Saturday, March 25, 2006

Costochondral Separation and Diving

March 25th, 2006
Costochondral Separation and Diving
From DivemedTFS Newsletter,December 30, 2001


Question from a reader:

After a dive I was removing my wet suit and twisted around to grab my zipper cord and had severe pain in the chest. I was given O2 on the boat with little relief and went to the doctor here in Samoa and was told not to worry. (We do not have a chamber here, but since the doctor told me not to worry, I basically tried to put it out my head).

The general pain to touch subsided after a couple of days, but an ache continued to bother me. The pain evolved into a strange combination of pains during the day. At night when I lay down, it eases up. Now, after three months of enduring all of this uneasiness in my chest, I am worried that the injury was actually related to the dive (not the act of taking off the wetsuit). I am currently feeling a general tightness around the upper right chest area, sometimes it feels like nerve pain stretching towards my shoulder from my chest, oftentimes, the pain extends to
my back and is quite uncomfortable beside and below my right shoulder blade. Massage
seems to help, but the pain soon returns.

I also sometimes have a strange tingling throughout the area below where the collarbone attaches to the chest, it feels like something is in my throat, sometimes almost a hot sensation with a taste. I have been on an acid inhibitor (nexium), so I don’t believe it is coming from my stomach. I have seen a doctor here in Samoa, but he doesn’t know much about dive medicine. I am a male, 41 years old and generally quite healthy and I stay in shape. This injury has become rather debilitating and I would like to try to do something about it. I would like some advice.
Thank you for your time.

Answer:
Answers to questions are for information only, do not imply diagnosis or treatment and should always be used in conjunction with the advice of an examining physician.

What you are describing is probably ’sternocostal or costochondral separation’, an injury that is seen fairly frequently with trauma situations but not often associated with wet suit removal. It is not serious but is difficult to diagnose or see on x-ray or other diagnostic methods and often is a diagnosis of exclusion.

The fact that it is associated with movement and pressure seems to rule out serious internal problems such as pulmonary problems, but it would be wise to have yourself checked for coronary artery disease.

One would have to agree that it most likely is not related to your dives. The condition can cause prolonged severe pain as you have noted and can often last for months. Pain syndromes can also be markedly worsened by anxiety of the unknown and one would suspect that this is having a part to play in your situation.

Here is another letter about the same subject:
I recently suffered chest pain in my right side after crashing on roller skates with my daughter (long story, but I had to prevent the 4-year-old from getting squashed). I landed on my right side with right arm stretched over my shoulder. Later in the evening (not immediately), I began to experience muscular-type pain at the interior edge of my ribcage, approximately 2″ below the sternum. I went to the doctor, and chest xrays were negative for cracks/fractures. 600mg of Ibuprofen taken a few times a day helps, but after a couple of days without, the pain begins to return. The pain is low grade with occasional sharp pain, no coughing, voice changes or shortness of breath. The injury appeared to get better, but my weight training seemed to aggrevate it. Therefore, I have rested it for over a month, but the low grade pain lingers.

While this has not impacted normal life, I have not been able to lift weights/exercise for our dive team. I’m still in good shape, but do not want to get too far gone before resuming. Based upon what I’ve read, I believe I either have a bruise, rib separation, or perhaps a cartilege stretch/tear.
I would very much appreciate information or websites that might contain information on such injuries so I might be able to accelerate the rehab. I’ve heard soft tissue rib injuries are some of the worst for rehab, but I’m willing to help the process in anyway possible. I’ve also wondered if an MRI might help diagnose the problem, or if that would even affect the recommendations.

Answer:
From your history provided this sounds like a costochondral separation, although an undisplaced rib fracture is possible. Rib fractures can take a long time to clear up (four to six weeks) and costochondral separations can take twice as long. You might want to be sure that you don’t have some other internal injury, such as liver damage (right side). It would probably ease your mind - if not your pain - to see a physician and be sure.

Here are some links:
http://www.ncemi.org/cse/cse0502.htm
http://www.cc.cc.ca.us/sportsmedicine/chest_injuries.htm