Thursday, 17 of January of 2019

Are You a Runner? Tendon Injuries To Avoid



http://www.kaganortho.comWith perfect weather finally here, Southwest Florida residents and winter visitors are happy to be outside taking advantage of cooler temperatures by going for a run or playing tennis. But a few precautions are in order to avoid injuring the Achilles tendon.

The Achilles tendon connects the two large muscles at the back of the calf to the heel of the foot. It’s most commonly injured during sports activities, according to the American Academy of Orthopedic Surgeons.

Runners are particularly prone to Achilles tendon injuries, especially if they over train or pick up speed and intensity too quickly. But you might be surprised to find that wearing high heels can also contribute to Achilles tendon-related complaints. Wearing high heels frequently puts stress on the tendon.

Prevention is the best way to avoid an injury to the Achilles tendon. Be sure to do regular exercises that stretch and strengthen the leg muscles and tendons. Wear good quality athletic shoes that fit well during sports activities. Avoid running uphill and don’t take on too much training too quickly Also remember, it’s never a good idea to exercise through pain.

If you do sustain an injury to your Achilles tendon, in most cases, it will heal with a little nonsurgical intervention –rest and elevate the ankle; apply ice packs and take nonsteroidal anti-inflammatory medications. But, if the pain and swelling are severe, or the tenderness persists, call the doctor as you could have a tear, which may require more intensive treatment, ranging from immobilization and rehabilitation to outpatient surgery.

Want to know more information about orthopedic-related conditions and treatments? Go to, or call our office at 239-936-6778 to schedule an appointment.

Update on PRP & Other Injections



If you have chronic tendonitis in your elbow, knee pain from osteoarthritis, or bursitis in your hip, cortisone injections are an effective treatment that can reduce inflammation and discomfort. Now PRP or platelet-rich plasma is another type of injection that is gaining popularity as a way to reduce pain and disability prior to considering surgery.

The December Journal of the American Association of Orthopedic Surgeons and the November 14 issue of New Yorker magazine both featured the latest information about PRP. Here’s what the publications had to say about this high-tech, advanced treatment that Dr. Kagan has been offering for some time.

In the New Yorker article, Chris Waddell, a star athlete who is a paraplegic and the most decorated male skier in Paralympic history, talks about the major improvement PRP had on his shoulder injuries – a torn rotator cuff in one shoulder and a torn biceps tendon in the other shoulder. He says the successful treatment helped him regain his shoulder strength and decreased his pain almost 100 percent. But most importantly, it helped him avoid surgery.

How safe and effective is PRP? There are many opinions on PRP’s ability to accelerate healing and enhance tissue recovery. Whether you may benefit is a decision best made in a one-on-one consultation with a physician who is experienced in using the technique. PRP takes the patient’s own blood and separates the red and white blood cells from the platelets. Platelets have both clotting and growth factors, which are vital for healing. To treat the injury, a concentrated mix of platelets is injected into the joint, ligament or tendon.

In the AAOS journal articles, Dr. Scott Rodeo of Weill Medical College of Cornell University and Dr. Freddie Fu of the University of Pittsburgh School of Medicine express some caution. They suggest that PRP is a promising treatment option that may offer symptomatic relief in tendonitis and osteoarthritis, but recommend additional scientific research before it can be considered a proven therapy. The doctors recommended PRP as a “second line of defense” when other nonsurgical options have not been effective.

For more information about PRP and other treatment options for orthopedic-related injuries, go to, or call the office at 239-936-6778 to schedule a consultation.

Do Your Knees Ache? Here’’s What You Need To Know



shutterstock_137018378If your knee pain makes you limp when you walk or you dread going up and down stairs, you might be one of the millions of people with osteoarthritic knees. In fact, the Arthritis Foundation says the knee is one of the most common spots for osteoarthritis to develop. But you don’t have to let knee pain limit your enjoyment of life. According to the Centers for Disease Control, “many people with OA are not being proactive because of the misconception that arthritis is an inevitable part of aging and that the aches and pains are simply something you must learn to live with.

Here are 4 things you need to know about this chronic condition:

1. What is osteoarthritis? It’s a medical condition that damages the cartilage, bones, fluid and lining of the joint. Cartilage covers the ends of the bones in the knee joint. Without this protective cushion, the bones can rub against each other, causing friction and pain. Over time, fragments of bone or cartilage may break lose and float around. Spurs may develop on the end of the bones and the joint lining may become inflamed. All of this leads to swelling, tenderness, stiffness and pain.

