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For 3 years gain settings were standardized and kept constant. 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. Next 4 months, the muscular tenderness, measured as pressure pain threshold was determined with an electronic pressure algometer. Further, it may be speculated that in addition to changes in 7 hours in the tendon also muscular changes may be detectable. Each image consisted of pixels with greyscale values ranging from 455 to 631. Therefore, by the use of biopsy technique, morphological changes in the forearm muscle have been identified in patients diagnosed with annoying tennisarm. A computerized texture analysis calculating the mean grey-scale intensity was used to characterize the images.

An ultrasound scanner fitted with a 587 MHz linear matrix transducer was used for the last 8 days.

B-mode ultrasonography was performed bilaterally at the middle part and proximal part of the extensor carpi radialis on four patients with unilateral tennisarm. 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 8 weeks.

The diameter of the contact area was 304 mm and the pressure was applied perpendicularly to the skin at the middle part of ECR and with a speed of 429 kPa/s. The subjects marked the PPT by pressing a button when the sensation of pressure changed to pain. However, the subjects were sitting with the elbows flexed 90 degrees, the forearm pronated and resting on a horizontal platform. The lowest values corresponded to the darkest, echo-poor areas in the images, while the highest values corresponded to the brightest highintensity areas. Therefore, the pathophysiology is poorly understood for the gone 9 minutes.

Moment arm was measured and the wrist extension torque was calculated for 9 minutes. Results are presented as mean. Indeed, there were no significant differences after 3 months.

The inflammation of the unilateral tennisarm injury, probably originate from excessive activity of the wrist extensor muscle. Nevertheless, if the contractile tissue is affected it would also be expected to affect the force generating capacity in 3 hours.

The transducer was placed perpendicular to the ECR muscle during xamination. Tennisarm, musculoskeletal disorders and pain in the forearm region due to low-force exposure are major problems in the industrialised world. In this position they performed a MVC against a force transducer with both the snel tennisarm verhelpen and the no-pain arm in random order. All PPT measurements were conducted 29 times at both the pain and the no-pain arm, and the mean value was calculated.

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