Lateral Abdominal Muscles Research Articles

Prehabilitation of complex ventral hernia patients with Botulinum: a systematic review of the quantifiable effects of Botulinum.

Complex ventral hernia repair (CVHR) encompasses patient optimization, primary fascial closure (PFC), mesh reinforcement and component separation technique (CST), if needed. High rates of complications after CST are still reported. Prehabilitation by managing pre-operative modifiable risk factors, like abdominal wall compliance, possibly reduces these rates. Compliance can be modified by intramuscular injection of Botulinum in the lateral abdominal wall muscles (LAWM). Paralysis leads to elongation of these muscles, which may facilitate PFC and/or prevent CST. Evidence to use Botulinum in hernia patients is scarce and fragmented. An update of evidence for the effect of Botulinum is presented. A multi-database search was conducted for Botulinum studies in ventral hernia patients. A systematic review was performed to describe its primary effect on compliance (LAWM elongation) and secondary effects like PFC ± CST rate, complications and recurrence. 14 studies were included (377 patients) with a HDW of median 12 (10-15) cm. A typical intervention consisted of 200-300 U Botulinum in 3 points per hemi-abdomen under US guidance, > 2weeks pre-operatively and evaluated by CT just beforethe operation. The primary effect was a median LAWM elongation of 4.0cm per side without complications of the injection (four studies, 107 patients). The median PFC rate was 100%, CST rate 38%, wound-related complications 19%, medical complications 18% and recurrence 0% (14 studies). Botulinum safely elongates the abdominal wall muscles, but the level of evidence available remains low. Any patient in whom PFC is expected to be difficult, could be a candidate for prehabilitation with Botulinum.

Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation.

Although changes in lateral abdominal wall musculature after posterior component separation with transversus abdominis release have been investigated, the effects of endoscopic subcutaneous anterior component separation (ES-ACS) on postoperative muscle anatomy have not been evaluated. The purpose of this study was to evaluate changes in the lateral abdominal muscles after ES-ACS. Computed tomography (CT) images of patients who underwent ES-ACS were retrospectively evaluated. Lateral abdominal wall thickness and external oblique displacement were measured at the level of fixed retroperitoneal structures. Measurements on the ES-ACS side were compared with those on the contralateral undivided side or with preoperative images in patients with bilateral procedures. Fifteen patients met the criteria for study inclusion. Most patients (n = 13, 86.7%) underwent unilateral ES-ACS. The most commonly performed procedure was laparoscopic intraperitoneal onlay mesh-plus hernia repair (n = 12, 80.0%; the remaining patients underwent open repair). The Mean defect width was 8.4cm (range 6-15cm). There was no difference in the thickness of the lateral abdominal musculature between ES-ACS and undivided sides. There was a significant lateral displacement of the external oblique muscle from the lateral edge of the rectus abdominis on the ES-ACS side (mean distance 3.7cm; p = 0.0006). No midline hernia recurrences, iatrogenic linea semilunaris hernias, or lateral eventrations were observed during a mean follow-up period of 2.6years (range 0.5-7.4years). ES-ACS resulted in no atrophy of the lateral abdominal muscles in long-term CT follow-up. The procedure is a safe and effective adjunct to complex hernia repair in selected patients.

Image-guided botulinum toxin injection in the lateral abdominal wall prior to abdominal wall reconstruction surgery: review of techniques and results.

Ventral hernias represent the most common complication after abdominal surgery. Loss of domain and/or large ventral hernias in patients are especially challenging for surgeons to manage, but preoperative image-guided botulinum toxin injection has emerged as an effective adjunct to abdominal wall surgery. Loss of domain is caused by chronic muscle retraction of the lateral abdominal wall and leads to an irreducible protrusion of abdominal viscera into the hernia sac. Botulinum toxin can be used in the oblique muscles as a chemical component relaxation technique to aid abdominal wall reconstruction. Intramuscular botulinum toxin injection causes functional denervation by blocking neurotransmitter acetylcholine release resulting in flaccid paralysis and elongation of lateral abdominal wall muscles, increasing the rate of fascial closure during abdominal wall reconstruction, and decreasing recurrence rates. In total, 200-300units of onabotulinumtoxinA (Botox®) or 500units of abobotulinumtoxinA (Dypsort®) in a 2:1 dilution with normal saline is most commonly used. Botulinum toxin can be injected with ultrasonographic, EMG, or CT guidance. Injection should be performed at least 2weeks prior to abdominal wall reconstruction, for maximal effect during surgery. At minimum, botulinum toxin should be injected into the external and internal oblique muscles at three separate sites bilaterally for a total of six injections. Although botulinum toxin use for abdominal wall reconstruction is currently not indicated by the Food and Drug Administration, it is safe with only minor complications reported in literature.

