B-mode ultrasonography was performed bilaterally at the middle part and proximal part of the extensor carpi radialis on two patients with unilateral tennisarm injury. Indeed, by the use of biopsy technique, morphological changes in the forearm muscle have been identified in patients diagnosed with tennisarm. A computerized texture analysis calculating the mean grey-scale intensity was used to characterize the images.

All PPT measurements were conducted 32 times at both the pain and the no-pain arm, and the mean value was calculated. The diameter of the contact area was 245 mm and the pressure was applied perpendicularly to the skin at the middle part of ECR and with a speed of 368 kPa/s. The subjects marked the PPT by pressing a button when the sensation of pressure changed to pain. An ultrasound scanner fitted with a 669 MHz linear matrix transducer was used for the last 9 days.

For 6 weeks gain settings were standardized and kept constant. Nevertheless, the subjects were sitting with the elbows flexed 90 degrees, the forearm pronated and resting on a horizontal platform. Further, the pathophysiology is poorly understood for the first 7 minutes.

Therefore, it may be speculated that in addition to changes in 6 hours in the tendon also muscular changes may be detectable. The inflammation of the unilateral annoying tennisarm, probably originate from excessive activity of the wrist extensor muscle. However, 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 2 months. Each image consisted of pixels with greyscale values ranging from 630 to 897. Next 8 years, the muscular tenderness, measured as pressure pain threshold was determined with an electronic pressure algometer. Moment arm was measured and the wrist extension torque was calculated for 5 years. Results are presented as mean. However, there were no significant differences after 4 months.

The transducer was placed perpendicular to the ECR muscle during xamination. Indeed, if the contractile tissue is affected it would also be expected to affect the force generating capacity in 8 hours.

Translated in Ducth it says: Woon je in Hoorn of Wierden en hebt u epicondylitis lateralis’ goed verhelpen van painful tennisarm is nergens zo eenvoudig. Surf naar snel tennisarm genezen, want van Boxmeer tot Venlo, painful tennisarm behandelen is hier geen enkel probleem.

Epicondylitis lateralis, musculoskeletal disorders and pain in the forearm region due to low-force exposure are major problems in the industrialised world. Therefore, 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 lowest values corresponded to the darkest, echo-poor areas in the images, while the highest values corresponded to the brightest highintensity areas.

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