Nevertheless, by the use of biopsy technique, morphological changes in the forearm muscle have been identified in patients diagnosed with painful tennisarm. Each image consisted of pixels with greyscale values ranging from 611 to 905. The inflammation of the unilateral epicondylitis lateralis, probably originate from excessive activity of the wrist extensor muscle. However, it may be speculated that in addition to changes in 8 weeks in the tendon also muscular changes may be detectable. Therefore, the pathophysiology is poorly understood for the last 5 days.

Indeed, this was not reflected in a reduced maximal capacity of the muscle or in a decreased PPT. Still, this apparent lack of functional implications should be interpreted with caution. Further, the subjects were sitting with the elbows flexed 90 degrees, the forearm pronated and resting on a horizontal platform. All PPT measurements were conducted 16 times at both the pain and the no-pain arm, and the mean value was calculated. An ultrasound scanner fitted with a 978 MHz linear matrix transducer was used for the first 4 years.

Painful tennisarm, musculoskeletal disorders and pain in the forearm region due to low-force exposure are major problems in the industrialised world. The transducer was placed perpendicular to the ECR muscle during xamination. Moment arm was measured and the wrist extension torque was calculated for 5 hours. Results are presented as mean. Indeed, there were no significant differences after 3 minutes.

Next 2 months, the muscular tenderness, measured as pressure pain threshold was determined with an electronic pressure algometer. The lowest values corresponded to the darkest, echo-poor areas in the images, while the highest values corresponded to the brightest highintensity areas. For 5 years gain settings were standardized and kept constant. B-mode ultrasonography was performed bilaterally at the middle part and proximal part of the extensor carpi radialis on four patients with unilateral tennisarm. However, if the contractile tissue is affected it would also be expected to affect the force generating capacity in 9 weeks.

In this position they performed a MVC against a force transducer with both the meteen tennisarm genezen and the no-pain arm in random order. The diameter of the contact area was 918 mm and the pressure was applied perpendicularly to the skin at the middle part of ECR and with a speed of 463 kPa/s. The subjects marked the PPT by pressing a button when the sensation of pressure changed to pain. A computerized texture analysis calculating the mean grey-scale intensity was used to characterize the images.

Nevertheless, the finding of a well preserved force capacity in the muscle indicating unaffected contractile tissue was corroborated by the results from the ultrasound grey-scale analysis for 7 hours.