Lateral Abdominal Muscle Symmetry And Risk Of Sports Injury In Baseball Players

Lateral abdominal muscles play a significant role in trunk control and rotation during baseball batting. Repetitive and unidirectional baseball batting could lead to asymmetric hypertrophy of lateral abdominal muscles. This adaptive change may subsequently impose abnormal loads on the spine and predispose baseball players to sports injury. No study has examined whether adolescent baseball players present lateral abdominal muscle asymmetry and its relationship with risk of sports injury. PURPOSE: This study aimed to compare the thickness of lateral abdominal muscles on both sides of the trunk, and to investigate whether asymmetry of lateral abdominal muscle thickness was correlated with risk of sports injury in high school baseball players METHODS: Fifteen position players from a high school baseball team (right-handed batting and throwing; aged 16.0 ± 1.1 years, height 172.6 ± 5.0 cm, weight 73.3 ± 10.8 kg) completed the Functional Movement Screen (FMS) testing. B-mode ultrasound images were recorded from the external abdominal oblique (EO), internal abdominal oblique (IO), and transverse abdominis (TA) at the end of expiration in the crook-lying position. The absolute thickness of each lateral abdominal muscle for both sides was determined and compared using paired t-tests. The relationship between the asymmetry ratio (difference between two sides expressed as a percent of the dominant side) and FMS composite score was analyzed using the Spearman correlation coefficient. RESULTS: The EO thickness was significantly greater in the dominant side than in the non-dominant side (6.85 ± 1.13 vs. 5.05 ± 1.46 mm, p < 0.001), and the TA thickness was significantly greater in the non-dominant side than in the dominant side (4.21 ± 0.85 vs. 3.49 ± 0.60 mm, p = 0.003). Only the asymmetry ratio of TA was significantly correlated with the FMS composite score (r = 0.54, p = 0.040). CONCLUSIONS: High school baseball players showed side-to-side thickness asymmetry in the EO and TA. The significant correlation between the TA asymmetry ratio and FMS composite score suggests an increased risk of sports injury. High school baseball teams should consider integrating TA training into players’ routine training program. Supported by the Ministry of Science and Technology of Taiwan (MOST 108-2410-H-006-098)

Shear wave elastography for assessing lateral abdominal muscles in thoracolumbar scoliosis: A preliminary study

There are no studies on the scoliotic population in which lateral abdominal muscle (LAM) was measured. The aim of the study was to deliver the first results on LAM elasticity assessed by shear wave elastography (SWE) in right-side and left-side thoracolumbar scoliosis patients. Twelve patients (mean age 12.25) with thoracolumbar scoliosis were included in the study. Muscle thickness and SWE of the obliquus external (OE), obliquus internal, and transversus abdominis (TrA) were measured with an ultrasound scanner. Measurements were taken at rest and during isometric contraction. An analysis showed that in right-side scoliosis, the OE muscle on the convex side was stiffer by 7.25kPa compared to the concave side. The OE muscle on the convex side in right-side scoliosis was also stiffer by 11.6kPa compared to the convex side in left-side scoliosis. In left-side scoliosis, the TrA muscle on the concave side was stiffer by 7.84 kPa compared to the convex side. Changes in LAM elasticity of thoracolumbar scoliosis were observed. A different pattern of LAM stiffness in different curve directions may be expected. OE and TrA shear moduli are the most sensitive to change in adolescent spinal deformation.

