Semiquantitative index of symptomatic minor instability of the lateral elbow at CT arthrography (SMILE index): clinical applicability and reproducibility study

CT Arthrography of the Elbow: What Radiologists Should Know

“…intra-articular findings detectable at CT arthrography, such as radiocapitellar chondromalacia and pathological laxity of the annular ligament (Figure 7) [54]. Extreme cases of concomitant LCL and common extensor tendon full-thickness rupture can also sometimes be seen as sequelae of repeated corticosteroid injections performed without US guidance for the treatment of lateral epicondylitis [55], with extravasation of intraarticular contrast agent in peritendinous soft tissues (Figure 8).…”

“…Extreme cases of concomitant LCL and common extensor tendon full-thickness rupture can also sometimes be seen as sequelae of repeated corticosteroid injections performed without US guidance for the treatment of lateral epicondylitis [55], with extravasation of intraarticular contrast agent in peritendinous soft tissues (Figure 8). Overuse-related lateral elbow pain, often diagnosed as lateral epicondylitis, may be often associated with a condition of elbow instability termed symptomatic minor instability of the lateral elbow (SMILE), which has been shown to present with several intra-articular findings detectable at CT arthrography, such as radiocapitellar chondromalacia and pathological laxity of the annular ligament (Figure 7) [54]. Extreme cases of concomitant LCL and common extensor tendon full-thickness rupture can also sometimes be seen as sequelae of repeated corticosteroid injections performed without US guidance for the treatment of lateral epicondylitis [55], with extravasation of intra-articular contrast agent in peritendinous soft tissues (Figure 8).…”

Don’t forget to SMILE—a novel radiological index to characterize symptomatic minor instability of the lateral elbow

“…In their article "Semiquantitative index of symptomatic minor instability of the lateral elbow at CT arthrography (SMILE index): clinical applicability and reproducibility study, " Zagarella et al propose a novel radiological index that considers different aspects of SMILE, i.e., chondromalacia, annular ligament laxity, synovial thickening, humeroradial joint asymmetry, and capsular tears. A maximum of 8 points can be attributed in total, allowing for a fine-granular classification of minor instability [6]. Interestingly, the SMILE index was conceptualized and investigated based on the detailed analysis of 90 CT arthrograms in 80 individuals with ultrasound-guided articular injection of contrast agent.…”