Abstract
ObjectiveTo determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls.MethodsFrom October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients.ResultsThe maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001).ConclusionsThe application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.
Highlights
Diastasis recti abdominis (DRA) is the enlargement of the distance between the edges of the recti abdominis along the linea alba with no fascial defect [1, 2]
Eligible subjects were recruited based on the following inclusion criteria: 1) age between 18 and 60 y/o; 2) inter-rectus distance (IRD) greater than or equal to 2-finger width on palpation, irrespective of the locations along the midline, measured in the standard supine crocklying position with arms crossed over the chest; and 3) full-term fetus
We assumed that the mean value for mean trunk rotation torque was 37 (N·m) in DRA patients and 45.3 (N·m) in non-DRA patients, based on the data reported by Hills et al [21]
Summary
Diastasis recti abdominis (DRA) is the enlargement of the distance between the edges of the recti abdominis along the linea alba with no fascial defect [1, 2]. The rectus muscles are fused at the midline with no more than 1 to 2 cm separation [3]. The widths of the two recti abdominis muscles are assessed by palpation 4.5 cm above and 4.5 cm below the umbilicus, along the linea alba [6]. A width greater than or equal to the width of two fingers is defined as DRA [5]. No separation or a width of less than two fingers is defined as no DRA. Prior studies investigated the application of advanced imaging technology, like B-mode ultrasound (US), on the evaluation of inter-rectus distance (IRD) measurement. Most studies demonstrate the superior accuracy and validity of imaging tools compared to palpation [7,8,9]
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