The Relationship Between Low Back Pain Incidence and Ultrasound Assessment of Trunk Muscles in Adult Soccer Players: A Cohort Study

Background: Few studies have demonstrated the connection between trunk muscle thickness and low back pain (LBP) in athletes. Objectives: This study aimed to define whether the thickness of the lateral abdominal muscles (LAM) and lumbar multifidus (LM) are related to LBP incidence in elite male soccer players. Methods: In this short-term cohort study, 42 elite male soccer players from professional soccer teams were followed for a season. The muscle thickness of LAM and the cross-sectional area (CSA) of the LM were assessed. The relation between the incidence of LBP and the aforementioned factors was evaluated after the cohort study. Results: Thirty-seven participants completed the study, and seven participants (18.91%) experienced LBP during the follow-up period. No significant relationship was detected between LBP and the thickness of LAM and CSA of LM (P &gt; 0.05). None of the other variables had any relationship with LBP incidence (P &gt; 0.05). Conclusions: The LAM thickness and CSA of LM during a resting position and drawing-in maneuver was found not to be directly related to LBP incidence in elite male soccer players in the short term. Assessing these muscles’ conditions in more functional positions could be considered for further research.

Intraindividual variation of the transversus abdominis plane block: an exploratory study in healthy volunteers

IntroductionThe transversus abdominis plane block is widely used in postoperative pain management after abdominal surgery. However, large interindividual variation in the cutaneous distribution area of the block has been demonstrated....

Intrarater Reliability of Shear Wave Elastography for the Quantification of Lateral Abdominal Muscle Elasticity in Idiopathic Scoliosis Patients

ObjectiveTo date, studies evaluating the reliability of shear wave elastography (SWE) measures of the lateral abdominal muscles (LAMs) in adolescent patients with idiopathic scoliosis (AIS) have never been performed. The aim of the study was to assess the intrarater reliability of SWE and thickness of the LAMs at rest and during isometric contraction (10% of maximal voluntary contraction). MethodsThis was a single-group, repeated-measures intrarater reliability study. Twenty-four patients with AIS between ages 10 and 17 years took part in the study. Two and 3 repeated SWE measurements were recorded in the supine resting position and during isometric contraction, respectively. Two sessions were performed with a 7-day interval. ResultsBy using the mean of 2 measures in the supine, resting position, intraexaminer reliability point estimates (intraclass correlation coefficient [ICC]3.2) ranged from 0.75 to 0.84 for external oblique, internal oblique, and transversus abdominis muscles. During the isometric contraction, the ICC3.3 results ranged from 0.70 to 0.83. The ICC results for muscle thicknesses in both conditions ranged from 0.89 to 0.96. ConclusionMeasurements of LAM elasticity are reliable in patients with AIS. The superficial fat layer did not influence the measurement error between 2 sets of measurements in the examined adolescent population. The images extracted from SWE can successfully be used to assess LAM thicknesses with high reliability.

Comparison of Lateral Abdominal Musculature Activation during Expiration with an Expiratory Flow Control Device Versus the Abdominal Drawing-in Maneuver in Healthy Women: A Cross-Sectional Observational Pilot Study.

Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). Materials and Methods: A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Results: Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA (p = 0.001) and IO (p = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM (p = 0.001, Cohen’s d = 2.183) and at rest and with the EFCD (p = 0.001, Cohen’s d = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found (p = 0.055, Cohen’s d = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest (p = 0.038), Cohen’s d = 0.081). Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA.

Relationship between Trunk Muscularity and Club Head Speed in Male Golfers.

This study examined how the volume of trunk muscles and its bilateral asymmetry are related to club head speed in golfers. Fourteen right-handed male golfers performed five driver shots, and the club head speed for each trial was calculated from a three-dimensional reflective marker position of the club head immediately before impact. The volume of each side of the rectus abdominis, erector spinae, psoas major, quadratus lumborum, lateral abdominal wall muscle, and multifidus was determined using magnetic resonance imaging. For each muscle, the ratio of the larger to smaller side in muscle volume was calculated to assess bilateral asymmetry. The club head speed correlated positively with the volume of each side of the rectus abdominis and erector spinae, left quadratus lumborum, and the asymmetric ratio of the psoas major (r=0.595-0.747), but negatively with the asymmetric ratio of the quadratus lumborum (r=-0.641). Multiple regression analysis revealed that the right erector spinae volume and the asymmetric ratio of the psoas major were significant contributors for the club head speed (R2=0.797). These results indicate that the variation in the club head speed can be strongly explained by the absolute volume and bilateral asymmetry of specific trunk muscles.

Pelvic floor and abdominal muscle responses during hypopressive exercises in women with pelvic floor dysfunction.

