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Scandinavian Journal of Surgery : SJS :... Sep 2021Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis...
BACKGROUND
Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike.
METHODS
The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience.
RESULTS
The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient's symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior.
DISCUSSION
The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
Topics: Abdominal Core; Abdominal Wall; Female; Hernia, Ventral; Humans; Pregnancy; Rectus Abdominis; Sweden
PubMed: 32988320
DOI: 10.1177/1457496920961000 -
The Journal of Orthopaedic and Sports... Jul 2016Study Design Cross-sectional repeated measures. Background Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD).... (Observational Study)
Observational Study
Study Design Cross-sectional repeated measures. Background Rehabilitation of diastasis rectus abdominis (DRA) generally aims to reduce the inter-rectus distance (IRD). We tested the hypothesis that activation of the transversus abdominis (TrA) before a curl-up would reduce IRD narrowing, with less linea alba (LA) distortion/deformation, which may allow better force transfer between sides of the abdominal wall. Objectives This study investigated behavior of the LA and IRD during curl-ups performed naturally and with preactivation of the TrA. Methods Curl-ups were performed by 26 women with DRA and 17 healthy control participants using a natural strategy (automatic curl-up) and with TrA preactivation (TrA curl-up). Ultrasound images were recorded at 2 points above the umbilicus (U point and UX point). Ultrasound measures of IRD and a novel measure of LA distortion (distortion index: average deviation of the LA from the shortest path between the recti) were compared between 3 tasks (rest, automatic curl-up, TrA curl-up), between groups, and between measurement points (analysis of variance). Results Automatic curl-up by women with DRA narrowed the IRD from resting values (mean U-point between-task difference, -1.19 cm; 95% confidence interval [CI]: -1.45, -0.93; P<.001 and mean UX-point between-task difference, -0.51 cm; 95% CI: -0.69, -0.34; P<.001), but LA distortion increased (mean U-point between-task difference, 0.018; 95% CI: 0.0003, 0.041; P = .046 and mean UX-point between-task difference, 0.025; 95% CI: 0.004, 0.045; P = .02). Although TrA curl-up induced no narrowing or less IRD narrowing than automatic curl-up (mean U-point difference between TrA curl-up versus rest, -0.56 cm; 95% CI: -0.82, -0.31; P<.001 and mean UX-point between-task difference, 0.02 cm; 95% CI: -0.22, 0.19; P = .86), LA distortion was less (mean U-point between-task difference, -0.025; 95% CI: -0.037, -0.012; P<.001 and mean UX-point between-task difference, -0.021; 95% CI: -0.038, -0.005; P = .01). Inter-rectus distance and the distortion index did not change from rest or differ between tasks for controls (P≥.55). Conclusion Narrowing of the IRD during automatic curl-up in DRA distorts the LA. The distortion index requires further validation, but findings imply that less IRD narrowing with TrA preactivation might improve force transfer between sides of the abdomen. The clinical implication is that reduced IRD narrowing by TrA contraction, which has been discouraged, may positively impact abdominal mechanics. J Orthop Sports Phys Ther 2016;46(7):580-589. doi:10.2519/jospt.2016.6536.
Topics: Abdominal Wall; Adult; Cross-Sectional Studies; Exercise Therapy; Female; Humans; Male; Muscle Contraction; Rectus Abdominis; Ultrasonography; Young Adult
PubMed: 27363572
DOI: 10.2519/jospt.2016.6536 -
Ugeskrift For Laeger Nov 2013Diastasis rectus abdominis is a common condition, which may be mistaken for a ventral hernia. The literature is generally of poor quality. The evidence for the effect of... (Review)
Review
Diastasis rectus abdominis is a common condition, which may be mistaken for a ventral hernia. The literature is generally of poor quality. The evidence for the effect of conservative and surgical treatment is controversial and long-term results are unknown. Present analyses find that complication rates range from 4% to 88% and the most frequent complication is seroma formation. The risk of recurrence is up to 40%. Treatment of rectus diastasis should preferably follow scientific protocols and be restricted to patients with severe physical complaints.
Topics: Abdominal Wall; Humans; Laparoscopy; Plastic Surgery Procedures; Rectus Abdominis; Suture Techniques
PubMed: 24629315
DOI: No ID Found -
Arthroscopy : the Journal of... Dec 2020Often referred to as a "sports hernia" or "core muscle injury," athletic pubalgia is a common yet poorly defined athletic injury. It is characterized by abdominal and...