2. What causes it? According to the Arthritis Foundation, osteoarthritis is no longer thought of as simply a “mechanical process” where the joint wears out due to age. Instead, the current view is that osteoarthritis has multiple risk factors, including a predisposition based on family history; being overweight, which can put pressure on the knee joint; traumatic injury or accident; chronic overuse and stress to the joint.

3. Is there a cure? At the present time, there isn’t a cure for osteoarthritis, but there are number of treatment options, both surgical and nonsurgical. Exercise, over the counter medications and topical creams can help early stage disease. Injections and prescription drugs may help more advance conditions. But chronic pain and disability is best relieved through joint replacement surgery.

4. How is it diagnosed? The doctor will conduct a physical exam, which includes inspecting your knee for swelling, warmth or tenderness, and evaluating how far you can extend your leg without discomfort. X-rays can identify a narrowing of spaces in the joint and other evidence of joint disease. It can also rule out other conditions, such as bone fracture. If needed, more advanced imaging techniques, such as CT scan, ultrasound or MRI may be considered.

If OA knee pain is affecting you quality of life, call us today at 239-036-6778 to schedule a consultation. For more general information on osteoarthritis, go to

Joint Replacement Surgery May Help Reduce Heart Disease



249001_517150311655291_934451022_nGreat news for people with osteoarthritis undergoing joint replacement surgery may significantly reduce the risk for a serious cardiovascular event, such as heart attack, stroke, coronary artery bypass surgery, angioplasty, congestive heart failure or death related to heart disease.

According to a new medical study, knee replacement surgery may cut the risk for heart attack and stroke by as much as 54 percent, while hip replacement can reduce the risk by 39 percent. Even patients who had at least one risk factor for heart disease, such as high blood pressure or diabetes, benefited. After joint replacement, they had a 29 percent decreased risk of developing a serious cardiovascular event.

The study was published in the November issue of BMJ, an international medical journal for physicians, and reported in stories featured in New York Times and Arthritis Today, a publication of the Arthritis Foundation. Physician researchers compared 153 people who had moderate to severe osteoarthritis and had undergone either a knee or hip replacement, against a second group of 153 people who also had osteoarthritis and were of similar age, income level, weight, smoking status and other factors. However, the second group did not receive joint replacement surgery. All the individuals were then studied over a seven year period.

Although researchers are quoted saying they are not entirely sure exactly why joint replacement offers protective benefits, they suspect it is related to a combination of factors. With the surgery eliminating the pain, stiffness and swelling of osteoarthritis, stress levels are reduced and there is greater interest in exercising and physical activity, which helps maintain healthy weight and fosters a more positive outlook. Patients are also less likely to be frequent, long-term users of non-steroidal anti-inflammatory drugs, which can cause side-effects, such as increased risk of heart attack and stroke.

If you or a loved one are searching for treatment options to help manage your symptoms from osteoarthritis, please call our office at 239-936-6778 to schedule a consultation. Or, for more information, go to

Update on the DePuy Hip Replacement Lawsuit




An Articular Surface Replacement, removed from a patient.
Photo Credit: The New York Times

Metal on metal implants for hip replacement surgery have been the subject of intense scrutiny and media attention for some time now. Bloomberg Business News and the New York Times recently reported that Johnson & Johnson has “tentatively agreed” to an estimated $4 billion settlement to settle some 7,500 lawsuits against its DePuy Articular Surface Replacement (ASR) hip implant device.

Metal-on-metal implants were initially thought to be a breakthrough product that would last longer, offer greater stability and improve bone conservation, but unfortunately that is not turned out to be the case. In January of this year, the FDA issued a safety bulletin, citing growing clinical evidence that shows a failure rate two to three times that of non-metal-on-metal devices.

In addition, the impact of metal rubbing on metal can cause tiny metal particles to flake off, causing damage to muscle and bone, as well as a high level of metal ions in the blood. Many patients have been forced to undergo hip revision surgery to remove the flawed implant and replace it with a different design.

Thousands of patients have filed lawsuits against DePuy and other manufacturers of metal implants, claiming the devices were defective and have harmed their health. When formal announcement in the DePuy ASR case is released some time this week, it is expected to be one of the largest product liability claims to be paid involving a medical device. The New York Times reports that only patients who have undergone revision surgery to replace the defective ASR implant will be included in the current settlement.

If you are dealing with chronic hip pain from osteoarthritis or are concerned about a hip replacement that you had in the past, please feel free to call our office at 239-936-6778 to schedule a consolation. For more information about joint replacement or other orthopedic-related conditions, go to

What Are Non-Steroidal Anti-Inflammatory Drugs?



shutterstock_163544123Happy Thanksgiving from Dr. John Kagan and staff to all of our patients and their families. We are grateful for the support we have received from the Southwest Florida community for more than three decades. In this week’s blog we address Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which are the most frequently prescribed medication on the market today for people with osteoarthritis, bursitis and tendonitis. NSAIDs relieve pain, reduce swelling and inflammation, and help lower fevers.

