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Concept: Rectus abdominis muscle

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Diastasis of the rectus abdominis muscles (DRAM) is characterised by thinning and widening of the linea alba, combined with laxity of the ventral abdominal musculature. This causes the midline to “bulge” when intra-abdominal pressure is increased. Plastic surgery treatment for DRAM has been thoroughly evaluated, though general surgical treatments and the efficacy of physiotherapy remain elusive. The aim of this systematic literature review is to evaluate both general surgical and physiotherapeutic treatment options for restoring DRAM in terms of postoperative complications, patient satisfaction, and recurrence rates.

Concepts: Hospital, Surgery, Physician, Plastic surgery, Surgeon, Reconstructive surgery, General surgery, Rectus abdominis muscle

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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.

Concepts: Scientific method, Transversus abdominis muscle, Absolute deviation, Standard deviation, Abdomen, Analysis of variance, Rectus abdominis muscle, Linea alba

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Gottschall, JS, Mills, J, and Hastings, B. Integration core exercises elicit greater muscle activation than isolation exercises. J Strength Cond Res 27(3): 590-596, 2013-The American College of Sports Medicine and the United States Department of Health and Human Services advocate core training as a means to improve stability, reduce injury, and maintain mobility. There are countless exercises that target the primary core trunk muscles (abdominal and lumbar) with the aim of providing these benefits. However, it is unknown as to which exercises elicit the greatest activation thereby maximizing functional gains and peak performance. Thus, our purpose was to determine whether integration core exercises that require activation of the distal trunk muscles (deltoid and gluteal) elicit greater activation of primary trunk muscles in comparison with isolation core exercises that only require activation of the proximal trunk muscles. Twenty participants, 10 men and 10 women, completed 16 randomly assigned exercises (e.g., crunch, upper body extension, and hover variations). We measured muscle activity with surface electromyography of the anterior deltoid, rectus abdominus, external abdominal oblique, lumbar erector spinae, thoracic erector spinae, and gluteus maximus. Our results indicate that the activation of the abdominal and lumbar muscles was the greatest during the exercises that required deltoid and gluteal recruitment. In conclusion, when completing the core strength guidelines, an integrated routine that incorporates the activation of distal trunk musculature would be optimal in terms of maximizing strength, improving endurance, enhancing stability, reducing injury, and maintaining mobility.

Concepts: Muscle, Physical exercise, Electromyography, Muscle contraction, Muscular system, Exercise physiology, Rectus abdominis muscle, Crunch

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The rectus abdominis muscle is a work horse for free and pedicled muscle coverage. Traditional harvest violates the anterior rectus sheath and requires an abdominal incision. Robotic harvest can be reliably and efficiently performed using three ports, and no additional incisions.

Concepts: Rectus abdominis muscle, Rectus sheath

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Rib cartilage is an abundant source for cartilage grafts when significant dorsal nasal augmentation or structural support is indicated. Diced cartilage wrapped in fascia was developed to counteract warping, visibility, and displacement of rib cartilage as a dorsal solid graft. The technique for wrapping diced cartilage has evolved during the past several years.

Concepts: Epidemiology, Clinical trial, Pharmaceutical industry, Clinical research, Grafting, Fascia, Rectus abdominis muscle

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Abdominal wall deformity secondary to pregnancy is multidirectional. Plication of the anterior rectus sheath is the most widely used technique for correction of this condition. However, it would be desirable to simultaneously perform the transverse and longitudinal repair of this deformity. The aim of this study was to assess changes in the length of the musculoaponeurotic layer after diastasis recti repair using triangular mattress sutures.

Concepts: David Gilmour, Rectus abdominis muscle, Rectus sheath

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Currently, autologous breast reconstruction with a free tissue transfer from the lower abdomen is considered to be a safe method that provides a stable long-term solution. The DIEP-flap and the ms-2-TRAM-flap reconstructions have helped reduce donor site morbidity. In order to assess the potential differences between these techniques, we carried out myosonographic evaluations that assessed the muscle dynamics pre- and post-operatively. In addition to investigating the properties of the rectus abdominis muscle post-operatively, this prospective study also allowed us to analyse the muscle preoperatively and to investigate the prospects for harvesting a DIEP-flap as opposed to a TRAM-flap.