Often referred to as a "sports hernia" or "core muscle injury," athletic pubalgia is a common yet poorly defined athletic injury. It is characterized by abdominal and groin pain likely from weakening or tearing of the abdominal wall without evidence of a true hernia. Symptoms can appear acutely or insidiously, primarily as groin and lower abdominal pain that can radiate toward the perineum and proximal adductors. Pain is exacerbated by athletic activity such as kicking, cutting, and sprinting. The pubis acts as a pivot point between the abdominal musculature and lower-extremity adductors, and therefore, pain with palpation over the symphysis or its surrounding structures is typical in athletic pubalgia. Symptoms can be reproduced during a resisted sit-up or with a forced cough or sneeze. Clinical examination should include an evaluation of articular hip pathology to identify underlying femoroacetabular impingement syndrome. Magnetic resonance imaging can aid in ruling out other pathologies and identify specific findings including tears or strains of the ipsilateral rectus abdominis or adductor tendons. Lidocaine injections can be used to localize the source of the pain. First-line treatment consists of a period of rest and anti-inflammatories, followed by a course of focused physical therapy. If conservative therapy fails to allow an athlete to return to activity, a variety of open or laparoscopic surgical techniques can be used. The surgical principles include reattachment of the rectus abdominis and repair or reinforcement of the abdominal musculature in layers to re-create the inguinal ligament anatomy. At times, variations of pelvic floor repair are performed or the addition of an adductor tenotomy or repair is used concomitantly. Numerous studies report a high rate of return to play after surgical management. Diagnosis and appropriate treatment of coexisting femoroacetabular impingement syndrome are crucial to a successful return to athletic activity.
Topics: Abdominal Pain; Athletes; Athletic Injuries; Femoracetabular Impingement; Groin; Hernia, Abdominal; Herniorrhaphy; Humans; Magnetic Resonance Imaging; Male; Physical Examination; Pubic Bone; Rectus Abdominis; Tendons; Tenotomy
PubMed: 33276883
DOI: 10.1016/j.arthro.2020.09.022 -
Surgical and Radiologic Anatomy : SRA Apr 2021The anterior abdominal muscle wall has a strong aesthetic connotation, primarily because of the classical anatomical description of the rectus abdominis muscle in the...
PURPOSE
The anterior abdominal muscle wall has a strong aesthetic connotation, primarily because of the classical anatomical description of the rectus abdominis muscle in the collective consciousness. However, the morphological reality of the general population considerably deviates from this description. Therefore, we investigated the anthropometric characteristics correlated with the anatomy of the rectus abdominis muscle.
METHODS
We performed a computed tomography scan anatomical study of recti abdominis muscles in 86 patients with no history of abdominal surgery. We noted the transverse and anteroposterior measurements of the rectus abdominis muscle, the transverse measurement of the linea alba, and the cutaneous and muscular abdominal perimeters. We compared these morphological elements with anthropometric data (sex, age, weight, height, and body mass index [BMI]).
RESULTS
BMI was positively correlated with cutaneous abdominal perimeter (r = 0.89, p < 0.001) and muscular abdominal perimeter (r = 0.7, p < 0.001). The correlation of BMI with cutaneous abdominal perimeter was not influenced by sex (r = 0.90 and r = 0.89 in men and women, respectively). The correlation of BMI with muscular abdominal perimeter was greater in men than in women (r = 0.80 vs. r = 0.75). The muscular abdominal perimeter was more strongly correlated with the transverse measurement of the rectus abdominis muscle in men than in women (r = 0.75 vs. r = 0.59). The muscular abdominal perimeter was more strongly correlated with the linea alba in women than in men (r = 0.51 vs. r = 0.31).
CONCLUSION
The anatomy of the anterior abdominal wall correlated with anthropometric data, including BMI. Rectus abdominis muscles and linea alba structures differed between men and women.
Topics: Abdominal Wall; Adult; Age Factors; Aged; Aged, 80 and over; Body Height; Body Mass Index; Body Weight; Esthetics; Female; Humans; Male; Middle Aged; Rectus Abdominis; Retrospective Studies; Sex Factors; Tomography, X-Ray Computed
PubMed: 33399920
DOI: 10.1007/s00276-020-02655-9 -
The Journal of Obstetrics and... Aug 2010The abdominal wall is an uncommon site of extrapelvic endometriosis, which usually develops in a previous surgical scar and it should be considered in the differential... (Review)
Review
The abdominal wall is an uncommon site of extrapelvic endometriosis, which usually develops in a previous surgical scar and it should be considered in the differential diagnosis of any abdominal swelling. Endometriosis involving the rectus abdominis muscle is a very rare event and its rarity explains the incomplete nature of the reports in the literature. Up to the present, 18 cases with lesions contained entirely within the rectus abdominis muscle were clearly documented in medical literature with only four cases as a primary location. We report a case, which came to our observation, of primary endometriosis of the rectus abdominis muscle. The patient underwent only surgery without any medical treatment. Currently, the patient is in follow up for four years with no recovery of the disease. In our experience, surgery is the treatment of choice and it is decisive. We reviewed the literature and summarized all reported cases.
Topics: Abdominal Wall; Adult; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Muscular Diseases; Rectus Abdominis; Treatment Outcome
PubMed: 20666967
DOI: 10.1111/j.1447-0756.2010.01236.x -
Hernia : the Journal of Hernias and... Aug 2017Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of... (Comparative Study)
Comparative Study
PURPOSE
Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions.
