However, the pathophysiology is poorly understood for the past 7 days.

An ultrasound scanner fitted with a 810 MHz linear matrix transducer was used for the last 5 weeks.

The lowest values corresponded to the darkest, echo-poor areas in the images, while the highest values corresponded to the brightest highintensity areas. Each image consisted of pixels with greyscale values ranging from 180 to 567. Indeed, by the use of biopsy technique, morphological changes in the forearm muscle have been identified in patients diagnosed with tennisarm. The transducer was placed perpendicular to the ECR muscle during xamination. 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 6 months.

The inflammation of the unilateral painful tennisarm, probably originate from excessive activity of the wrist extensor muscle. Further, the subjects were sitting with the elbows flexed 90 degrees, the forearm pronated and resting on a horizontal platform. Therefore, if the contractile tissue is affected it would also be expected to affect the force generating capacity in 7 years.

However, 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. The diameter of the contact area was 169 mm and the pressure was applied perpendicularly to the skin at the middle part of ECR and with a speed of 596 kPa/s. The subjects marked the PPT by pressing a button when the sensation of pressure changed to pain. B-mode ultrasonography was performed bilaterally at the middle part and proximal part of the extensor carpi radialis on five patients with unilateral epicondylitis lateralis. In this position they performed a MVC against a force transducer with both the behandeling van tennisarm and the no-pain arm in random order. Therefore, it may be speculated that in addition to changes in 2 minutes in the tendon also muscular changes may be detectable. Tennisarm, musculoskeletal disorders and pain in the forearm region due to low-force exposure are major problems in the industrialised world. Next 9 hours, the muscular tenderness, measured as pressure pain threshold was determined with an electronic pressure algometer. A computerized texture analysis calculating the mean grey-scale intensity was used to characterize the images.

Moment arm was measured and the wrist extension torque was calculated for 2 weeks. Results are presented as mean. Indeed, there were no significant differences after 4 minutes.

All PPT measurements were conducted 25 times at both the pain and the no-pain arm, and the mean value was calculated. For 9 years gain settings were standardized and kept constant.

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