Shoulder problem

diverrob

I am looking for some additional information from anyone who may have an opinion. First I will tell my story.

I have had an injured right shoulder since Dec 05 (Hockey). The diagnosis from the doctor was injury to the supraspinatus tendon/muscle. I attended physiotherapy for few weeks and worked on strengthening the surrounding muscles. I got results quickly to a point but still have pain with some movements of the arm/shoulder. I planed a dive to 240’ for :15 aprox 5 weeks ago I was using an Evolution Rebreather with TX 10/45. The dive went as planned, I ended up following the deco on my Cochran so I would not bend it. The settings on the Evo were Gradient 10/80, descend to 50’@ 0.7 then switch to 1.3 for the rest of the dive @ aprox 40’ I switched to 1.4 and @ 20’ I flushed with O2 and stayed on O2 for the remainder of the dive. The settings on the Cochran were 1.2 for the entire dive with 35% conservatism. After the dive I noticed some loud crackling in my right shoulder when I rotated it and was concerned so I call our Medic from work (I work as a Navy Clearance Diver). He came over to my house aprox 1.5 hours post dive and examined me. I presented no classic symptoms of DCS. After discussion with our medic we decided to contact the duty Advanced Diving Medical Officer (Doctor), she agreed to see me that night and we went down to work. During her examination she performed a full neurological exam along with the standard checks (BP, HR, hearing…) The only thing out of the norm was the audible crackling noise from my shoulder (which was becoming less as the surface interval increased) I had no pain, numbness, rash…… She decided that it was not DCS and recommended a MRI to see if my previous injury was more than first thought. I agreed and decided to lay off the deep diving for a while. The next week I completed a dive that was 60min @ 30’ on a setting of 0.7 usind an air Dill. After the dive I was able to here the same noise but not as loud this time. This further convinced me that it was not DCS related but I am still not doing any deep diving until I get the results of the MRI. If anyone has any comments I would like to here them. Thanks

saturation

This is very interesting. Bubbles are hypothesized to form more easily in hypoperfused tissues, mostly after injury or surgery to joints. However, there is no proof of the same and if one recovers fully after a joint injury, there shouldn't be perfusion issues this striking. The supraspinatus is not on the joint itself but is above it. That crackling is likely crepitus, and it can occur due to bubbles, like subcutaneous emphysema.

Is there no crackling at all between dives? When it does happen, it only occurs < 24 hrs after a dive and dissappears soon after 24 hours?

If so, I would get the MRI soon after a dive, while the crackling is at its worst. It would be remarkable to see bubbles in the joint space or tendons. Otherwise, crepitus may just appear from arthritic changes of the joint, and reflects changes on the joint, not the muscle or tendon.

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I.G. Saturation, MD

{ Comments are informational only and not meant to be medical advice applicable to a particular case. Consult your physician when considering information posted here }

hchoat

I've had three fairly significant orthopedic injuries in the last few years, and after each I have noticed crepitus in the areas affected (I've generally noticed it after exercise of any sort). I've never had any DCS issues associated with any of the injuries.

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diverrob

"Is there no crackling at all between dives? When it does happen, it only occurs < 24 hrs after a dive and disappears soon after 24 hours?"

There is some noise between dives but you have to have your ear on the joint to hear it. The noise is loudest after the dive and seems to resolve it's self 4 hours post dive. The thing that gets me is that there is no other symptoms

Rob

GKAM

I sometimes have the same symptoms after long dives. On my right shoulder. No pain, no DCI symptoms. Just a distinctive noise when I move my arm. It tends to lessen as the SI increases.

It is definitely correlated to the way I decompress. Deep stops definitely help lessen this phenomenon. I had a discussion with a Navy dive doctor some years ago and he said this has to do with my own physiology as my body allows for gas to become trapped inside the shoulder socket. He did not seem very concerned about it...

Very interested to see the same thing happens to others too. I also have these sounds sometimes coming from my sternum as I move the whole thorax.

GKAM

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abowie

We all get excited when we get symptoms after diving; the inescapable view is that it is DCS until proven otherwise.

I see joints full of bubbles every week; it often happens during arthroscopies. They do not make funny noises in my experience.

In medicine there is a truism: "common things occur commonly". You have a musculoskeletal injury to your shoulder. The likelihood is that that is what is causing your funny noises. That movement and exercise associated with diving exacerbates it is not that surprising.

If it was my shoulder I would go and get some professional advice from an orthopod or a sports physician.

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diverrob

Thanks, I have started a more aggressive treatment/therapy with Active Release and Physio. I believe that your statement has allot of merit and I am keeping a close eye on the symptoms post diving. I also have limited my deep diving and padded my deco until this is resolved. Thanks for your input

Rob

dive2dive2000

Rob,

How old are you, the reason for asking over 35 and recovery becomes longer than the norm, over 40 and a lot longer. I also stopped playing around 32 my body just stopped healing. I would remain sore for 4 or 5 days, and I was in a minimum check league. Getting old sucks

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Safe Diving,
Martin

diverrob

You sure are right about that! I am 37 and ever since 35 things take forever to heal. I don't think I can just give up Hockey I started playing late still love it too much!

diverrob

Well I have an appointment made for my MRI this week and would like to know if it is worth trying to recreate the noise before I get the MRI or is it not necessary

Rob