METHODS
Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscle thickness was measured on both preoperative and follow-up computed tomography (CT) scans to calculate percent atrophy of the muscle after surgery.
RESULTS
At average follow-up of 24.5 and 19.0 months, respectively, rectus abdominis atrophy was 18.9% greater in the chevron (n = 30) than in the midline (n = 180) group (21.8 vs. 2.9%, p < 0.0001). Half the patients with a chevron incision had >20% atrophy at follow-up compared with 10% with a midline incision [odds ratio (OR) 9.0, p < 0.0001]. No significant difference was observed in incisional hernia rates or wound infections between groups.
CONCLUSION
In this study, chevron incisions resulted in seven times more atrophy of the rectus abdominis compared with midline incisions. The long-term effects of transecting the rectus abdominis and disrupting its innervation creates challenging abdominal wall pathology. Atrophy of the abdominal wall can not be readily fixed with an operation, and this significant side effect of a transverse incision should be factored into the surgeon's decision-making process when choosing a transverse over a midline incision.
Topics: Abdominal Wall; Aged; Atrophy; Female; Hernia, Ventral; Humans; Incisional Hernia; Laparotomy; Male; Middle Aged; Muscular Atrophy; Rectus Abdominis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 28343314
DOI: 10.1007/s10029-017-1593-z -
Journal of Ultrasound Sep 2020This is a rare case of a post-traumatic rectus abdominis muscle tear in an adolescent female diagnosed by ultrasonography (US). Conservative management is also described.
PURPOSE
This is a rare case of a post-traumatic rectus abdominis muscle tear in an adolescent female diagnosed by ultrasonography (US). Conservative management is also described.
METHODS
A 14-year-old female presented to a chiropractic clinic with extreme pain and tenderness in the right lower quadrant (RLQ) after post-plyometric power kneel box jumps. Movement aggravated her pain and she demonstrated active abdominal guarding with RLQ palpation. Ultrasonography revealed a subacute Grade 2 right rectus abdominis muscle tear, without evidence of hyperemia or a hematoma. Following the diagnosis of a right rectus abdominis muscle tear, she was treated with spinal manipulation and a course of musculoskeletal rehabilitation directed at truncal stabilization.
RESULTS
After treatment, the patient was able to return to play 5 week post-injury without any pain or discomfort. A follow-up US at 3 months provided evidence of muscle healing without complications.
CONCLUSION
This case demonstrates the diagnosis of a rare rectus abdominis muscle tear managed conservatively. To our knowledge, less than a dozen cases are reported using US in the evaluation and diagnosis of a rectus abdominis tear.
Topics: Adolescent; Athletic Injuries; Conservative Treatment; Female; Humans; Rectus Abdominis; Ultrasonography
PubMed: 31721108
DOI: 10.1007/s40477-019-00416-y -
International Journal of Environmental... Jun 2022To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the efficacy of exercise intervention using a real-time video conferencing platform (ZOOM) on inter-recti distance, abdominal muscle thickness, static trunk endurance, and maternal quality of life, 37 women with diastasis recti between six months and one year postpartum were randomly divided into the online (n = 19) and offline (n = 18) groups. The online group underwent 40-min trunk stabilization exercise sessions twice a week for six weeks, through a real-time video conference platform, while the offline group attended the same program in person. The inter-recti distance and muscle thickness between the abdominal muscles were measured by rehabilitation ultrasound imaging, the Torso endurance test was used to compare the static trunk endurance, and the maternal quality of life questionnaire (MAPP-QOL, score) was applied. Significant improvements were observed in the inter-recti distance between the rectus abdominis, abdominal muscle thickness, static trunk endurance, and maternal quality of life in both groups (p < 0.001); a more significant improvement was observed in the offline group. No significant differences were observed between groups except for the left rectus abdominis thickness and Psychological/Baby and Relational/Spouse-Partner subscale in the maternal quality of life index (p > 0.05). Exercise interventions delivered in a real-time videoconferencing platform are effective at improving the inter-recti distance, trunk stability, and quality of life in postpartum women and may be an alternate to face-to-face intervention.
Topics: Exercise; Female; Humans; Postpartum Period; Quality of Life; Rectus Abdominis; Videoconferencing
PubMed: 35742279
DOI: 10.3390/ijerph19127031 -
Journal of the College of Physicians... Dec 2014Endometriosis is characterized by an abnormal existence of functional endometrial tissue outside the uterine cavity, typically occuring within the pelvis of women in...
Endometriosis is characterized by an abnormal existence of functional endometrial tissue outside the uterine cavity, typically occuring within the pelvis of women in reproductive age. We report two cases with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarean incision along with the rectus abdominis muscle. Pre-operative evaluation included magnetic resonance imaging. The masses were dissected free from the surrounding tissue and excised with clear margins. Diagnosis of the excised lesions were verified by histopathology.
Topics: Abdominal Wall; Adult; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Muscular Diseases; Rectus Abdominis; Treatment Outcome; Ultrasonography
PubMed: 25523734
DOI: No ID Found