To measure the neuromuscular activation of the pelvic floor and abdominal muscles concurrently with vaginal closure forces induced during a hypopressive exercise (HE) and to identify the contribution of the HEs sequences (posture and maneuver) in the muscle's activation. A cross-sectional study design was employed. Sixty-six women who had participated in a physical therapy program focused on HEs were recruited. Pelvic floor muscle (PFM) activation was measured using surface electromyography (sEMG) in supine and in the orthostatic position, and vaginal closure force was measured through vaginal dynamometry in supine. Activation of the abdominal, gluteal, and hip adductor muscles was measured using sEMG. Maximum effort voluntary contractions (MVCs) of the PFMs and reference contractions of the abdominal and hip muscles were acquired for normalization purposes. A HE was then performed in a supine position with one leg raised, then in an orthostatic position. During the supine HE, the peak PFM sEMG amplitude was 74.4% to 86.5% (49.6%-109.6%) of MVC, the peak vaginal closure force was between 51.2% and 55.7% (95.5%-382.9%) of MVC, and the muscles of the lateral abdominal wall were activated between 25.4% and 35.3% of the reference contraction. During the orthostatic HE, PFM activation was 61.4% (40.1%-105.6%) of MVC, and the lateral abdominal wall muscles contracted at 22.8% of the reference activation level. The PFMs, abdominal, gluteal, and adductor muscles are activated during the performance of a HE. The activation level of the PFMs and abdominal muscles is likely insufficient to result in strength gains; however, they could have an endurance effect.

Effects of the Draw-in Maneuver on the Thickness of the Lateral Abdominal Muscles and Trunk Stability When Standing and Walking

Effects of the Draw-in Maneuver on the Thickness of the Lateral Abdominal Muscles and Trunk Stability When Standing and Walking

The macquarie system for comprehensive management of complex ventral hernia.

Despite recent advances in the operative management of complex ventral hernia (CVH), significant challenges remain. Closure of large defects can have serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. Certain features of CVH make repair technically demanding and time consuming, such as massive fascial defects, unusual hernia locations, involvement of other abdominal wall structures and previous tissue trauma. Preoperative assessment with three-dimensional volume rendered CT (3DVR-CT) imaging and an illustrative series of clinical cases is introduced for repair of CVH using laparoscopic approach. CVH presented here include traumatic hernias involving extensive tissue trauma, massive ventral hernias with defects > 20cm in width, hernias requiring additional procedures such as wiring of ribs, and hernias in difficult locations such as suprapubic and flank hernias. Specific techniques such as individually tailoring mesh and size, transfascial mesh straps fixation and transcutaneous defect closure will be discussed. All hernias in this series have been repaired laparoscopically (Lap) or laparoscopic-open-laparoscopic (LOL) technique with transcutaneous fascial closure. After hernia closure the mesh is placed in either an intra-peritoneal onlay mesh (IPOM) placement or modified Rives-Stoppa technique with pre-peritoneal mesh placement. CVH repair requires multidisciplinary planning with management tailored to each patient's clinical and surgical requirements. The surgeon must have a variety of surgical skills and strategies to address the multiple and/or atypical defects that affect these patients.

EFFECT OF CONNECTIVE INSUFFICIENCY AND SIZES OF MEDIAN HERNIAS ON BEFORE AND POSTOPERATIVE FUNCTION OF THE ABDOMINAL MUSCLE

The article analyzes the results of electromyography of the abdominal muscles in 189 patients with median postoperative hernia of the anterior abdominal wall of different sizes before and after the combined methods of hernioplasty, including considering the level of connective tissue failure. In the preoperative period, electromyography was performed in 69 (36,6%), after combined hernioplasty, 120 (63,4%) patients. The patients were divided into a group of 161 (85,1%) patients with clinically significant or histologically confirmed connective tissue insufficiency and into a group of 28 (14,9%) patients without it. The distribution of patients in the examination groups was carried out using an original method of assessing the degree of deviation of collagen fibers from the projection of the Langer lines in microscopic specimens of the skin areas excised during the operation and based on the results of a retrospective analysis of case histories with determination of the intraoperative adhesions of the adhesions in the abdominal cavity or hernial sac. In the formed groups, we studied the amplitude, frequency, front and area of electromyograms obtained from the direct and lateral muscles of the anterior abdominal wall. It was found that in patients with median postoperative hernias, mesenchymal dysplasia was the main reason for the decrease in functional activity and the imbalance of forces between the direct and lateral abdominal muscles. Optimal restoration of electroactivity of the abdominal muscles after combined hernioplasty occurred among patients without clinically significant connective tissue insufficiency. When reaching a giant postoperative hernia of gigantic size in patients with a clinically significant level of connective tissue dysplasia, the functioning of the abdominal muscles decreased by 26%, and in patients without it only by 15%. The pathology of collagen in skin grafts excised during surgery was detected in 91,5% of patients with mid-incisional hernias.

