Description

ABSTRACT

Amamri A, Miliani A, Boudour R, Mellal Y, Dib M, Medaouar, Bedjaoui A. Dysbaric osteonecrosis:

Case series osteonecrosis in divers. Undersea Hyperb Med. 2026 First Quarter; 53(1):83-89.

Introduction: This is the first published study examining decompression illness (DCI) among divers

in Algeria. DCI is a complex syndrome caused by bubbles of inert gas that form in the body due to

an improper decompression process, following exposure to increased pressure underwater. Algerian

diving conditions pose significant challenges to divers. The study focuses on red coral diving, a popular

and long-standing practice in eastern Algeria. We present three case reports describing dysbaric

osteonecrosis of the humeral head with varying degrees of severity and presentation. Dysbaric

osteonecrosis (DON), a rare complication in professional divers and compressed-air workers, presents a

controversial link to previous decompression sickness (DCS) with musculoskeletal pain (type 1 DCS). The

potential for these ischemic lesions to progress to osteonecrosis after DCS remains unclear.

Case Report: This report describes a professional diver declared permanently unfit for diving due to

advanced dysbaric osteonecrosis of the shoulder, following type 1 DCS in the same region treated with

hyperbaric oxygen therapy. This case highlights the potential association between these events and

emphasizes the importance of close monitoring after acute type 1 DCS.

Discussion: Early magnetic resonance imaging (MRI) evaluation of all DCS cases with musculoskeletal

pain is recommended to detect potential osteo-medullary damage. Such damage could worsen with

continued diving and potentially transition into bone necrosis.

Keywords: Algeria; diving; diving fitness; decompression sickness; dysbaric osteonecrosis; hyperbaric

medicine; musculoskeletal pain; Red Coral diver

DOI: 10.22462/782