Friday, May 16, 2014

May Pelvic PT Distance Journal Club

May journal club outlines are available on the blog

Recordings can be accessed with this link

Next call will be June 4th.

Impact of levator trauma on pelvic floor muscle function

Rojas RG, Wong V, Shek KL, Dietz HP. Int Urogynecol J 2014;25:375-380.

Beth Shelly PT, DPT, WCS, BCB PMD
May 7, 2014 Pelvic PT Distance Journal Club

Method - 433 primips, Blinded measurements before and after delivery
·         Questionnaires
·         MMT by Oxford scale
·         4D translabial US (specifics on page 377)

Macrotrauma = levator avulsion
·         15% of parous women
·         Defined as puborectalis insertion of all three central segments of US were abnormal.

Microtrauma = overdistention of levator hiatus
·         21%  of vaginal deliveries
·         Defined as increase of over 20% in hiatus during valsalva comparing pre to post delivery
·         May be related to
o   Over stretching of connective tissue
o   Overstretching of PFM
o   Changes in resting tone, baseline cortical activation
o   Changes in neuromuscular pathways

Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.

Gyang AN, Feranec JB, Patel RC, Lamvu GM. Int Urogynecol J 2014;25:313-318

Beth Shelly PT, DPT, WCS, BCB PMD
May 7, 2014 Distance Journal Club

Method - expert opinion paper on management of post mesh pain

Post op mesh pain = 0% to 30%
Causes - PFM spasm, pudendal neuralgia, infection

PFM spasm
·         14% to 22% prevalence
·         Symptoms - dyspareunia, LBP, bowel sx (constipation, diarrhea, excessive flatus, painful defecation), urinary sx (frequency, urgency, nocturia)
·         Signs - PFM pain greater than 3/10, increased PFM tone