DAN Medical Frequently Asked Questions

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Osteochondritis

DAN responds to concerns relating to this inflammation of bony tissue.After two days of diving, I experienced a sharp pain along the right side of my rib cage near the center of my chest. I had experienced it the day before; I took aspirin and rested. The pain wasn't as bad then, and it went away after several hours. I probably experienced the most pain when I took a deep breath.

I was concerned about decompression illness (DCI), so I went to the local medical clinic. The diagnosis was osteochondritis. I have never had this condition before, and it only lasted for three days and was gone by the time I went home. The doctor ruled out DCI and, according to my chest X-ray, she said I had an area of inflammation where my pain was located. She gave me a shot and some medication to use daily until the prescription ran out.

The only thing different about my dives was this: I did roll-in entries for the two days of diving. I usually make a giant-stride entry. Could this have caused my chest pain? I am a 45-year-old woman in good health. I do regular exercise that includes weightlifting.

You were right to seek medical evaluation for your discomfort. Osteochondritis, an inflammation of bony tissue that results from an injury, tear or detachment to the cartilage portion of a joint, is most commonly found in the knee. In some cases, the connective surfaces between the breastbone and the ribs or in the spinal column can become damaged due to this inflammation.

Whenever a diver complains of chest pain, several possible diagnoses must be ruled out. The first is pulmonary barotrauma, an over-pressure injury to the lung; the other is a related pneumothorax, or lung collapse. Both conditions can cause chest pain, especially when the injured person tries a deep breath. To rule this out, a physician can use a chest X-ray, a spiral CT scan or listen to the individual's breathing. The examining physician should rule out any cardiac event like a mild heart attack.

Finally, it has to be determined whether your pain is really DCI disguised as chest pain. After a physical examination and an X-ray have eliminated the above-mentioned potential diagnoses, osteochondritis is a reasonable diagnosis, although it is not very common in scuba divers.

Any physical activity involving lifting or straining against a heavy weight may have caused this inflammation. It is impossible to know which activity triggered this episode. Straining against the weight of your tank, which is shifted upward as you fall out of the boat backwards, may have caused an inflammation. For those who have never used a roll-in entry, it is generally practiced from a smaller boat or inflatable craft. It will allow multiple divers to enter the water at the same time, and divers don't have to stand up in the boat after donning their equipment.

The inflammation may also have begun as you lifted yourself from a sitting position balancing your weight as you moved backward and upward to the gunwales of the boat. This is not a common body movement in everyday life. It may have even begun from just lifting luggage off the airport conveyor belt.

It is impossible to say when it occurred, but all it would have taken was enough stress to irritate the cartilage. Then either the repetitive movement of gearing up to dive, falling into the water backward or perhaps even breathing underwater against the resistance of your equipment further aggravated the condition.

The resolution of your symptoms after taking medications and refraining from further diving seems to have been the right advice. Once you are free of symptoms and back to full activity, begin diving again.