Fit for diving after musculoskeletal decompression sickness: how to detect and manage bone lesions?

Abstract

Musculoskeletal decompression sickness (MS DCS) is a clinical condition characterized by joint pain following scuba diving. Recent studies have shown a potential link between MS DCS and bone lesions, including dysbaric osteonecrosis. This article highlights the importance of early detection and management of bone damage in MS DCS patients. It is recommended that a specialist diving doctor be consulted for a comprehensive assessment to ensure an accurate diagnosis and treatment plan. Ordering a joint MRI two months after the accident is the best way to detect the presence of intraosseous edema, the main risk of which is osteonecrosis, especially if the humeral or femoral head is involved. This clinical communication highlights the need for caution when resuming diving activities after MS DCS involving the shoulder or hip, as bone involvement may complicate recovery. Hyperbaric oxygen therapy sessions have been shown to have an anti-edematous effect, which can be beneficial in accelerating intraosseous healing and limiting the risk of progression to osteonecrosis. Overall, this article underscores the critical role of the diving physician in ensuring the safe return to diving for individuals recovering from MS DCS.