Thursday, 17 of January of 2019

Category » Joint Pain

How Exercise Can Help Joint Pain



shutterstock_127325003While joint pain from osteoarthritis may eventually require surgery, before then, it’s a good idea to explore all the non-surgical ways you can decrease discomfort and increase your range of motion. One of the most overlooked options is free, easy to accomplish and effective – exercise.

You might be thinking that exercise is the last thing on your mind if your joints are achy, tender and stiff. In fact, you might be inclined to move as little as possible. But medical experts will tell you that keeping up an appropriate fitness routine is exactly what you should be doing. In fact, Harvard Medical School calls exercise the secret to joint pain relief. It can definitely help improve the quality of your life.

Here’s why. Exercise strengths muscles, tendons and ligaments that hold the joint in place. It allows your body to stretch and be more flexible, helps maintain stronger bones and gives you more energy. It can also help control your weight, or loose weight, which can take pressure of the joints.

You may not be able to doing anything strenuous like run, play tennis or volleyball, but you could walk outside or on a treadmill, swim laps or do water aerobics, ride a bike or just perform stretching exercises at home or the gym. The key is to pace yourself and not overdo it. If you or a loved one is coping with arthritis and unsure which type of exercise is safe for you to perform, ask your doctor for a recommendation. Perhaps you might even consider a few sessions with a physical therapist if you haven’t been active in a while.

For more information about joint pain and treatment options, contact the office of Dr. Kagan at 239-936-6778 or go to


What Is That Bump On The Back Of My Wrist?




Photo Credit: Mayo Clinic

Have you ever had a small, round, fluid-filled lump develop on top of the wrist or at the base of your palm? These non-cancerous lumps are called ganglion cysts and they are very common. They can be a little as a pea or as large as a small tangerine. In addition to the hand and wrist, they can develop at the ankle and foot and at a finger joint.

Quite often ganglion cysts “appear and disappear” without concern and don’t require treatment. But sometimes they can become large enough to put pressure on the nerves, which can create pain, tingling and muscle weakness. They can also interfere with moving your wrist or simply be unsightly in appearance.

What can you do? The American Academy of Orthopedic Surgeons suggests that the first step might be to take over-the-counter pain relievers and wear a wrist brace or splint to relieve discomfort. But if that option proves ineffective, there are two minimally invasive choices.

Needle aspiration involves inserting a small needle into the cyst to drain the fluid and reduce the pressure on the nerves.  The cyst and part of the joint capsule or tendon sheath can also be surgically removed. Both of these choices are good ones, but it’s important to know that even if the procedure is successful, unfortunately, ganglion cysts have a high rate of recurrence.

Who’s at risk for developing a ganglion cyst? The Mayo Clinic reports that although anyone can bet them, the cysts are more common in young women between the ages of 20 and 30, as well as in people who have osteoarthritis of the finger or wrist or who have had a joint or tendon injury.

For more information about hand conditions or other orthopedic-related concerns, call Dr. John Kagan at 239-936-6778 or go to

What is Trigger Finger?



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Photo Credit:

The term trigger finger may sound amusing, but it is far from humorous if you have this chronic, painful condition. Why is it called trigger finger? According to the American Academy of Orthopedic Surgeons, the condition can cause one or more fingers or your thumb to get “stuck” or “caught” in a bent position. Then when you try to straighten the finger, it may feel like it snaps or pops. This is different from osteoarthritis where your finger joints feel achy, stiff and swollen.

The official medical name for trigger finger is stenosing tenosynovitis. It’s basically a tendon problem. A substance called tenosynovium releases lubricating fluid that allows the tendon in your fingers or thumb to bend and straighten smoothly inside a protective sheath of tissue. But if the tenosynovium becomes inflamed and swollen, it can cause the space within the sheath to become narrowed and constricted. As you bend or straighten your finger or thumb it can “catch” for a moment before releasing and “popping” like a trigger. Over time, the chronic inflammation can cause a thickening of the tendon and bumps or nodules to form at the base of the thumb or finger.

Who’s at risk for trigger finger? People whose occupation requires repetitive gripping, such as working with power tools or musicians who have to grip a musical instrument like a guitar for extended periods of time. People with health conditions like diabetes, thyroid disorders, gout and rheumatoid arthritis are also more prone to it. In addition, it’s more common in women than men.

For mild symptoms, nonsurgical treatment is the first step. Wearing a splint keeps the fingers extended and prevents you from curling them at night when you sleep. Finger exercises can help  improve range of motion. Anti-inflammatory drugs like Advil and Motrin can reduce the swelling and steroid injections may offer some relief.

But if nonsurgical treatments don’t seem to help, minimally invasive outpatient surgery may be the answer, especially if the condition becomes painful enough to interfere with your ability to use your fingers. The surgery is fairly straightforward. The surgeon makes a tiny incision and releases or “opens up” the tightened portion of the tendon sheath, which releases the stress on the tendon and provides relief.

