I injured my shoulder, and would like to get back to diving, and I'd like to educate myself a bit on the relationship between diving and the healing process, in particular: (a) how diving might affect healing, (b) how the presence of swollen or damaged tissue affects decompression, and how one might account for that when planning the dive. I'd be grateful for any comments or pointers. Some things are pretty obvious: follow doctors' recommendations, take into account the additional risk of having reduced strength and range of movement, etc. Some other things might be less obvious, and it's mostly those that I'm hoping to find out about... Disclaimer: yes, I'm seeking advice on an internet forum, and no, I'm not using ScubaBoard as a substitute for professional treatment. The purpose of this post is mostly to satisfy my intellectual curiosity, and to help me better appreciate the extent of my ignorance. Thanks!
Diving and the healing process.
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There actually isn't very much that I could find on these topics.
Hyperbaric oxygen is used to accelerate healing in chronic wounds, but the environment of those wounds is frequently hypoxic, and there are some data to indicate that if they are not, hyperbaric treatment doesn't change anything. I could find nothing at all on hyperbaric treatment of other types of (closed) injuries.
There is a theoretical concern about susceptibility to DCS in areas of scar tissue, based on the idea that they have relatively poor perfusion. I've looked this one up before and found no studies or clinical series to support that this is a concern in reality, and I do know that many of us dive after fractures and operations, without experiencing symptoms in the healed areas.
As someone who has battled biceps tendonitis since a fall a couple of years ago, I can say that there are a number of activities involved in diving that can aggravate shoulder issues: Carrying and lifting tanks, donning and doffing dry suits or wetsuits, carrying the arms out in front of you, and valve drills are among them.
Hyperbaric oxygen is used to accelerate healing in chronic wounds, but the environment of those wounds is frequently hypoxic, and there are some data to indicate that if they are not, hyperbaric treatment doesn't change anything. I could find nothing at all on hyperbaric treatment of other types of (closed) injuries.
There is a theoretical concern about susceptibility to DCS in areas of scar tissue, based on the idea that they have relatively poor perfusion. I've looked this one up before and found no studies or clinical series to support that this is a concern in reality, and I do know that many of us dive after fractures and operations, without experiencing symptoms in the healed areas.
As someone who has battled biceps tendonitis since a fall a couple of years ago, I can say that there are a number of activities involved in diving that can aggravate shoulder issues: Carrying and lifting tanks, donning and doffing dry suits or wetsuits, carrying the arms out in front of you, and valve drills are among them.
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I'm with Lynn that unless you are cranking PO2's you won't see much difference and even that is likely only going to last while you are under the influence of O2. Most of us feel better after coming off of high PO2's, but it doesn't last very long. If your shoulder has ltd mobility sidemount may be the best option for you since you can wheel the tanks around on a cart to the water, and have the valves in front of you to work with. If it is your right shoulder and you dive single tanks, you may want to look into a lefty valve for doubles and use that so valve manipulation is done with your good shoulder.
Really, the only thing I've changed is that I ask for help getting the shoulder of my dry suit up to where it should be -- yanking my arm up to get it to slide up seems to be one of the worst things I do. I don't dive my sidemount rig, because the over- internal rotation of the shoulder when reaching the attachment points behind me was how the whole thing took off in a really bad way. (It started with two falls.). In general, I try to avoid using my right hand above shoulder level as much as possible. But I'm not a great patient, and I never saw anybody about this except the Ortho fellow I was diving with who diagnosed it in the first place 
Yup, I was just thinking that maybe I should accelerate my venture into the world of sidemount, I already got in touch with an instructor. I was wondering whether it may be worth carrying 100% O2 bottle, and cranking up conservatism to get some deco time even for recreational dives, whether there is even a theoretical argument supported by some data (or subjective experience) that this would have any practical benefit...
Really, the only thing I've changed is that I ask for help getting the shoulder of my dry suit up to where it should be -- yanking my arm up to get it to slide up seems to be one of the worst things I do. I don't dive my sidemount rig, because the over- internal rotation of the shoulder when reaching the attachment points behind me was how the whole thing took off in a really bad way. (It started with two falls.). In general, I try to avoid using my right hand above shoulder level as much as possible. But I'm not a great patient, and I never saw anybody about this except the Ortho fellow I was diving with who diagnosed it in the first place
Ah, you write in the present tense, so you still suffer from this today? This sounds worrisome... I realize sidemount might or might not be the answer, depending on what the ortho guy might find upon closer examination. Reaching behind for my lower back does seem much easier than raising my arm laterally, though, I'm afraid I'll have to break down my doubles for a while, and my plans to finally take GUE Fundies will also have to wait...
sphyrnidus
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@KR2y5: You don't specify what kind of injury you have so that makes it hard to say anything about it. I'm not an orthopedist, but I have shoulders. Riding in a group I bumped in to the guy in front of me and fell of my bicycle, dislodging my AC joint on the left side. It hurt and I just went on and dove like always. Then some years later I did something stupid again and fell of my motorbike on a muddy hill and we tumbled over and I landed on my right shoulder. I heard the crunch (again) and immediately knew that now my other AC joint had dislodged. So I thought it will heal like last time. Except it didn't. After three months it still hurt like hell, I couldn't lie down on it and I couldn't lift my arm and had to eat with my left hand. Driving was a challenge too. A frozen shoulder. The orthopedist said it would go away eventually, but it didn't subside very fast. We had planned our annual skiing trip in December ( I fell in July) and I thought lets see, we had booked anyway, I'll sit and read a book if I can't ski. But miraculously due to the movement of the arm swing the pain was gone after the second day. Now after three years I'm still aware I have shoulders. I have some trouble gearing up, I can't get in to my wing by myself and getting out of the suit is a challenge too. But the pain is gone and I can function normally for a guy my age of 62, I can't complain..
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you won't pass fundies with a busted shoulder..... lots of valve drills in there.
You don't need to up conservatism, just do a 5 minute stop at 20 feet for your dives, it won't hurt, especially if the computer is keeping track of your CNS clock and tissue loading.
You don't need to up conservatism, just do a 5 minute stop at 20 feet for your dives, it won't hurt, especially if the computer is keeping track of your CNS clock and tissue loading.
I fell into water with my arm extended, it felt as if the arm got pulled out of my body, and "snapped" back in place as if on a rubber spring. I have been feeling dull pain and weakness, and a limited range of motion, particularly lateral arm raise, there is quite a bit of swelling. I had it examined in the ER a few hours later, the X-ray at that time did not reveal bone fracture, still waiting to get my MRI or Ultrasound exam to find out how much tear there might be in the tendon tissue. Based on the X-ray, and a brief physical examination by the on-site orthopedic surgeon, the hypothesis was that sudden bone movement has bruised the tendon, the tentative diagnosis is post-traumatic rotator cuff tendonitis.
Argh, now I'm even more determined to fix the damned thing. I must pass fundies! Surely, mind will prevail over matter.
I shattered my collarbone in a bicycle accident a few years ago, and it was a long healing process before I could dive again. My fear was frozen shoulder syndrome following prolonged inactivity, and I began working on flexibility exercises as soon as I was allowed. As a planned technical diving trip neared, I got into the pool with my doubles for the first time and found I could not reach my valves with that arm. I worked on the flexibility some more and I had several therapeutic massages. The massages were a huge help. The masseuse was very knowledgeable about this sort of thing, and she worked wonders on that entire area. I was finally able to reach my valves easily just before the trip.
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