How to differentiate muscle joint pain due to tiredness from being bent

[boulderjohn]

After a heavy dive day my wife had some wrist pain after lugging some tanks around. She ended up in the chamber, and the diving-doc asked if the pain had gone away. She said no, and he said carpal tunnel, and took her out of the chamber.

Get in a chamber. Does it stop hurting? Yes => bent, no => still not sure.

I used to get a tingling in my fingers after weekends of heavy diving. To cut to the chase, it turned out to be carpal tunnel, aggravated by tank handling. I mentioned this to Simon Mitchell, and he responded that many a carpal tunnel problem has been treated as DCS.

In response, to Ken, after those weekends, the carpal tunnel tingling subsided on its own on just about the same schedule as it would have had they put me in the chamber.

For me, the key pain centered on the middle of the right scapula. Now, I did nothing to strain the right scapula, but I was in denial anyway.

 

[boulderjohn]

Years ago someone posted a letter from DAN regarding having qualified personnel in a chamber because of the likelihood of a misdiagnosis. The letter cited spinal stenosis, a narrowing of the spinal column that impacts the nerves, as a common problem that is often misdiagnosed as DCS.

At nearly the same time, a study was published that suggested that spinal stenosis might be a risk factor for DCS. In the study, they looked at people who had had DCS at some time in the past and checked for possible risk factors. They found a higher than expected number had spinal stenosis and concluded that it was a risk factor. How had they determined that the people had DCS in the past? They surveyed people who had been treated for DCS. I hope all readers understand the problem--being treated for DCS does not mean you had DCS. The higher than expected incidence of DCS treatment with people who had spinal stenosis might instead reflect a high number of misdiagnoses.

 

[kinoons]

Years ago someone posted a letter from DAN regarding having qualified personnel in a chamber because of the likelihood of a misdiagnosis. The letter cited spinal stenosis, a narrowing of the spinal column that impacts the nerves, as a common problem that is often misdiagnosed as DCS.

At nearly the same time, a study was published that suggested that spinal stenosis might be a risk factor for DCS. In the study, they looked at people who had had DCS at some time in the past and checked for possible risk factors. They found a higher than expected number had spinal stenosis and concluded that it was a risk factor. How had they determined that the people had DCS in the past? They surveyed people who had been treated for DCS. I hope all readers understand the problem--being treated for DCS does not mean you had DCS. The higher than expected incidence of DCS treatment with people who had spinal stenosis might instead reflect a high number of misdiagnoses.

Misdiagnosis is certianly possible, especially when, as you note, things often get better on their own even if we do nothing (or we do something, but that something wouldn’t have helped).

In the case of DCS I would think of the recompression chamber similar to how I think about cardiac cath for a STEMI (heart attack). You shouldn’t have a 100% positive cardiac cath rate. If you never have a negative study (inject dye and do not see a blockage in a coronary artery) that means you’re not treating some real heart attacks.

I’d think of the chamber the same way. If you never have a case where you treat someone for DCS and they don’t have it, it’s likely someone with DCS isn’t getting treated. I haven’t had to deal with DCS in my practice, and we don’t have a chamber, so I’d never see any complications from using one. @dukedivemedicine are the risks of using a recompression chamber significantly greater than the risk of not treating a case of DCS. I’d guess no, but I don’t know that for sure.

 

[Duke Dive Medicine]

Misdiagnosis is certianly possible, especially when, as you note, things often get better on their own even if we do nothing (or we do something, but that something wouldn’t have helped).

In the case of DCS I would think of the recompression chamber similar to how I think about cardiac cath for a STEMI (heart attack). You shouldn’t have a 100% positive cardiac cath rate. If you never have a negative study (inject dye and do not see a blockage in a coronary artery) that means you’re not treating some real heart attacks.

I’d think of the chamber the same way. If you never have a case where you treat someone for DCS and they don’t have it, it’s likely someone with DCS isn’t getting treated. I haven’t had to deal with DCS in my practice, and we don’t have a chamber, so I’d never see any complications from using one. @dukedivemedicine are the risks of using a recompression chamber significantly greater than the risk of not treating a case of DCS. I’d guess no, but I don’t know that for sure.

That's a good analogy, though the risks involved in HBO2 treatment are lower than those in cardiac catheterization, especially when compared to potential benefits, so we would definitely tend to err on the side of treatment as you described. For pain-only DCS it's a shortcut to pain relief and also helps mitigate the risk of aseptic/dysbaric osteonecrosis down the line.

Best regards,
DDM

 

[BlueTrin]

Thanks for all the input, I thought actually that there would have been something that could have been used to differentiate both issues.

For info, I have passed this to the person who mentioned this issue …