Most people know NSAIDs by their brand name, such as Advil, Motrin, ibuprofen, Aleve, Ecotrin and aspirin, all of which are available over the counter without a prescription. A higher-dose strength NSAID is available by prescription only. These medications include Celebrex, Naprosyn, Voltaren, among others. NSAIDs are very effective and considered reasonably safe, but there are potential side effects to consider.

According to the American Academy of Orthopedic Surgeons, NASIDs work by preventing an enzyme in the body called COX from doing its job. One form of the enzyme, COX-2 (cyclooxygenase), is created when a joint is inflamed or injured. But another form of the enzyme, COX1, protects the lining of the stomach from digestive acids. Blocking this protection can increase the risk of stomach pain and bleeding, heartburn and ulcers.

In addition, NSAIDs reduce the blood-clotting ability of the blood, which may be positive for some people, but could be harmful to others. Be sure to talk with your doctor before taking an NSAID if you already take a blood-thinning medication such as Coumadin for heart disease. A warning label appears on every NSAID bottle or package that cautions about the increased risk for heart attack, high blood pressure, stroke or stomach bleeding in certain people who take the drugs. NSAIDs may also cause a severe allergic reaction in some people, as well as interfere with liver or kidney function.

To reduce any potential complication, talk with your doctor about whether NSAIDs are right for you and the dose that is best. In general:

1) Take the lowest dose of NSAID that brings pain relief.

2) Don’t take NSAIDs longer than is necessary and take only the dosage prescribed for you.

3) Be sure to let the doctor know about any pre-existing medical conditions you may have, such as high blood pressure, asthma, or a history of ulcers, kidney or liver disease, heart attack or stroke – as well as other medications that you may be taking that could interfere with NSAIDs.

If you have any questions or concerns, do not hesitate to call of our office at 239-936-6778. For more information about orthopedic-related conditions and treatment, go to

Can Diet Make A Difference With Osteoarthritis?



We’ve all heard about a heart-healthy diet to reduce your risk of cardiovascular disease. But what about osteoarthritis? Is there an “arthritis diet” that will make a difference in alleviating the pain, stiffness and swelling associated with chronic joint disease?

Healthy Diet

An article in the November issue of Arthritis Today, reports that yes, a balanced, nutritious diet does make a difference when it comes to managing osteoarthritis and may even reduce your risk of developing it. What type of diet is best? One that emphasizes plant-based foods, says Ruth Frenchman, a spokesperson for the American Dietetic Association, who is quoted in the Arthritis Today article. Here are some of her suggestions for a joint-friendly diet:

*Small portions are the key. As you get older you need to eat less to stay the same weight. Maintaining a healthy weight reduces stress on the joints. You can also cut down on extra calories by avoiding sugary foods and limiting carbohydrates.

*Two-thirds of your daily diet should come from fruits, vegetables and whole grains. How much is enough? The recommended daily serving of fresh, frozen or dried fruit for the average adult is one-and-a-half to two cups. But be careful of fruit juice, which is high in sugar. For vegetables, here is the rule of thumb: eat two to three cups of vegetables daily, preferably dark green and orange vegetables, such as spinach, broccoli, greens, sweet potatoes, carrots and squash.

*Choose whole grains and lean, low-fat meat, poultry and fish, or dried beans, peas, nuts and seeds.

*Add low-fat or no-fat calcium-rich dairy products to help maintain strong bones. A total of three cups of cheese, milk or yogurt daily is recommended. Keep in mind that one-and-a-half ounces of cheese equal one cup of milk.

But it’s not only eating healthy that is important; maintaining an appropriate weight for your body type is also essential. Did you know that each pound you gain adds nearly four pounds of extra stress to your knees and increases pressure on the hips six-fold? The extra weight can eventually damage the cartilage that cushions and protects the joints, especially in the hips and knees. 

The Arthritis Foundation also reports that new research is showing a potential link between diabetes, blood sugar and joint damage – yet another reason to eat healthy and manage your weight. High blood sugar levels may trigger inflammation and “cause the formation of certain molecules that make cartilage stiffer and more sensitive to mechanical stress.”

Dr. Kagan and his staff certainly recommend eating a nutritious diet, keeping your weight down and making sure that you exercise regularly. But despite your best intentions, osteoarthritis may affect your quality of life. If chronic joint pain begins to limit your day-to-day activity level, we are here to help. Call us at 239-936-6778 or go to for more information.

