Persons employed in deep-diving activities, hyperbaric-chamber operations, or compressed-air work are subject to dysbaric osteonecrosis. But there are certain other systemic and metabolic abnormalities associated with nontraumatic osseous avascular necrosis that likewise cause disabling juxta-epiphyseal lesions and asymptomatic metadiaphyseal lesions that are virtually indistinguishable from those of dysbaric osteonecrosis. However, once an individual has been exposed to dysbaric phenomena, any lesion that subsequently develops will unfortunately be attributed to the occupational exposure. Applicants who have conditions associated with nontraumatic osteonecrosis, as well as previous dysbaric exposure, should be thoroughly evaluated during the preemployment examination. Many of these disturbances are reviewed - alcoholism, gout, hypercortisonism, hemoglobinopathies, earlier injuries, and occlusive vascular disease - all of which can be found in an otherwise healthy population of working men.
Dysbarism-Related Osteonecrosis, Proceedings of a Symposium on Dysbaric Osteonecrosis, NIOSH, Cincinnati, Ohio