Brendan Coleman1,2, F Michael Davis3. 1. Auckland Orthopaedic Practice, Auckland 1543, New Zealand. 2. Corresponding author: Dr Brendan Coleman, Auckland Orthopaedic Practice, PO Box 74 446, Auckland 1543, New Zealand, brendan@aopractice.co.nz. 3. Department of Anaesthesiology, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
Abstract
INTRODUCTION: Dysbaric osteonecrosis (DON) in people working under increased atmospheric pressure is well documented. It is generally less common in military and commercial divers than in caisson workers, except in some high-risk groups, such as in many indigenous diving industries where workers have little or no understanding of decompression principles. With the increasing popularity within the recreational diving community of deep air and mixed-gas decompression diving ('technical diving'), it is likely that diving physicians may see an increase in the prevalence of DON in this group in the future. METHODS: The case report is presented of a technical diving instructor, with a 30-year history of deep diving, who developed bilateral humeral head DON and required a right shoulder hemi-arthroplasty. A focused literature search was also undertaken to identify published cases of DON in recreational divers. RESULTS: The frequency, duration and depth of exposure to pressure, inadequate decompression, the occurrence of DCS and increasing age have been common features associated with DON in both divers and caisson workers. Many of these features were present in this technical diver. CONCLUSIONS: Whilst DON is uncommon in recreational air scuba divers, all the above risk factors are present to a greater degree in technical diving. It is suggested that medical review for DON is merited from time to time in this potentially high-risk group of recreational divers. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
INTRODUCTION:Dysbaric osteonecrosis (DON) in people working under increased atmospheric pressure is well documented. It is generally less common in military and commercial divers than in caisson workers, except in some high-risk groups, such as in many indigenous diving industries where workers have little or no understanding of decompression principles. With the increasing popularity within the recreational diving community of deep air and mixed-gas decompression diving ('technical diving'), it is likely that diving physicians may see an increase in the prevalence of DON in this group in the future. METHODS: The case report is presented of a technical diving instructor, with a 30-year history of deep diving, who developed bilateral humeral head DON and required a right shoulder hemi-arthroplasty. A focused literature search was also undertaken to identify published cases of DON in recreational divers. RESULTS: The frequency, duration and depth of exposure to pressure, inadequate decompression, the occurrence of DCS and increasing age have been common features associated with DON in both divers and caisson workers. Many of these features were present in this technical diver. CONCLUSIONS: Whilst DON is uncommon in recreational air scuba divers, all the above risk factors are present to a greater degree in technical diving. It is suggested that medical review for DON is merited from time to time in this potentially high-risk group of recreational divers. Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
Entities:
Keywords:
Case reports; Decompression sickness; Deep diving; Dysbaric osteonecrosis; Orthopaedics; Radiological imaging; Technical diving
Authors: Laura J Tuominen; Sofia Sokolowski; Richard V Lundell; Anne K Räisänen-Sokolowski Journal: Diving Hyperb Med Date: 2022-06-30 Impact factor: 1.228