sea urchins

[devjr]

I prefer this explanation, mainly because it agrees with my own experience:

http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=34

 

[BillP]

Hi devjr:

That DAN link is a good one, thanks for posting it. It pretty well agrees with what DocV and Scubadoc were saying, and I hope their posts and the DAN article cleared up your questions for you.

Originally posted by devjr
I never heard of anyone extracting the spines or getting an infection. Is that what people do nowadays? How do they get the spines out?

I'm sure that you saw in the DAN article where they said, "If a spine is able to be removed, do so gently and meticulously, as spines are fragile and break readily." That's the careful vertical extraction (say with tweezers) that bengiddins, DocV and Scubadoc were talking about. But DAN goes on to suggest, "seek medical help promptly", when the injury is in the area of a joint (as DocV warned about) and they mention potential problems from spines and fragments of spines left in. That recommended prompt medical help might involve the surgical extraction of spines, as also already mentioned.

I'm sure you also saw where the DAN article mentioned, "treat infection with antibiotics." While you might not have ever heard of anyone contracting an infection from a sea urchin injury, apparently others have.

HTH,

Bill

 

[devjr]

BillP, thanks; the article goes on to say that spines broken off are absorbed, and doesn't refer to the broken spines as "pigment". Pigment would wash out with the blood anyway. As far as infections, the article says "IF" infection happens, do such and so forth. There are a lot of ifs. From this board, actual infections seem to be more common with foot injuries for obvious reasons, and perhaps in certain geographic areas and from certain types of urchin.

Of course, one can postulate an infection arising from any injury which breaks the skin. I've never personally experienced an infection from sea urchin and certainly wouldn't seek surgical removal of numerous small imbedded spines on the theory that one might arise. I know many people who have had similar experiences and who have not required medical treatment. Why? Possibly, urchin venom is an antiseptic. I should add that I've never seen a joint injury which the DAN article refers to. An injury of this sort might be of more concern and need attention. However, anybody who thinks they can pick out the typical urchin splinter is in for a surprise. It would require long hot soaks, and when that fails, excision.

The purpose of an article of this type is to cover every type of contingency. As I said initially, I've not seen some of these injuries. However, DAN's common sense description of typical injuries and their natural resolution is appreciated and is something that seems lacking or omitted when the subject comes up in a discussion group.

 

[JustAddWater]

Thanks for the info! I had thought the urine remedy was pretty much just for novelty conversation.
Thanks,
JAW

 

[DocVikingo]

Hi devjr,

Except for the "urine thing," I don't believe that common sense has generally been lost in this thread.

Let's discuss a few of the topics:

1. Puncture near a joint:

"J Travel Med 2000 Jan;7(1):43-5

Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.

Liram N, Gomori M, Perouansky M.

Hadassah University Hospital (HUH), Department of Orthopaedics, Spine Surgery Unit. Ein-Karem, Jerusalem, Israel and the Anglo-European Chiropractic College, Bournemouth U.K.

Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. Synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. Magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint."

2. Hot water treatment is recommended by noted dive medicine physicians Drs. Paul Auerback, Paul Cianci, & Joseph Kaplan, amongst others.

3. As regards infection, Zoltan Trizna, MD, PhD, Assistant Professor, Department of Dermatology, Texas Tech University Health Science Center, indicates: "Mechanical injuries followed by infection – Wounds that become secondarily infected either by debris or microscopic organisms found in the water. Improper wound care (rinsing injuries with seawater possibly loaded with microorganisms) can be a source of wound infections. Inoculation of infectious agents can commonly occur when suffering penetration injuries or lacerations caused by sea urchin spine, stingray, seal bite, or other bites (eg, octopus, fish). Depending on the depth of the inoculation and on the microorganisms inoculated, severe infections of the underlying tissues and structures also can occur. In addition to possibly evolving into severe systemic infection, such processes may lead to deformities and loss of function."

4. While I agree that removal of these spines using a tweezers, needle or other such instrument is not always easy or effective, most treatment protocols that I am aware do suggest at least attempting removal.

I do, however, have trouble making sense about sea urchin venom possibly being an antiseptic. Do you have a source of support for this speculation?

Best regards.

DocVikingo

 

[BillP]

Hi devjr:

Correct me if I'm wrong, but you seem to be suffering under the false impression that other posters in this thread were implying that sea urchin injuries always require medical attention and surgical extraction of every piece of the spine. If you re-read the thread I think you'll find that such is not the case. Your point that most sea urchin injuries can be taken care of by the diver and will heal spontaneously is well taken. But in your answer to bengiddins where you recounted your extensive experience with urchins and you said, "I never heard of anyone extracting the spines or getting an infection" you seemed to be taking the opposite extreme and implying that one never needs to seek medical attention for an urchin injury or even give the injury any particular care. And your follow-up post (War of the Quotes!?) seems to confirm the impression that you felt you needed to counter the misinformation of others. Now, I know that you couldn't really have been trying to imply that sea urchin injuries can't lead to significant problems and don't ever require medical attention because that would be just plain wrong. But I can see how others might feel that they need to "correct" the misleading impression that you (unintentionally?) left.

Read the thread again. Bengiddins' posts were quite good, and while they could have additional information added to them, they did not require correction. DocV and Scubadoc's posts were also very helpful and did not require anyone going to "war" with their statements. I do have to take issue with several of your statements however. Yes the DAN article did say ""IF infection happens, do such and so forth", but it did not say, "If by some outrageous misfortune you just happen to be the very first person to ever get an infection from a sea urchin injury, do such and so forth". So to answer your earlier question, Yes, people can get infections from sea urchin injuries even though devjr has never personally heard of it, and divers on this board (you included) need to be aware of this possibility. And yes, divers should try to extract any part of the spine that they can easily extract without doing further damage, even though you have never heard of such a thing. Frankly, there seems to be a great deal about dive medicine that you have never heard of, and if you still fail to realize that, I think it important for other board members to keep it in mind when they read your posts on medical topics.

I believe that your impression that articles like the one in DAN are meant to "cover every type of contingency" is also mistaken. It would be very hard for a 2 page article (including one page of that taken up by photos and an ad) in a lay dive magazine to be totally comprehensive. I think it more likely was meant to be a brief overview of the topic. They did not mention the pigment on the spines, but a couple of dive medicine books do. Both Bove and Davis' Diving Medicine and Edmonds' Diving and Subaquatic Medicine say about urchin spines, "The spines are covered by a black pigment, which can be mistaken for the actual spine during its removal." I suspect it likely that the "little black splinters" you saw were the remnants of this pigment and like many people you had incidentally extracted most of the spine fragments when you removed your arm from the urchin. Perhaps that's why you didn't have further problems. I don't see where anyone in this thread said that each of those black splinters required removal. It looks like you have once again misinterpreted what you have read. Rather I would point out to you that the extraction mentioned refers to larger fragments of spines that are accessible from the surface with something like tweezers, reserving surgical extraction for fragments that are actually causing (or very likely to cause) significant problems. Oh, and no, blood would not "wash out" all of the pigment. While bleeding does clean a wound to some extent, it's really more just something your mother told you to get you to stop crying about the blood.

Clear now?

HTH,

Bill