joint pain - intermittent intensity, affected by movement

[Makhno]

Greetings,

I've heard and read (and was once advised by DAN when I called them a number of years ago) that shoulder pain after diving is likely due to muscle or tendon strain, rather than DCS, if the pain:

• is of intermittent intensity (rather than fairly constant), and
• is aggravated by arm movement.

I found that same info posted here by Dr. Deco as well: "It is generally said that DCS pain is present even without movement. The pain does not necessarily increase when the joint is moved, either actively or passively." http://www.scubaboard.com/forums/as...rence-between-dcs-plain-old-nerve-issues.html

And from DAN's website: "If the pain can be produced with movement of the affected joint only, then it is more than likely a musculoskeletal strain or injury. The pain generally associated with decompression illness is not affected by movement or lack of movement and usually remains fairly constant . . . The ability to reproduce the symptom with movement indicates a stress or repetitive movement injury." DAN Divers Alert Network

But then I read this: "The joint is usually not tender to touch but movement may aggravate the pain. . . . " http://www.divingmedicine.info/divingmedicine/Welcome_files/Ch 15.pdf Diving Medicine for Scuba Divers (2010 Edition) by Dr Carl Edmonds Dr Bob Thomas Dr Bart McKenzie and John Pennefather (emphasis added). That source further states: "In general, any pain in or near a joint after compressed air dives in excess of 10 metres (or shallower with repetitive or prolonged dives) must be assumed to be DCS until proven otherwise." (emphasis in original).

What's the latest on this?

Thanks in advance for your replies.

 

[cutlass]

Thankfully, you provided the source of the quote. The text immediately preceeding that quote is this:

There may occasionally be difficulty distinguishing between DCS and other causes of a painful joint such as strain, injury or arthritis. In the latter conditions, the joint is usually tender to touch and may be red and swollen. Generalised arthritis is often bilateral and symmetrical and involves smaller joints, and local pressure application produces no relief. These signs are uncommon in DCS.

Your quote in isolation can be confusing. But IMO, the situation is clarified by adding the above text into consideration and in the order it appears in the article; i.e. before your quote. Thus, after an assessment -- which includes comparing joint movement and pain -- is somewhat uncharacteristic of strain, injury, or arthritis then the suspicion of DCS must rise foremost in priority.

You may ask, "Why isn't the first priority given to DCS since it's potentially the most serious condition"? There are two reasons, IMO. First, the other possbilities are more common and assessment for them can be done very rapidly, at little cost of time and resources. Second, the treatment for DCS is a chamber ride, in many ways a much more costly proposition.

Yes, one can argue for the reverse; that it seems that the most conservative decision would be immediate admittance into the chamber and then assess for the other alternatives. But IMO, that would be irresponsible because what if another DCS event -- a real one -- rolls in? This is an extremely common real-life problem of managing scarce healthcare resources.

 

[TSandM]

I do think, from the stories I have read and heard, that most hyperbaric physicians err on the side of assuming DCS, rather than the reverse.

I think it can be quite difficult to sort exertional pain/strain from DCS, especially when it occurs in the shoulder (a common site).

 

[cutlass]

That certainly makes sense, under the (obvious?) understanding that the case is already a transfer or referral from another facility or first responder/medical control who triaged. Then one must assume DCS until proven otherwise.

 

[DocVikingo]

I think it can be quite difficult to sort exertional pain/strain from DCS, especially when it occurs in the shoulder (a common site).

In fact, the most common joint site, e.g., JOINT PAIN (MUSCULO-SKELETAL DCS, BENDS) (http://www.divingmedicine.info/divingmedicine/Welcome_files/Ch 15.pdf)

Regards,

DocVikingo

 

[Makhno]

Thanks to you all for your replies.

You're right, cutlass, I should have provided the full quote for the benefit of anyone who reads this thread. (The reason I didn't was that when I posted, I was thinking self-centeredly only of my shoulder, which isn't red nor swollen nor noticeably tender to the touch, and I don't have arthritis -- so the earlier part of the quote isn't relevant to my most immediate concern right now).

 

[hodson]

Joint pain really the painful thing and the body suffering that one pain knows well about the
intensity of that one pain.... I also have some kind of that pain but cure medically soon and have
follow the physician advice.....