The Effects of Stabilization Exercise on the Thickness of Lateral Abdominal Muscles During Standing Tasks in Women With Chronic Low Back Pain: A Randomized Triple-Blinded Clinical Trial Study.

Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks. The purpose of this study was (1)to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2)to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes. This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups: GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland-Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability. The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03). Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP.

Combination of Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A Enables the Laparoscopic Transabdominal Preperitoneal Approach for Repairing Giant Inguinoscrotal Hernias

Background: Reports on preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA) for managing giant inguinoscrotal hernias are limited. Hence, we report our experience with these preoperative techniques in patients with this condition. Materials and Methods: Observational study of 8 consecutive patients with giant inguinoscrotal hernias between January 2018 and December 2018. All patients were treated preoperatively with BTA injection to the lateral abdominal wall muscles and PPP for passive abdominal cavity expansion. Length of abdominal wall muscles, volume of inguinal hernia (VIH), volume of the abdominal cavity (VAC), and VIH/VAC ratio were measured before and after PPP and BTA using abdominal computed tomography. All hernias were repaired laparoscopically using transabdominal preperitoneal (TAPP) repair techniques. Results: The mean insufflated volume of air for PPP was 5625 ± 845 mL for 15.4 ± 1.6 days. An average reduction of 5.3% of the VIH/VAC ratio after PPP and BTA was obtained (P < .01). The length of lateral abdominal muscles with a mean gain of 3.3 cm/side (P < .01) and complications associated with PPP were 12.5% and with surgical technique, 25%. Laparoscopic TAPP repair was achieved in all cases, with no clinical evidence of postoperative abdominal hypertension. The mean follow-up was 22 months; no hernia recurrences have been reported. Conclusions: Combination of PPP and BTA is feasible and useful for surgically managing giant inguinoscrotal hernias, which can avoid abdominal compartment syndrome after laparoscopic TAPP repair of giant inguinoscrotal hernias.

Abdominal functional electrical stimulation to assist ventilator weaning in critical illness: a double-blinded, randomised, sham-controlled pilot study

BackgroundFor every day a person is dependent on mechanical ventilation, respiratory and cardiac complications increase, quality of life decreases and costs increase by > $USD 1500. Interventions that improve respiratory muscle function during mechanical ventilation can reduce ventilation duration. The aim of this pilot study was to assess the feasibility of employing an abdominal functional electrical stimulation (abdominal FES) training program with critically ill mechanically ventilated patients. We also investigated the effect of abdominal FES on respiratory muscle atrophy, mechanical ventilation duration and intensive care unit (ICU) length of stay.MethodsTwenty critically ill mechanically ventilated participants were recruited over a 6-month period from one metropolitan teaching hospital. They were randomly assigned to receive active or sham (control) abdominal FES for 30 min, twice per day, 5 days per week, until ICU discharge. Feasibility was assessed through participant compliance to stimulation sessions. Abdominal and diaphragm muscle thickness were measured using ultrasound 3 times in the first week, and weekly thereafter by a blinded assessor. Respiratory function was recorded when the participant could first breathe independently and at ICU discharge, with ventilation duration and ICU length of stay also recorded at ICU discharge by a blinded assessor.ResultsFourteen of 20 participants survived to ICU discharge (8, intervention; 6, control). One control was transferred before extubation, while one withdrew consent and one was withdrawn for staff safety after extubation. Median compliance to stimulation sessions was 92.1% (IQR 5.77%) in the intervention group, and 97.2% (IQR 7.40%) in the control group (p = 0.384). While this pilot study is not adequately powered to make an accurate statistical conclusion, there appeared to be no between-group thickness changes of the rectus abdominis (p = 0.099 at day 3), diaphragm (p = 0.652 at day 3) or combined lateral abdominal muscles (p = 0.074 at day 3). However, ICU length of stay (p = 0.011) and ventilation duration (p = 0.039) appeared to be shorter in the intervention compared to the control group.ConclusionsOur compliance rates demonstrate the feasibility of using abdominal FES with critically ill mechanically ventilated patients. While abdominal FES did not lead to differences in abdominal muscle or diaphragm thickness, it may be an effective method to reduce ventilation duration and ICU length of stay in this patient group. A fully powered study into this effect is warranted.Trial registrationThe Australian New Zealand Clinical Trials Registry, ACTRN12617001180303. Registered 9 August 2017.

