title: Levator avulsion and grading of pelvic floor muscle strength.
abstract: In a retrospective study investigating the relationship between levator avulsion and clinical grading of levator ani muscle strength, we analyzed the 3D/4D translabial ultrasound and digital assessment data of 1,112 women seen in a tertiary Urogynecological clinic. Levator avulsion was diagnosed whenever the examiner was unable to palpate the insertion of the pubovisceral muscle on the inferior pubic ramus and/or whenever a discontinuity between bone and muscle was detected on ultrasound. For clinical grading of levator muscle strength, we used the modified Oxford grading. Avulsion defects were found in 252 women (23%), and this was associated with a highly significant reduction in the overall Oxford grading (2.07 vs 2.81, P < 0.001). The prevalence of avulsion increased depending on the side differences in the modified Oxford grading: from 16% when there was no difference to 76% when the side difference was 1.5 or higher (P < 0.001). Avulsion of the puborectalis muscle seems to have a marked effect on pelvic floor muscle strength, which may help in diagnosing trauma.
authors.affiliation: Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, NSW 2750, Australia. hpdietz@bigpond.com
authors.forename: H P
authors.initials: HP
authors.lastname: Dietz
authors.forename: C
authors.initials: C
authors.lastname: Shek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D014549:Urinary Incontinence / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*