Decompression Sickness - Signs and Symptoms

Signs and Symptoms

While bubbles can form anywhere in the body, DCS is most frequently observed in the shoulders, elbows, knees, and ankles. Joint pain ("the bends") accounts for about 60% to 70% of all altitude DCS cases, with the shoulder being the most common site. Neurological symptoms are present in 10% to 15% of DCS cases with headache and visual disturbances the most common symptom. Skin manifestations are present in about 10% to 15% of cases. Pulmonary DCS ("the chokes") is very rare in divers and has been observed much less frequently in aviators since the introduction of oxygen pre-breathing protocols. The table below shows symptoms for different DCS types.

Signs and symptoms of decompression sickness
DCS type Bubble location Signs & symptoms (clinical manifestations)
Musculoskeletal Mostly large joints

(elbows, shoulders, hip, wrists, knees, ankles)
  • Localized deep pain, ranging from mild to excruciating. Sometimes a dull ache, but rarely a sharp pain.
  • Active and passive motion of the joint aggravates the pain.
  • The pain may be reduced by bending the joint to find a more comfortable position.
  • If caused by altitude, pain can occur immediately or up to many hours later.
Cutaneous Skin
  • Itching, usually around the ears, face, neck, arms, and upper torso
  • Sensation of tiny insects crawling over the skin (formication)
  • Mottled or marbled skin usually around the shoulders, upper chest and abdomen, with itching
  • Swelling of the skin, accompanied by tiny scar-like skin depressions (pitting edema)
Neurologic Brain
  • Altered sensation, tingling or numbness paresthesia, increased sensitivity hyperesthesia
  • Confusion or memory loss (amnesia)
  • Visual abnormalities
  • Unexplained mood or behaviour changes
  • Seizures, unconsciousness
Neurologic Spinal cord
  • Ascending weakness or paralysis in the legs
  • Girdling abdominal or chest pain
  • Urinary incontinence and fecal incontinence
Constitutional Whole body
  • Headache
  • Unexplained fatigue
  • Generalised malaise, poorly localised aches
Audiovestibular Inner ear
  • Loss of balance
  • Dizziness, vertigo, nausea, vomiting
  • Hearing loss
Pulmonary Lungs
  • Dry persistent cough
  • Burning chest pain under the sternum, aggravated by breathing
  • Shortness of breath

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