Thursday, 17 of January of 2019

Category » Bursitis

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.

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

Shoulder Injuries – What to Expect



Football injuriesAs football season moves into full swing across the country, shoulder injuries are inevitable, whether players are NFL pros, college or high school athletes. Most of the time, injuries come from contact with another player as a result of a tackle, block or collision or fall to the ground. Even though players wear protective gear, rotator cuff injuries, sprains, strains, contusions and fractures are common shoulder injuries that can be sustained during the game or practice.

The American Academy of Orthopedic Surgeons describes the shoulder as several joints that combine with tendons and muscles to allow you to move your arm in a wide range of motion. Of course, this also makes the shoulder prone to injury.

But it’s not only football athletes who can suffer from a shoulder-related problem. The discomfort of bursitis, tendinitis or tendon tears, shoulder instability, impingement and osteoarthritis can affect anyone of any age or athletic ability.

If your shoulder is giving you chronic trouble, making it difficult to lift your arm or the pain wakes you up at night, don’t put off scheduling an evaluation to determine the cause and best treatment plan.

What can you expect during a consultation?

In addition to a physical exam, the doctor may order an X-ray or arthrogram, which involves injecting dye into the shoulder to help better visualize the joint and surrounding tissue. Sometimes, diagnostic imaging tests such as, CT Scan, ultrasound or MRI, may be required if the doctor wants to gain a more detailed picture of the anatomy, especially of the muscles, ligaments and tendons. Arthroscopy, which uses a tiny video-camera to allow the doctor to see inside the joint, can be used for both diagnostic evaluation and surgical repair of the problem.

For more information about shoulder pain or other orthopedic injuries, go to or call the office at 239-936-6778 to schedule a consultation.

Could Bursitis Be The Cause of Your Hip, Knee or Elbow Pain?



shutterstock_111719057Just like cartilage acts as a cushion between two bones, small jelly-like sacs called bursa act as a cushion between bones and muscles. Irritation and inflammation of the bursa in the shoulder, elbow, hip, knee and heel is fairly common, but that doesn’t make bursitis any easier to tolerate.  

What causes bursitis? Typically, it result from repetitive movements that stress the joint. Think of carpenters sawing lumber, painters kneeling for a long time to pain a baseboard, gardeners weeding or trimming bushes, musicians strumming a guitar and athletes pitching or throwing a ball. All of these activities increase the risk for bursitis.

How do you know if you have bursitis? The American Academy of Orthopedic Surgery repots that for hip bursitis, the pain usually begins at the point of the hip and spreads to the outside of the thigh area. It may be worse at night if you sleep on the affected hip and can also be painful after long periods of walking, squatting or climbing stairs. 

Medications to control inflammation and discomfort can be helpful, as can cortisone injections. Although it’s not a commonly performed procedure, some doctors remove a chronically inflamed bursa through arthroscopic surgery.

The Mayo Clinic offers the following prevention tips:

  • When possible, avoid repetitive activities that worsen the discomfort.
  • Take frequent breaks when performing repetitive tasks.
  • Use a cushion to protect joints, such as knee pads and elbow pads.
  • Increase the gripping surface on tools by using gloves, grip tape, or other padding.
  • Use an oversized grip on golf clubs and a two-handed backhand in tennis.
  • Use two hands to hold heavy tools.
  • Don’t sit still for long periods.

To schedule a consultation with Dr. Kagan,  call 239-936-6778 or go to for more information on orthopedic-related concerns.

Don’t Let Hip Pain Slow You Down



Hip pain is a common orthopedic complaint

What do former Olympic gymnast Mary Lou Retton, singer Billy Joel, former president George Bush and golfer Jack Nicklaus have in common?  Each suffered from years of chronic hip pain until they decided to undergo successful hip replacements surgery.

At age 37, Retton was younger than most hip replacement patients when she had surgery.  But years of rigorous training, plus a congenital hip deformity, made it almost impossible for her to be active without surgery. Nicklaus was in his late 50s by the time he decided to have the procedure done. The pain from osteoarthritis had become severe enough to prevent him from enjoying golf and playing with his grandchildren.

While hip pain can be debilitating and disabling, there are many surgical and nonsurgical treatment options to take away the pain and return patients to an active lifestyle.

Hip Anatomy

The first step is to understand how the hip joint works.  One of the body’s largest and strongest joints, the hip joint is designed as a ball and socket, with the rounded end of the thighbone fitting into a socket formed in the pelvis bone.

Cartilage covers the surface of the bones and acts as a cushion to reduce friction during movement.  Muscles, tendons and ligaments connect the bones and keep the hip joint stable, allowing us to run, walk, jump, climb, turn and sit.

While the hip joint is built to handle a significant amount of pressure, accidents, degenerative conditions like osteoarthritis, and activities that repeatedly overstress the joint can lead to problems.

The most common complaint is sharp or lingering pain that may begin in the hip area and radiate to the lower back, thigh, buttocks or groin.  Many people find the hip joint feels stiff.  Others experience swelling, redness or tenderness to the touch.  All of these symptoms are signs of an underlying problem that will need to be evaluated by a specialist so appropriate treatment can be prescribed.

