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David Story writes:
>My understanding is that dysbaric osteonecrosis has not been
>documented in divers outside the commercial environment, and that it
>is not a risk to be worried about in conservative diving. My
>personal, non-expert hypothesis is that the folks getting this are
>doing a lot of Sur-D and minimal decompressions and hence end up with
>heavy asymptomatic bubble loadings after their working dives.
>
>I've not seen the report you mention about dysbaric osteonecrosis
>occuring after a single dive: could they have mean it *could* occur
>after single dive, or did they actually have controlled data on a
>person with no other risk factors suffering DO after a single dive?
Thanks for the correction, the hyperbaric rather than dysbaric came from
my memory as I didn't have the references handy at work.
I have now got the references in front of me, so I can add a bit more to what
I wrote previously.
The reference to there being a case of DO after a single deep dive occurs in
both Lippman and Edmonds, but without reference to a particular study. Some
quotes:
From Lipmann ("Deeper into Diving"):
"In Australia in 1976, a group of 19 sport divers volunteered to be X-rayed
for signs of DO. Three of the divers (15.8%) were found to have bone leisons,
however, this is far higher than expected for sport divers [Williams]. A
report of the incidence of bone necrosis in 4980 North Sea divers which was
published in 1979, showed no lesions in divers who dived on compressed air
at depths shallower than 100ft (30m). Dives between 103 and 165 ft (31-50m)
carried an incidence of 0.8% [Knight]."
[Williams] Williams B. and Unsworth, I. (1976), "Skeletal changes in divers",
Australian Radiology, Vol 20, pp 83-94.
[Knight] Knight, J. (1982), "How common is Dysbaric Osteonecrosis", SPUMS
Journal; Vol 16, October-December pp 12-16.
NB: SPUMS is the South Pacific Underwater Medical Society.
From Edmonds ("Diving Medicine for scuba divers"):
"X-ray changes have been seen as soon as 3 months after a dive and it has been
reported following a single deep dive."
"Early lesions can now be identified with newer techniques. Injected radioactive
Technetium ("bone scans") will bind to an osteonecrotic area and can be
detected with a scanner within 2 weeks of the injury. The lesions can also be
identified in excellent detail using MRI scanning."
"In divers who develop decompression sickness, a followup bone scan after
2-4 weeks should detect areas of bone damage."
It seems that DO is primarily associated with dives deeper than 165ft and
with those people doing a lot of diving. Hence my interest in whether the
technical diving community has carried out any study of its members.
Regards,
David.
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