Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively

Emanuelsson, Peter; Dahlstrand, Ursula; Strömsten, U.; Gunnarsson, Ulf; Strigård, Karin; Stark, Birgit

doi:10.1007/s10029-014-1221-0

Cited by 23 publications

(25 citation statements)

References 19 publications

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“…If the symptoms from ARD emanate from a decrease in abdominal wall muscle strength, it should be possible to determine a correlation between the width of the ARD and abdominal muscle strength. As shown previously [6,] the correlation between the ARD width estimated clinically using a tape measure and that estimated by CT scan is low. The intraoperative finding was regarded as the ‘true' ARD width, and that correlated fairly well with preoperative clinical assessment using a tape measure.…”

Section: Introductionmentioning

confidence: 85%

“…Since muscle strength may be assumed to affect the patient's functional symptoms, our findings support the use of ARD width as one of the criteria for surgical treatment. Even if this study showed no significant correlation between preoperative clinical ARD width assessment and muscle strength, this is the method that hitherto has been shown to best approximate intraoperative ARD width (‘true' width) in the lower midline [6]. …”

Section: Discussionmentioning

confidence: 99%

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Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength

Gunnarsson

Stark²,

Dahlstrand³

et al. 2015

Dig Surg

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Background: Surgery for Abdominal Rectus Diastasis (ARD) is a controversial topic and some argue that it is solely an aesthetic problem. Many symptoms in these patients are indefinite, and no objective criteria have been established, indicating which patients are likely to benefit from surgery. This study investigated the correlation between preoperative assessment and intraoperative measurement of ARD width, and objective measurements of muscle strength. Methods: 57 patients undergoing surgery for ARD underwent preoperative assessment of ARD width by clinical measurement and CT scan, and thereafter intraoperative measurement. Abdominal muscle strength was investigated using the Biodex System 4 including flexion, extension and isometric measurements. Correlations were calculated by the Spearman test. Results: Intraoperative ARD width between the umbilicus and the symphysis correlated strongly with Biodex measurements during flexion (p = 0.007, R = -0.35) and isometric work load (p = 0.01, R = -0.34). The following measurements showed no correlation: between muscle strength and BMI; muscle strength and waistline; or between muscle strength and ARD width above the umbilicus, assessed preoperatively at the outpatient clinic, by CT scan, or measured intraoperatively. Conclusion: There is a strong correlation between intraoperatively measured ARD width below the umbilicus and flexion and isometric abdominal muscle strength measured with the Biodex System 4.

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Section: Introductionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength

Gunnarsson

Stark²,

Dahlstrand³

et al. 2015

Dig Surg

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“…The condition is often characterized by bulging or sagging in the abdominal midline during abdominal muscle contraction. Although no consensus regarding the definition of DRA exists, it is often defined in the literature as separation of the recti greater than 22–30 mm.…”

Section: Introductionmentioning

confidence: 99%

Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life

et al. 2019

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BackgroundDuring pregnancy, women are at risk of developing persistent symptomatic diastasis recti abdominis (DRA), which may have a detrimental effect on their physical function and quality of life (QoL). The aim of this prospective cohort study was to determine the effect of surgical repair of DRA on abdominal trunk function, urinary incontinence and QoL in postpartum women with trunk instability symptoms resistant to training.MethodsPostpartum women with diagnosed DRA and training‐resistant symptoms underwent double‐row plication of the linea alba. Abdominal trunk function was evaluated as the primary endpoint using a multimodal examination tool, the Abdominal Trunk Function Protocol. Recurrence was assessed by CT, urinary incontinence was evaluated using the Urogenital Distress Inventory (UDI‐6) and Incontinence Impact Questionnaire (IIQ‐7), and QoL was assessed with the Short Form 36 (SF‐36®) questionnaire. All subjects were examined before and 1 year after surgery.ResultsSixty women were recruited. There was no DRA recurrence at the 1‐year follow‐up. Self‐reported abdominal trunk function had improved in 98 per cent of patients, with a mean score improvement of 79·1 per cent. In the physiological tests monitored by a physiotherapist, 76 per cent performed better and endured exercise tests longer than before surgery. All SF‐36® subscales improved significantly compared with preoperative scores and reached levels similar to, or higher than, the normative Swedish female population. For the UDI‐6 and IIQ‐7, 47 and 37 per cent respectively reported fewer symptoms at follow‐up than before surgery, and 13 and 8 per cent respectively reported more symptoms.ConclusionIn this series of postpartum women presenting with DRA and symptoms of trunk instability resistant to training, surgical reconstruction resulted in a significant improvement in abdominal trunk function, urinary incontinence and QoL.

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“…In comparison with intraoperative findings also, US meas urement has proven reliable, particularly in the abovena vel area, while at the belownavel level there is a slight tendency to underestimate the separation between the two muscles [24,29]. The same applies to MRI [30] meas urements and to CT [31] measurements, both of which underestimate somehow the extent of muscles separation [32,33]. The minor discrepancies found between preop eratory measures, including imaging modalities other than US, and intraoperatory measures are possibly due to the muscle tone relaxation during general anaesthesia [32].…”

mentioning

confidence: 99%

Diastasis of rectus abdominis muscles: patterns of anatomical variation as demonstrated by ultrasound

Corvino¹,

Rosa

Sbordone³

et al. 2019

Pol J Radiol

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Purpose:The aim of our study was to categorise the anatomical variations of rectus abdominis muscle diastasis (dia stasis recti) by using ultrasound (US). Material and methods:In a oneyear period 92 women were evaluated with US because of suspected diastasis of rectus muscles. Patients were examined in a supine position, with head extended, upper limbs aligned to the trunk, and knees flexed. US was performed with highfrequency, broadband transducers. Trapezoid fieldofview and extend ed fieldofview were employed to measure diastasis exceeding 5 cm. Diastasis was defined as a margintomargin distance > 20 mm at rest and classified according to the following anatomical patterns: open only above the navel, open only below the navel, open at the navel level, open completely but wider above the navel, and open completely but wider below the navel. Results: Diastasis was found in 82 patients (3061 years old, mean age 35 years). The width was 2197 mm, mean 39 mm. The prevalence and severity of the anatomical patterns was as follows: open only above the navel in 48 pa tients (2188 mm, mean 40 mm), open only below the navel in one patient (33 mm), open at the navel level in seven patients (2339 mm, mean 34 mm), open completely but wider above the navel in 24 patients (2197 mm, mean 41 mm), open completely but wider below the navel in two patients (2129 mm, mean 25 mm). Conclusions:The abovenavel patterns of recti muscle diastasis are the most common. Even when open completely, diastasis is usually wider above the navel. Knowledge of the anatomical type of rectus muscle diastasis could be of value to the patient (exercises to do and to avoid) and to the surgeon (abdominoplasty planning).

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Analysis of the abdominal musculo-aponeurotic anatomy in rectus diastasis: comparison of CT scanning and preoperative clinical assessment with direct measurement intraoperatively

Abstract: Clinical assessment prior to surgery provides more accurate information than CT scanning in the assessment of ARD width. CT scanning underestimates ARD width when compared with intraoperative measurement.

Cited by 23 publications

References 19 publications

Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength

Correlation between Abdominal Rectus Diastasis Width and Abdominal Muscle Strength

Cohort study of the effect of surgical repair of symptomatic diastasis recti abdominis on abdominal trunk function and quality of life

Diastasis of rectus abdominis muscles: patterns of anatomical variation as demonstrated by ultrasound

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