Imaging Case of the Week 136

This right hand x-ray is from a 40 year old with pain and swelling at the base of his right thumb. What can be observed and what is its significance?


Right thumb x-ray

[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The x-ray shows a displaced avulsion fracture of the ulnar base of the proximal phalanx of the right thumb.

This is known as Skier’s thumb and is associated with the rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb.

Skier's thumb

The patient was referred to hand surgeon for operative repair.

An ultrasound scan obtained showed the displaced osseous fragment, containing the distal attachment of the UCL, lying superficial to the adductor aponeurosis. This pattern of injury is called a ‘Stener lesion’ and is an indication for surgical repair.