Reduce Hand & Wrist Pain With These Easy Exercises



Chronic pain, stiffness and swelling in your fingers, hand and wrist can make it difficult to do even the simplest tasks, from opening a jar to buttoning your shirt. Osteoarthritis is the most frequent cause for this type of discomfort, but other conditions may also be a factor, such as carpal tunnel syndrome, ganglion cysts or sprains from a fall or overuse due to a sports injury.

Here are some simple exercises from Harvard Medical School that can help increase mobility, while decreasing pain.

Step 1. Place a rolled-up towel on a table and put your forearm on it, palm side down. Move the hand upward gently until you feel a light stretch. Relax the hand and return to the starting position.

Step 2. Keep your forearm on the towel and gently move your wrist up and down through the full range of motion.

Step 3. Sit with your arm at your side. Bend your elbow so it’s at a 90-degree angle with your palm facing down. Now gently rotate your forearm so that your palm faces up, then down. Repeat several times

Step 4. Extend your finger straight out from your hand. Curl the fingers in like a hook; then extend them again. Now make a full fist and extend your fingers again. Repeat several times.

If you experience numbness or tingling in your hand, fingers or wrist or severe pain, check with the doctor first before doing any exercises, no matter how gentle. Dr. Kagan not only specializes in knee, hip and shoulder pain, but also orthopedic conditions affecting the hand and wrist. For more information or to schedule a consultation, call 239-936-6778 or go to

Six Halloween Tips To Keep Children Safe



HalloweenAs the little princesses, ghosts and goblins come out in full force this Thursday, Oct. 31, for Halloween, here are a few suggestions from the American Academy of Orthopedic Surgeons to make sure your little trick-or-treater stays safe — and free from any orthopedic-related injuries.

Six Safety Tips

1.  Caution your child to walk on sidewalks whenever possible, to look for cars before crossing the street and to obey all traffic signals.

2.  Make sure that masks, hats and face paint do not block your child’s vision.

3.  Avoid the risk of tripping and falling by making sure that your child’s shoes fit well and are slip-resistant, and that costumes aren’t so long they drag on the ground.

4.  Carry a cell phone in case of an emergency.

5.  Pumpkin carving is fun, but be cautious. Use a pumpkin carving kit or knives specially made for carving. These are designed so they are less likely to get stuck in the thick pumpkin skin.

6.  If someone does get cut, apply pressure with a clean cloth and elevate the area above the heart. Then, clean the wound and apply a bandage. If the cut is deep or the bleeding doesn’t stop within 10-15 minutes, seek medical evaluation.

Halloween is the holiday with the fourth highest number of ER visits according to a study published in Pediatrics. Not surprisingly, children ages 10-14 had the most number of injuries – typically the age when parents are no longer directly supervising their activities. Finger and hand injuries from pumpkin carving and falls from long costumes or costumes that obstruct vision are the most common reason for a trip to the emergency department or a follow-up call with a doctor.

Accidents happen, but following common sense rules and paying attention may help avoid serious injury.  If you have a concern about an orthopedic-related injury this Halloween, or any other time of year, Dr. John Kagan is here to help.  Call 239-936-6778 or go to

October is Physical Therapy Month



In recognition of October as Physical Therapy Month, Dr. Kagan and staff want to acknowledge the importance of physical therapy in helping patients recover from orthopedic-related injuries and thank these professionals for the excellent work  they do every day.

Physical therapists are vital members of the healthcare team. They have completed a master’s degree or doctorate degree in their field and work hand-in-hand with doctors to help patients recover after everything from sports or workplace injuries, to traumatic car or workplace accidents, joint replacement surgery and other orthopedic issues.

“No matter what area of the body ails you – neck, shoulder, back or knee, physical therapists have an established history of helping people improve their quality of life,” reports the American Physical Therapy Association.

What exactly do physical therapists do? Physical therapists have specialized training in anatomy, the musculoskeletal system and kinesiology (the study of how the body moves), which allows them to prescribe various strategies that help reduce pain; improve mobility and range of motion; and prevent injury or re-injury. Often, physical therapy is the first step in the treatment plan when a patient comes for an orthopedic consultation. Physical therapy is also recommended following orthopedic surgery to help patients recover faster.

Just how effective is physical therapy? A study published in the May 2013 New England Journal of Medicine found physical therapy was a good first choice before surgery for moderate knee osteoarthritis and mild meniscus tears in the knee.

Congratulations to the many physical therapists who have helped our patients over the years.

For more information about Dr. Kagan or treatment for orthopedic-related conditions, go to

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