Étude prospective sur les accidents de décompression ostéomyoarticulaires en plongée de loisir : leurs facteurs de risque et leur potentiel évolutif en ostéonécrose dysbarique

Objectives

Dysbaric osteonecrosis is a complication that can result from repetitive and prolonged hyperbaric exposures and the correlation with a previous type 1 decompression sickness described as a joint pain remains a controversial subject. The study was designed to determine the risk factors of type 1 decompression sickness in recreational divers and their potential to shortly evolve into osteonecrosis.

Methods

All the osteoarthromuscular decompression sickness treated between October 2004 and November 2005 in one of three hyperbaric centers assigned in the Provence-Alpes-Côte d'Azur region were analyzed in a prospective way of standardized collections, and the majority was explored with MRI in order to screen ischaemic osteomedullar damages.

Results

Eleven cases (8,5%) were inventoried amongst the 129 diving accidents treated during this period. These joint pains were mainly located in the shoulder area (81%) and involved a majority of male experienced divers after performing deep and long dives (90%) furthermore more than 50% of these divers had greater than one dive within a twelve hour period. The average age was 38,5 years with a body mass index of 27,5 kg/m². All dives were performed with a dive computer without omitted decompression. Ten injured divers (90%) were examined by MRI shortly after the accident, but only one diver (10%) had lesions compatible with osteonecrosis.

Conclusion

This preliminary study shows that osteoarthromuscular decompression sickness in recreational diving are essentially involved in dives considered to carry a high risk for bubble production. The conditions of occurence appear also to be related with some individual factors that must be specified in other studies. Nevertheless, the risk of early underlying dysbaric osteonecrosis development is quite low.