Electrical function of the abdominal muscles after combined plastic of extensive median hernias in the context of connective tissue dysplasia

Relevance. Improving the electrical function of abdominal muscles in patients with extensive median hernias of the anterior abdominal wall can be facilitated by optimizing the choice of methods for combined hernioplasty, taking into account the clinical severity of connective tissue dysplasia among the hernia carriers.&#x0D; Objective. Study the electrical function of abdominal muscles after the methods of combined hernioplasty of extensive median hernias, taking into account the severity of connective tissue dysplasia among the hernia carriers.&#x0D; Results. The average numbers of electromyogram frequencies of the abdominal muscles of patients with extensive median hernias from the group without clinical signs of connective tissue dysplasia were almost the same after all the applied methods of combined hernioplasty. The predominance of the rectus muscles electric function over the lateral abdominal muscles among the patients of this group was 33,5 %.&#x0D; Electrofunctional rehabilitation of the abdominal muscles of patients in the second group of examinations depended on the method of combined hernioplasty and changed in the event of an increase or decrease in the severity of connective tissue dysplasia. The recovery of electroactivity of abdominal muscles in the postoperative period in patients from the second group was more significant with an increase in the number of abdominal muscles applied to aponeuroses and vagina of relaxing sections, which contributed to an increase in mobility and contractility of the musculoaponeurotic layers of the anterior abdominal wall.&#x0D; Conclusions. Thus, with an increase in the severity of connective tissue dysplasia in patients with extensive median abdominal hernias, the method of combined hernioplasty with the most pronounced relaxing effect in relation to the anterior abdominal wall promoted optimal rehabilitation of abdominal muscles.

Aberrant innervation of the lateral abdominal muscles by direct branch of L4 nerve

Surgical approache through the posterior abdominal wall used for nephrectomy or other access to contents of the retroperitoneal space requires to be cognizant of the regional nerve supply to the posterolateral abdominal wall muscles. We herein report a, to our knowledge, previously undescribed direct branch from the L4 spinal nerve that formed a plexus with regional nerves to then innervate the lateral abdominal wall musculature. Such a nerve variant should be considered by the surgeon who operates this region.

Deformations of abdominal muscles under experimentally induced low back pain

PurposeLow back pain (LBP) is associated with altered motor control and muscle activity; however, it remains unknown whether these changes predispose humans to injury and pain or are the consequence of ongoing nociceptive processes. In this experimental study, we aimed to use a novel ultrasound imaging technique for the measurement of lateral abdominal wall muscle activity: the tissue deformation index (TDI).MethodsForty-two healthy subjects (22.30 ± 1.49 years of age) were exposed to postural perturbation induced by rapid arm movement. Activity of three muscles, the transversus abdominis (TrA) and the internal and external oblique (EO), was recorded by ultrasound imaging (M-mode) with and without induction of LBP. Pain was induced by electrical stimulation applied bilaterally to the lumbar spine.ResultsNo significant differences in the TDI between right and left sides of the body (p > 0.05) were found. Generally, muscles deformed slower with pain compared to non-painful conditions; however, only EO muscle displayed a statistically significant reduction in deformation velocity (p ≤ 0.00001). TDI for EO decreased from 0.065% per ms ( ± 0.038, 95% CI 0.057–0.074) to 0.053% per ms ( ± 0.035, 95% CI 0.046–0.061). Furthermore, characteristic inter-muscular TDI gradients were observed, directed from inner towards outer muscular layers, with TrA showing the lowest TDI and EO the highest.ConclusionExperimentally induced LBP suppresses deformation of the superficial abdominal muscles and increases the variability of local/deep muscles. Further research is required to confirm these observations.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.