aseptic bone necrosis

[DallasNewbie]

I talked to my wife, who is a PharmD (Doctor of Pharamcy), who said that it really doesn't matter how you get osteonecrosis, any osteopath (bone doc) should be able to diagnose and treat it.

Do you mean any orthopedist?

 

[ScubaDadMiami]

I have, for quite some time now, been questioning the DIR divers who dive deep, use repetitive decompression, and seem to be pushing the limits. They are risking their health in the long term.

I hear a statement but I do not see any evidence to support it here. On what are you relying when you say this? By this I mean, in what way are they risking their health more than other divers by engaging in these activities?

I do not think that there are any in-depth studies for long term that are out there on this.

 

[John C. Ratliff]

I hear a statement but I do not see any evidence to support it here. On what are you relying when you say this? By this I mean, in what way are they risking their health more than other divers by engaging in these activities?

I do not think that there are any in-depth studies for long term that are out there on this.

First, before I give my sources, I want everyone to know that you can go on-line and get at least the abstracts to the studies and papers for yourselves. You don't any longer have to rely upon some "expert" to get medical information. There is a service out there called "PubMed" which makes these studies available to the general public free of charge. Some publications will charge for the full paper, but put the abstract on-line for free downloading. Go to:

http://www.pubmed.gov

then type in your search words. In this case, I used the technical term "dysbaric osteonecrosis" for the search. Here are some of the studies:

"Aseptic bone necrosis in an amateur scuba diver," by GDM Laden, and P Grout, Br J Sports Med 2004,38:e19 (http://www.bjsportmed.com/cgi/content/full/38/5/e19). The abstract states:

A case is reported that provides further evidence of an old occupational hazard, dysbaric osteonecrosis, presenting in a new population (sports scuba divers) who also appear to be at risk. It highlights the need for an accurate diagnosis of diving related illnesses)

Dysbaric osteonecrosis: a reassessment and hypothesis, C.D.D. Hutter, Departemnt of Anaesthesia, City Hospital, Nottingham, UK, Medical Hypothesis (2000), 54(4), pgs. 585-590.

Summary...It is proposed that rapid compression by impeding venous drainage from bone initiates intramedullary venous stasis. In the presence of intramedullary gas bubbles, this may progress to thrombosis, ischemia and bone necrosis. THe review offers an explanation for total sparing of the knee joint in dysbaric osteonecrosis, and sole involvement of the hip and shoulder (in terms of sub-articular lesions and subsequent joint collapse). In addition to continued observance of proper decompression procedures, a slower rate of compression may further reduce the incidence of dysbaric osteonecrosis...

Dysbaric osteonecrosis in Turkish sponge divers. Toklu AS, Cimsit M., Undersea Hyperb Med. 2001 Summer; 28(2):83-8.

Skeletal radiographs were performed to determine the prevalence of dysbaric osteonecrosis (DON) in 51 Turkish sponge divers. DON was correlated with the diver's age and experience, maximum diving depth, and decompression sickness (DCS). Thirty-six of the 51 divers had radiographic evidence of one or more lesions, for a prevalence of 70.6% DON. Proximal humerus was the most effected site. Type B (head, neck, and shaft) lesions were most common, comprising 63.6% of all DON lesions. Type A (juxta-articular) lesions were observed in all 10 divers who complained of painful mation of their shoulder or hip joints. DON most commonly affected the proximal humerus. Reportedly, 38 of these 51 (74.5%) divers had experienced DCS. We did not fnd any significant relationship between DON and DCS, maximum diving depth, diving experience, and divers' age.

Those are some of the sources I read. In all, I got 51 "hits" on the subject in PubMed. One of the most interesting to me was:

Cumulative sperm whale bone damage and the bends.
Moore MJ, Early GA.
Department of Biology, Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA. mmoore@whoi.edu
Diving mosasaurs, plesiosaurs, and humans develop dysbaric osteonecrosis from end-artery nitrogen embolism ("the bends") in certain bones. Sixteen sperm whales from calves to large adults showed a size-related development of osteonecrosis in chevron and rib bone articulations, deltoid crests, and nasal bones. Occurrence in animals from the Pacific and Atlantic oceans over 111 years made a pathophysiological diagnosis of dysbarism most likely. Decompression avoidance therefore may constrain diving behavior. This suggests why some deep-diving mammals show periodic shallow-depth activity and why gas emboli are found in animals driven to surface precipitously by acoustic stressors such as mid-frequency sonar systems.
PMID: 15618509 [PubMed - indexed for MEDLINE]

Concerning my use of the type of doc above, I did not mean Osteopath, but instead meant Orthopedic surgeon. Thanks for that catch (it was late when I typed that).

John

 

[slingshot]

Imaging of the "hip bone" (femoral head) for avascular necrosis, performed by a radiologist in consultation with a treating orthopedic surgeon or other physician, will likely start with a standard x-ray. Even in people who go on to more advanced imaging for avascular necrosis, usually an MRI, a standard x-ray is useful as comparison when interpreting an MRI. A standard x-ray is also helpful for assessing other potential causes of chronic hip pain, such as osteoarthritis (a form of "wear and tear" degenerative arthritis). Talk with your doctor about your concerns.