Tendonitis exacerbated by diving?

[CuracaoJ]

I've had some pretty nasty tennis elbow on and off for about 5 years now. For the last year, the pain has been mild, or even non-existent, that is until I get under water! A typical example would be yesterday, I had virtually no pain before diving, then as soon as I hit 8-9MSW it was like someone hit me in the elbow with a sledge with pain radiating halfway to my hand and all the way up to my shoulder. I figure it can't have anything to do with Nitrogen loading at that point since I'm not in the water long. However, the pain continues to be bad for a good 48 hours after even a mild dive.

So the question: is there anything at all I can take to reduce either the pain while diving or the two day wear off? I know I can pop NSAIDs, and I have been taking one usually before diving, although I don't really notice a difference when I take one and when I don't. So does anyone else have any insight?

Thanks,
Jeff

 

[DocVikingo]

Hi Jeff,

Bummer.

The discomfort described almost surely isn't related to inert gas issues or the pressure of depth.

The following may prove helpful:

1. If the diver can tolerate it well, take a max or near max NSAID dose as indicated in the manufacturer's instructions for use at least an hour prior to diving.

2. Thoroughly warm up the joint by light movement/exercise for at least 5 minutes prior to diving.

3. Gently stretch the involved joint both before and after diving.

4. While diving try to keep the affected joint somewhat straight as opposed to tightly bent.

5. Make sure that thermal protection is adequate to keep the joint from chilling excessively.

6. Make sure that any thermal protection gear isn't binding on the joint.

7. Make sure that the BC fits properly and doesn't restrict blood flow to the affected limb.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient
relationship. It is not medical advice to you or any other individual, and
should not be construed as such.

 

[CuracaoJ]

Thanks Doc. I'll have to give the warming up a try. It normally doesn't hurt above the water, so I don't think about it. I'm almost positive it has to be pressure related though. It's happened to me over 50 times in the last few months. Always on descent, always between 5-15MSW. No binds anywhere, comfortable set up, warm water, never cold, arm usually bent or crossed in front of me. I can max out on Naproxin Sodium no problem, it doesn't bother my stomach.

 

[TSandM]

Tendonitis is an inflammatory condition -- having it flare as described, instantly, just doesn't go with the pathophysiology of the condition. Having certain motions hurt would be typical, if the problem is active -- if you lie on a bench and place your arms in the same position you carry them in while diving, does it reproduce the pain? But if you are totally asymptomatic on land, it would be VERY odd for the tendonitis to flare in the way you describe. Otherwise, I'd be thinking about a cervical disc issue, one where extending your neck as one does when diving is aggravating a nerve root. Is there any numbness or weakness associated with this?

 

[CuracaoJ]

I'm not completely asymptomatic on land it's just not nearly as aggravated. It's a diagnosed condition for which I have to go to periodic PT if it acts up. However, I know what causes it to act up, usually carrying heavy objects without a bend in my elbow (I have nightmares about 5 gallon paint buckets!). The position while diving imitated on land does not produce the pain. Nor does diving at shallow depths. I was just with some students last week for a couple of days and we don't go any deeper than 5-6 meters -- no problems. The next day I went on a normal dive and it hit me at about 12 meters. I am 99% positive that it is pressure related. Oddly enough the pain reduces at deeper depths say 30-40MSW, although the annoying after dive pain is still there. The cervical disc issue could be right on the money. I hold my head in amny different positions when with students as opposed to other dives. I'm going to look like a fool laying on my stomach in bed when I get home tonight holding my head up, but I'll give that a try. Mild weakness is associated with it, but no other symptoms that I would associate with nerves (no tingles, no weird numb spots, no odd shooting pains etc.).

Thanks for the help.

 

[CuracaoJ]

Well I laid on a bench last night and tried to immitate my dive position, no pain was created. I'm diving again tomorrow and Sunday, I'll keep my head down in a more natural position as I descend and see if it makes a difference.

 

[DocVikingo]

I'm diving again tomorrow and Sunday, I'll keep my head down in a more natural position as I descend and see if it makes a difference.

Hopefully this will provide some relief, CJ, but I have a couple of reservations.

For openers, disc-related pain in an upper extremity would almost certainly be due to cervical nerve root involvement and your descriptions do not seem to fit what is known about such involvement.

The most common levels in the cervical spine to be involved in upper extremity pain are C5–C6, followed by C6–C7, followed by C4–C5. C7–T1 involvement is uncommon.

- C5 nerve root injury/disease can result in deltoid area pain and weakness without numbness/paraesthesia.

- C6 nerve root injury/disease can cause weakness in the biceps and certain muscles of the wrist, and numbness/paraesthesia can occur on the thumb side of the hand.

- C7 nerve root injury/disease can cause weakness in the triceps and certain muscles of the fingers. Numbness/paraesthesia can radiate down the triceps and into the middle finger.

- C8 nerve root injury can manifest as weakness in the hand and numbness/paraesthesia in the little finger side of the hand.

I really can't think what sort of derangement of the cervical spine could result in complaints of "it was like someone hit me in the elbow with a sledge with pain radiating halfway to my hand and all the way up to my shoulder" with no weakness and "no tingles, no weird numb spots, no odd shooting pains etc."

Second, since by your description you have a fairly solid diagnosis of chronic tendonitis of the elbow that is "not completely asymptomatic on land it's just not nearly as aggravated," it would not necessarily require a whole lot of activity to exacerbate the existing inflammation.

Then again, since you responded to my first reply I can no longer think of any reason why severe elbow pain promptly should develop at 8-9MSW and then reduce at considerably deeper depths.

Thus, while I'm skeptical, experimenting carefully with head and neck position seems worth a try. Please let us know what happens.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[CuracaoJ]

Well fortunately I have not had an issue since my last post and have done 10 dives since then. However, all of those dives have either been with students, or spearfishing, both of which tend to keep my neck swiveling a lot more than just your standard leisure dive. I'm heading out with some divers this morning, and my tendonitis is just a touch tender at the moment, so we will see how it goes. I've also been taking your advice and warming up/stretching before every dive even if just for 30 seconds. If I figure anything more out as to why or how, I will certainly update here.

Thanks again,
Jeff

 

[DocVikingo]

Well fortunately I have not had an issue since my last post and have done 10 dives since then.

That is good news.

However, all of those dives have either been with students, or spearfishing, both of which tend to keep my neck swiveling a lot more than just your standard leisure dive.

Consistent with the reservations expressed in my post immediately above.

If I figure anything more out as to why or how, I will certainly update here.

Yes, please do.

Regards,

DocVikingo