Bone necrosis, specifically dysbaric osteonecrosis, is a type of bone injury that can happen as a long-term consequence of diving, particularly to divers who do decompression dives. Often, the first sign comes as unexplainable bone pain, which never disappears and seems to get worse after diving. While this pain sometimes responds to OTC pain medications, it rarely subsides completely.
Bone Injuries from Diving: Diagnosis and Indications
Doctors specializing in hyperbaric medicine are trained to watch for the signs of dysbaric osteonecrosis, which they can easily spot on an MRI scan, but which can rarely be seen with X-rays. The affected areas show up as lesions, typically caused when small blood vessels that supply the living bone are compromised by tiny bubbles, blood clots, or minuscule globules of fat that break free from marrow structure when the body is under pressure. The lesions usually show up in the shafts of long bones, and in shoulders, hips, and elbows.
While there other causes of osteonecrosis, including chronic kidney failure, vasculitis, alcoholism, and other illnesses that can compromise the blood supply to the bone, the disease often affects divers who have no other indicators; usually, these divers have been spending time underwater on a regular basis for years. A Japanese study found that approximately 70 percent of divers with 25 years or more experience suffer from some osteonecrosis lesions.
If you think you may be suffering from osteonecrosis, be prepared to have a frank discussion with a doctor regarding your diving habits, since these injuries are related to both depth and time of exposure. Thanks to advances in diving technology, doctors are starting to see more injuries like these in sports divers – they were once only common in commercial air, hardhat divers who spent lots of time at depths between 150 and 200 feet, and in compressed air workers and saturation divers.
Treatment for Bone Injuries Caused by Diving
Lesions in the hip or shoulder joints can ultimately lead to severe arthritis and can cause tissues to break down to the point that joint replacements may be necessary, while those in the elbows are usually less severe. In some cases, bone grafts using healthy bone chips from another site on the body have been found to be successful. Divers who have had joints replaced find they can dive again with no problems; however, doctors recommend they remain at depths of 130 feet or less in most cases.
Preventing Dive-Related Osteonecrosis
Divers who limit themselves to depths of 130 feet or less have not been found to have any problems with osteonecrosis, no matter how long they have been diving; doctors are finding the highest number of cases in sport divers who frequently spend time at depths between 170 and 200 feet.
Doctors specializing in hyperbaric medicine often advise people who are suffering from osteonecrosis to abstain from making dives deeper than 130 feet, since they have found that no decompression dives seem to have no impact on existing bone injuries related to diving; conversely, they have discovered that continuing to make deep dives when an injury is present seems to aggravate the condition and cause deterioration to accelerate. If you think you may have a dive-related bone injury, be sure to consult your doctor right away.