Nonsurgical Treatment for Hip Pain

Not all hip pain requires surgery.  It all depends on the reason for the discomfort. Runners, cyclists, tennis players and soccer players are often prone to “overuse” injuries, leading to inflammation and irritation of the hip tendons, or tendonitis. Pain occurs when the swollen tendon rubs against the pelvic bone. Rest, ice, anti-inflammatory medication, injections and physical therapy can be helpful in treating tendonitis.

Tight muscles or muscle imbalance can also cause hip pain.  Both athletes and people who sit for long periods of time, especially at a computer, are prone to tight hip flexors, hamstrings and abductors.   Stretching exercises that promote flexibility in this area can help reduce discomfort and correct imbalances.

Bursitis is another common cause of hip pain.  The bursa are fluid-filled sacs located near the joints in the body.  Like cartilage, the bursa serve as a lubricating cushion, but rather than covering ends of the bone, the bursa are located between the bone and muscles or tendons.

Bursitis occurs when the bursa becomes inflamed and irritated, making walking, climbing stairs and even crossing the legs painful.  Treatment usually includes rest, ice, anti-inflammatory medication and injections.

When Surgical Intervention is Required

Surgery is indicated for more serious causes of hip pain, including fractures, dislocation and osteoarthritis.

According to the American Academy of Orthopedic Surgeons, about 10 million men and women in the U.S. have osteoarthritis, a common degenerative condition of the joints that causes stiffness, pain and disability.

Osteoarthritis is often called the “wear and tear” arthritis.  In its advanced stage, there is chronic inflammation of the joint, the development of bone spurs around the edges of the joint and the wearing away of the cartilage that cushions the bones. Osteoarthritis of the hip makes it difficult to rotate or flex your hip. Walking, sitting, climbing or any activity can be a challenge.

There isn’t a “cure” for osteoarthritis, but the discomfort and disability can be alleviated with treatment.  When nonsurgical interventions fail to provide relief, arthroscopic surgery, which can include hip resurfacing, total hip replacement or minimally invasive hip replacement, is the answer.  An estimated 230,000 hip replacement surgeries are performed in the U.S. every year.

For more information hip pain and treatment options, go to or call the office for a consultation at 239-936-6778.       

Causes of Hip Pain

The first step in treating hip pain is to determine the cause. Your age, level of activity, gender and medical history are important clues in helping the doctor diagnose the source of persistent aches and pains. For example, someone in their 20s or 30s is more prone to certain types of medical conditions than someone in their 70s or 80s.

The four most common causes of hip pain include:

Osteoarthritis. Former president George H.W. Bush, singer Billy Joel and Olympic skater Rudy Galindo are among the millions of people who have received a hip replacement due to osteoarthritis, a painful condition that causes inflammation and breakdown of the cartilage in the hip joint.

Hip Fractures. Ninety percent of all hip fractures in the U.S. are the result of falls, says the American Academy of Orthopedic Surgery. In addition, women are two to three times more likely to have a hip fracture than men. That’s because women are more likely to develop osteoporosis, a degenerative condition that weakens the bones and makes them more brittle. It takes a lot to break a hip bone – except when it’s been damaged by osteoporosis.

Bursitis. Repetitive stress on the hip joint from sports such as running and bicycling, work that requires standing for long periods of time, and even gardening or stair climbing can irritate and inflame the bursa. The bursa is a small fluid-filled sac that cushions the muscles and the bones in the hip. If you have bursitis, the pain may be worse after you’ve been sitting for long periods of time or it may wake you up at night if you happen to lie on the affected hip.

Muscle Strains and Tendonitis. Overdoing it in sports, training errors, excessive stretching, or sudden increases in the level of activity can stress the hip tendons beyond capacity or tear the muscle fibers, causing pain and swelling and loss of strength. The AAOS offers these easy suggestions to prevent muscle strains or tendonitis: warm up before stretching, stretch slowly, wear the right shoe for the sport and participate in a conditioning program that builds muscle fitness and flexibility.

Treatment for hip pain may range from rest, ice and over-the-counter medication to surgery. For a list of painful hip conditions that require surgical intervention by an orthopedic surgeon, go to

Good News for Bursitis Sufferers

While the warm weather may beckon you outside, activities such as gardening or exercise may cause swollen and aching joints, which should not be ignored. A common cause of painful hips, knees, heels and elbows, bursitis results from inflamed or infected fluid-filled sacs or bursae that surround the joints. Prompt medical attention by an orthopaedic doctor can help you get to the source of the pain and treatment options to help alleviate it. Since bursitis symptoms resemble other joint problems such as arthritis or ligament injuries, a thorough evaluation by a trained orthopaedic surgeon is the best option. If bursitis is diagnosed, your physician can determine whether infection is involved and prevent it from spreading.

Typical symptoms of bursitis include:

  • Pain with or without joint movement
  • Swelling of the area surrounding the joint
  • Redness of the skin near the joint
  • Warmth of the area near the joint
  • Pain or tenderness when the bursa is touched

All types of bursitis often can be successfully managed non-surgically, and possible treatments include:

  • Use of ice packs or compressive dressings
  • Activity modification that may reduce stress or irritation
  • Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics
  • Corticosteroid injections (knee and elbow)
  • Stretching exercises
  • Change of footwear (heel).

Surgery may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved. An accurate diagnosis is important to determine the best treatment options to help the patient resolve pain and other symptoms and regain mobility and quality of life.

If you are suffering with joint pain, contact Dr. Kagan at 239-936-6778. Visit or for more resources.

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