in the infraspinatus muscle were statistically analyzed. Primary repair was often not feasible when both the length and width of the tear exceeded 40 mm on a preoperative magnetic resonance image, when the supraspinatus muscle was thin at the superior margin of the glenoid, and when a high signal intensity was observed in the infraspinatus muscle.