To dive with tendonitis / muscle soreness?

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60feet

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About 3 weeks ago, I began to experience some tingling in my upper left arm, followed by a mild, pulsating ache. The tingling disappeared after a day or so, but the ache persisted. I called DAN, but they ruled out DCS because the symptoms appeared more than 24 hours after my last dive. My doctor thinks it’s skeletal/muscular overexertion (pulling my gear bag around; weight lifting at the gym, etc.). It may also be tendonitis.

I have abstained from diving since the injury and have been icing the affected area and taking naproxen sodium. As of today, it’s almost healed with just some residual minor sensitivity and discomfort. By this weekend, it’ll be four weeks since my last dive, and I’m considering getting back underwater. However, I am concerned that my current condition may represent an increased chance of getting hit by DCS.

My dive plan would call for a very low-risk, conservative shore dive. Descend at about 20 fsw, spend 10-15 minutes to practice improving some skills with my buddy – bouyancy control, horizontal trim, hovering, relaxation, long breathing, moving slowly, etc. Then spend another 15-20 min doing a slow exploration to no more than 40 fsw. Then return towards shore and do a slow ascent with a 5 min safety stop, followed by a slow (30 ft/min) ascent to surface. Total time not to exceed 45 min.

Anyone out there who 1) has dove with a similar mild tendonitis/muscle ache or 2) knows or has heard of another diver who did or 3) has theoretical knowledge (Dr. Deco and any other doctors and scientists out there) on the likely DCS risk regarding diving while having a minor residual skeletal/muscular condition or tendonitis. I’ve read these article from DAN: http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=43 and http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=44
and would be interested in any additional info or insight. Thanks.
 
Wanted to follow up on this and share with you what I received from DAN via e-mail after I sought their advice on my situation. Their reply is as follows,

… snip… “The safest answer would be for you to wait to dive until the symptoms have completely resolved. This eliminates most concerns. There is no clinical evidence to prove that any individual with inflammation is at any greater risk of DCS due to the injury. Diving is possible with the conservative approach that you have outlined. The lower the potential nitrogen load the less risk. It is impossible for anyone to accurately quantify a specific individual's risk on any dive. With adherence to standard safe dive practices and any additional safety guidelines you should not be at any greater risk than any other diver…" snip...

"Divers Alert Network
---- ----, EMT-P DMT-A
DAN, Medical Information Specialist
Department of Anesthesiology
Duke University Medical Center”

==============================

Apparently there is a lack of clinical evidence to prove that a diver with muscular inflammation is at greater risk for DCS than when s/he is injury-free. But then it's not so surprising, considering that I've heard that the DCS incident rate for recreational divers is something on the order of 1 out of 10,000. At any rate, I've decided to stay dry until my injury is resolved before resuming diving. Better for me to do lots of "make-up" dives once completely healed than risk $ thousands for visits to a hyperbaric chamber...
 
Hi 60feet,

There is no evidence that divers with inflammation or soreness of muscle or connective tissue are at increased risk of DCI.

DAN's advice to wait until symptoms completely resolve before returning to scuba is appropriately conservative, although persons with chronic inflammatory conditions of tendons and joints can and do dive without apparent increased risk of DCI.

The diver with a continuing ache in an upper extremity will want to be careful not to exacerbate the injury when handing gear and baggage, dive conservative profiles and keep close tabs on any changes in sensations in the arm that could signal a superimposed incident of DCI.

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.

Regards,

DocVikingo
 
DocVikingo:
Hi 60feet,

There is no evidence that divers with inflammation or soreness of muscle or connective tissue are at increased risk of DCI.

DAN's advice to wait until symptoms completely resolve before returning to scuba is appropriately conservative, although persons with chronic inflammatory conditions of tendons and joints can and do dive without apparent increased risk of DCI.

The diver with a continuing ache in an upper extremity will want to be careful not to exacerbate the injury when handing gear and baggage, dive conservative profiles and keep close tabs on any changes in sensations in the arm that could signal a superimposed incident of DCI.

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.

Regards,

DocVikingo

Many thanks, DocVikingo, for the additional information on lack of evidence linking soreness of muscle / connective tissue to increased risk for DCS. It's quite reassuring; and yes, I understand that this is for educational purpose for not medical advice. I had consulted with 1) my GP doctor and 2) my brother who is also an internal medicine MD. Although both are competent, they're simply not that knowledgeable on diving-related medical risks/issues, etc. I continue to be amazed at the amount of good and useful dive-related information from you and others on this board. Scubaboard is a godsend! Thanks again.
 
Hi 60feet,

That is very kind of you to say and I appreciate it.

Regards,

DocVikingo
 
60feet:
Although both are competent, they're simply not that knowledgeable on diving-related medical risks/issues, etc.
That's why I force my brother (who's also MD but unfortunately not a diver) to study this subject whenever he has time.
 
Hello readers:

There are a thousand and one things that can go wrong with the body, and DCS is at the far end of the spectrum. It is not studied in medical school. Guyton’s book on medical physiology has one chapter devoted to with problem, but it is probably not covered. Additionally, it does not contain enough information for a practical differential diagnosis.

The arcane peculiarities of diving-related injuries might make a good episode for the TV series House.

Dr Deco :doctor:
 
I have a tendonitis problem, even I had an operation. I took the entry tech class (adv/deco) right before having an operation. I didn't find any problem even with a deep diving.
 
I just wanted to provide a quick status on my situation. I am happy to report that I have done two conservative dives recently (the last one 3 days ago) without any negative effect or results on my injury area. The first dive: 33' max depth, total bottom time of 52 min. The second dive a couple of days later: 34' max depth, total bottom time of 40 min. I still had some residual but very minor sensititivity in my upper left arm during each dive. Neither dive aggravated the condition at all! I was also very careful in gear handling, and even had the fortune to have a buddy carry my air tank to my car for me after one of the dives. As of today, my injury is almost completely healed, although I'm sure that it's not due to my return to water :).

My sincere thanks to DAN, Doc Vikingo, and Dr. Deco for the valuable information and insight in responding to my original inquiry. Your responses were reassuring and helped add confidence to my conservative and gradual return to diving. Also my appreciation to MonkSeal and hoosier for their comments as well.

60feet
 
60feet:
. However, I am concerned that my current condition may represent an increased chance of getting hit by DCS.

]

If tendonitis or sore muscles contributed to or caused DCS, I'd be dead.
 

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