title: Strength and fatigability of selected muscles in upper limb: assessing muscle imbalance relevant to tennis elbow.
abstract: OBJECTIVE
  The aetiology of tennis elbow has remained uncertain for more than a century. To examine muscle imbalance as a possible pathophysiological factor requires a reliable method of assessment. This paper describes the development of such a method and its performance in healthy subjects. We propose a combination of surface and fine-wire EMG of shoulder and forearm muscles and wrist strength measurements as a reliable tool for assessing muscle imbalance relevant to the pathophysiology of tennis elbow.
  
  
  METHODS
  Six healthy volunteers participated. EMG data were acquired at 50% maximal voluntary isometric contraction from five forearm muscles during grip and three shoulder muscles during external rotation and abduction, and analysed using normalized median frequency slope as a fatigue index. Wrist extension/flexion strength was measured using a purpose-built dynamometer.
  
  
  RESULTS
  Significant negative slope of median frequency was found for all muscles, with good reproducibility, and no significant difference in slope between the different muscles of the shoulder and the wrist. (Amplitude slope showed high variability and was therefore unsuitable for this purpose.) Wrist flexion was 27+/-8% stronger than extension (mean+/-SEM, p=0.006).
  
  
  CONCLUSIONS
  This is a reliable method for measuring muscle fatigue in forearm and shoulder. EMG and wrist strength studies together can be used for assessing and identifying the muscle balance in the wrist-forearm-shoulder chain.
authors.affiliation: Musculoskeletal Science Research Group, University of Liverpool, Liverpool, UK. omid1348@liv.ac.uk
authors.forename: O
authors.initials: O
authors.lastname: Alizadehkhaiyat
authors.forename: A C
authors.initials: AC
authors.lastname: Fisher
authors.forename: G J
authors.initials: GJ
authors.lastname: Kemp
authors.forename: S P
authors.initials: SP
authors.lastname: Frostick
mesh_terms: D000328:Adult; D000368:Aged; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018763:Muscle Fatigue / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D012399:Rotation; D013716:Tennis Elbow / Q000503:physiopathology*; D034941:Upper Extremity / Q000503:physiopathology*