Concepts: Plastic surgery, Abdomen, Breast reconstruction, Rectus abdominis muscle, Linea alba, Human abdomen, TRAM flap

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Diastasis recti abdominis is a condition defined as the separation between the rectus abdominis and the linea alba, which leads to weakness in the abdominal muscles. Diastasis may be slight or severe, sometimes resulting in herniation of the abdominal viscera. Following childbirth, most women develop some extent of muscle separation in the postpartum period. However, if the diastasis recti abdominis in the postpartum period remain severe, it should be corrected to prevent concurrent abdominal hernia, strangulation or incarceration. We herein present two Korean cases of postpartum women with severe diastasis recti abdominis with abdominal hernia; it is the first report of its kind from Korea. Two women were referred to our clinic with severe abdominal bulge. Computerized tomography scan showed widening of the linea alba with abdominal hernia. The standard abdominoplasty with multiple wide longitudinal plications of the abdominal wall was performed in each patient under general anesthesia. There was no recurrence of diastasis recti abdominis or abdominal hernia during follow-up periods. The application of abdominoplasty in postpartum women with severe diastasis recti abdominis with abdominal hernia is thus considered to be an efficient management option. We hope these cases can provide a reference for the treatment of similar situations.

Concepts: Childbirth, Surgery, Postnatal, Abdomen, Abdominal cavity, Rectus abdominis muscle, Linea alba, Human abdomen

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Study Design Longitudinal descriptive exploratory study. Objectives To evaluate the immediate effect induced by drawing in and abdominal crunch exercises on inter-rectus distance (IRD) of first time pregnant women measured at 4 time points during pregnancy and in the postpartum period. Background There is scant knowledge on the effect of different abdominal exercises on IRD in pregnant and postpartum women. Methods The study included 84 primiparous participants. Ultrasound images were recorded with a 12 MHz linear transducer at rest and during abdominal drawing in and abdominal crunch exercises, at 3 locations on the linea alba. IRD was measured at 4 time points: gestational weeks 35-41 and 6th to 8th, 12th to 14th, and 24th to 26th weeks postpartum. Separate 2-way repeated measures ANOVA were performed for each exercise (drawing in and abdominal crunch) and each measurement location to evaluate the immediate effects of exercises on IRD at each of the 4 time points. Similarly, 2-way ANOVAs were used to contrast the effects of the 2 exercises on IRD. Results Performing the DI exercise caused a significant change in width of the IRD at the location 2 cm below the umbilicus, narrowing the IRD by a mean (95% CI) of 3.8 mm (1.2, 6.4) at gestational week 35-41 and widening the IRD by 3.0 mm (1.4, 4.6) at 6th to 8th, by 1.8 mm (0.6, 3.1) at 12th to 14th, and by 2.5 mm (1.4, 3.6) at 24th to 26th weeks postpartum (P<.01). Performing the AC exercise led to a significant narrowing of the IRD (P<.01) at all 3 locations at all 4 time points, with the exception of 2 cm below the umbilicus at postpartum week 24-26. The average amount of narrowing varied from 1.6 to 20.9 mm, based on time and location. Conclusion Overall, there was a contrasting effect of the 2 exercises, with the abdominal crunch exercise consistently producing a significant narrowing of the IRD. In contrast, the DI exercise generally led to small widening of the IRD. J Orthop Sports Phys Ther, Epub 24 Aug 2015. doi:10.2519/jospt.2015.5459.

Concepts: Pregnancy, Childbirth, Embryo, Fetus, Gestational age, Pregnancy test, Rectus abdominis muscle, Bodyweight exercise

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Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions.

Concepts: Radiology, Injury, Anatomy, Pubic symphysis, Rectus abdominis muscle, Muscles of the torso, Rectus sheath, Pyramidalis muscle