title: The distribution of limb pain in decompression sickness.
abstract: BACKGROUND
  For many years there has been a widely held but largely unsubstantiated belief that pain in the upper limb in decompression sickness (DCS) is associated with bounce diving, whereas compressed air workers, saturation divers and high altitude aviators are more susceptible to involvement of the lower limbs.
  
  
  OBJECTIVE
  The hypothesis of counter current exchange of inert gas, modulated by changes in tissue temperature, has been evaluated as a possible mechanism to explain the reported distribution of limb pain in DCS.
  
  
  METHODS
  An extensive review of over 19,000 cases of limb pain decompression illness has been undertaken from case reports stored in the diving accident database at the Institute of Naval Medicine, in the published literature, and from unpublished clinical and experimental reports.
  
  
  RESULTS
  There was a predominance of upper limb involvement in bounce divers and, in contrast to traditional teaching, in aviators. By contrast, the lower limbs were more commonly involved in compressed air workers and saturation divers.
  
  
  CONCLUSIONS
  Each of the occupational exposures has been discussed individually with reference to counter-current exchange and other factors as potential influences on the distribution of disease. We conclude that counter-current exchange of inert gas may be implicated in the distribution of limb pain in DCS.
authors.affiliation: Institute of Naval Medicine, Hants, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: Sowden
authors.forename: E P
authors.initials: EP
authors.lastname: Kindwall
authors.forename: T J
authors.initials: TJ
authors.lastname: Francis
mesh_terms: D000136:Acid-Base Equilibrium; D001132:Arm / Q000098:blood supply; D001359:Aviation; D003665:Decompression Sickness / Q000150:complications / Q000503:physiopathology*; D004242:Diving / Q000009:adverse effects*; D006801:Humans; D007866:Leg / Q000098:blood supply; D005741:Noble Gases; D009784:Occupational Diseases / Q000150:complications / Q000503:physiopathology*; D010146:Pain / Q000209:etiology*; D010313:Partial Pressure; D012189:Retrospective Studies; D013696:Temperature
chemical_list: D005741:Noble Gases