Dysbaric osteonecrosis in diving fisherman: a case report
Keywords:Dysbaric osteonecrosis, diver, decompression sickness
Background: Dysbaric osteonecrosis (DON) is defined as avascular bone necrosis, usually involving specific parts of the long bones, which is seen in divers or compressed-air workers due to exposure to pressure. We describe a case of DON in an artisanal diving fisherman working underwater for many years. Methods: A 48-year-old male case was admitted to the occupational disease outpatient with left shoulder and arm pain for 1-2 years. Since the age of 20, he has been artisanal diving fishing with a hookah at a depth of 20-25 meters in the sea. In 2011, he received hyperbaric oxygen therapy for widespread pain in the whole body due to decompression sickness (DCS). In the case's left shoulder joint x-ray and magnetic resonance imaging, degenerative changes in the acromioclavicular joint and signal changes consistent with osteonecrosis starting from the subcortical area of the humeral head and extending to the proximal shaft of the humerus were observed. Conclusions: DON is among the most common long-term pathologies in professional divers. In Turkey, as in our case, not applying safe decompression procedures and unsafe diving practices are common among diving fishers. In studies, the frequency of exposure to pressure, duration and depth of dive, insufficient decompression, formation of DCS and increasing age were associated with DON. Today, DON remains an occupational hazard with significant medical and social consequences. Diving fishers should be informed about the sequelae of DCS and trained on the safety measures to be taken.
Uguen M, Pougnet R, Uguen A, et al. Dysbaric osteonecrosis in professional divers: two case reports. Undersea Hyperb Med. 2015;42(4):363-7.
Coleman B, Davis FM. Dysbaric osteonecrosis in technical divers: The new ‘at-risk’ group? Diving Hy-perb Med. 2020;50(3):295-299. Doi: 10.28920/dhm50.3.295-299
Aktaş Ş: Disbarik osteonekroz. Aktaş Ş (eds): Eğitmenler için dalış sağlığı. Istanbul: Türk deniz araştırmaları vakfı (TÜDAV), 2019;51:113-27.
Gempp E, Blatteau JE, Simon O, Stephant E. Musculoskeletal decompression sickness and risk of dysbaric osteonecrosis in recreational divers. Diving Hyperb Med. 2009;39(4):200-4.
Coulthard A, Pooley J, Reed J, Walder D. Pathophysiology of dysbaric osteonecrosis: a magnetic reso-nance imaging study. Undersea Hyperb Med. 1996;23(2):119-20.
Kenney IJ, Sonksen C. Dysbaric osteonecrosis in recreational divers: a study using magnetic resonance imaging. Undersea Hyperb Med. 2010 Sep-Oct;37(5):281-8. PMID: 20929185.
Miyanishi K, Kamo Y, Ihara H, Naka T, Hirakawa M, Sugioka Y. Risk factors for dysbaric osteonecrosis. Rheumatology (Oxford). 2006;45:855-8. Doi: 10.1093/rheumatology/kel013
Popa D, Medak A, Chin W, et al. Dysbaric osteonecrosis (DON) among the artisanal diving fishermen of Yucatán, Mexico. Diving Hyperb Med. 2020;50(4):391-398. Doi: 10.28920/dhm50.4.391-398
Toklu AS, Cimsit M. Sponge divers of the Aegean and medical consequences of risky compressed-air dive profiles. Aviat Space Environ Med. 2009;80(4):414-7. Doi: 10.3357/asem.2420.2009
In consideration of the publication of my manuscript or other written work, I hereby transfer to MATTIOLI 1885 SPA the sole and exclusive worldwide rights,
- to secure copyright;
- to produce preprints or reprints for sale or free distribution;
- to republish the article in a collection of articles or any other format related to the Journal.
Furthermore, I affirm that this article (text, illustrations, and/or tables) is original, unpublished, not under consideration by another journal, and not subject to copyright or any other of the rights that are hereby assigned to MATTIOLI 1885.