Don’t let chronic pain in your hand or fingers prevent you from enjoying life. Dr. Kagan has been treating patients with a variety of musculoskeletal conditions, including trigger finger, for more than three decades. Schedule a consultation by calling 239-936-6778 or for more information, go to

Joint-Friendly Exercises & Activities This Summer



shutterstock_72119581Does osteoarthritis joint pain, inflammation and stiffness make it difficult for you to move? That doesn’t mean you should avoid staying physically fit and active. Regular physical activity every day will actually help you better manage your condition by strengthening muscles around the joint and keeping tendons and ligaments more flexible, which will improve range of motion.

There are non-orthopedic benefits to exercise, too. Exercise increases heart rate and can help you maintain an appropriate weight - being overweight can place unnecessary added stress on tender joints.  Exercise also releases endorphins; a natural hormone the body produces that helps lift your mood, reduces tension and makes you feel better, helping with pain management.

The key to exercising despite osteoarthritis pain is identify the right type of activity that will be gentle and easy on the joints. Low-impact activity is best. Here are some ideas:


As Southwest Florida’s weather heats up with soaring temperatures and high humidity, exercising outdoors can seem more like a burden than an enjoyable way to keep in shape. Beat the heat by going for a swim or participating in water aerobics. Water cushions and supports the body’s weight, making it a very joint-friendly activity. Exercises that you may not be able to do “on land” during a regular aerobics class can be more easily accomplished in the water.

Walking & Bicycling

Both waking and bicycling are popular low-impact activities that won’t stress your joints like running or playing tennis. Walk or bike in the morning or evening to avoid the heat, or join a gym and walk on the treadmill or use a stationary bike. Many people also like to walk inside a shopping mall, either alone or in a group. While walking, pick up the pace slightly to get your heart rate up for a more aerobic impact.

Yoga & Tai Chi

Yoga and Tai Chi are excellent for improving strength, flexibility and balance – and they are easy on the joints. Many community center, gyms and similar organizations offer classes geared to various levels of fitness, health and age.


Dancing is another great full-body workout that is easy on the joints and can be enjoyed at any age.  You might not be able to participate in high-impact Latin-based Zumba classes, but certainly traditional ballroom dancing can help keep you stay active without putting too much stress on the joints.

For more information about joint pain and the surgical and nonsurgical options for treatment, visit

Study Reported At AAOS Meeting Highlights Total Knee Success



shutterstock_137018378For people who suffer from the chronic, crippling pain of severe osteoarthritis in their knee, life can be a challenge. Even walking or getting out of the car can be difficult. The pain can be bad enough to be disabling, limiting patients’ ability to work or stay physically fit through biking, dancing, tennis, golf or swimming.

Over the past two decades, knee replacement has been the gold standard for relieving pain and restoring mobility. But not as much was known about how the surgery impacted younger active adults who were still working. Now a new study reported this past spring at the 2013 annual meeting of the American Academy of Orthopedic Surgeons confirms the surgery’s benefits in all arenas of life.

The study, appropriately titled, “Do Patients Return to Work after Total Knee Arthroplasty?“ surveyed 660 patients ages 18 to 60 from one to three years after their surgery. The results? Ninety-eight percent of the patients were able to return to work, ranging from sedentary office jobs to those that involved heavy physical labor.

These results are impressive, especially since the AAOS reports that “more than one in four Americans have bone or joint health problems making these medical conditions the greatest cause of lost work days in the U.S.”

“We can now confirm that knee replacement is successful in keeping patients in the workforce and in preventing the pain and suffering that leads to loss of employment,” said the lead researcher in the study. “Returning patients back to work not only gives the patient a sense of fulfillment, but also is economically beneficial to society.”

Knee replacement is one of the most frequently performed procedures for chronic osteoarthritic pain in the knee. For more information about the surgery, or to schedule an appointment, call our office at 239-936-6778 or visit 

PRP Therapy: What is it and does it work?





Platelet-Rich Plasma, better known as PRP Therapy, is a new cutting-edge treatment designed to accelerate healing and relieve the pain of orthopedic injuries without the need for surgery.

Although some medical experts still consider the procedure controversial, PRP therapy is a widely used procedure in major medical centers and orthopedic practices around the country. Here in the Fort Myers area, Dr. Kagan offers it as a safe alternative nonsurgical treatment for a range of conditions, from sports-related overuse injuries to chronic degenerative joint pain from early-stage osteoarthritis.

What exactly is PRP?

A small amount of the patient’s own blood is drawn and placed into a centrifuge, a laboratory device that rapidly spins the blood fast enough to separate out the various components, including the platelets. The platelets, which have growth factors that promote healing and tissue regeneration, are mixed with the plasma, and then injected back into the patient directly into the injury site.

How quickly does the therapy work? 

Most people find that within three months they have marked improvement, although some may require more than one treatment. The idea behind PRP is that by injecting platelet-rich plasma into the damaged tissue, it will encourage the body’s own natural healing process for a faster recovery.

PRP therapy does not “grow” new cartilage, but it does reduce inflammation and speed up healing. Because the patient’s own blood is used, there is no concern about the body reacting to a foreign substance or the potential for negative side-effects.

PRP therapy is considered an “orthobiologic,” a treatment that the American Academy of Orthopedic Surgeons defines as a “product made from substances that are naturally found in your body. “ When used in higher concentrations than normal, these substances may heal damaged tissue faster.

A number of well-known athletes, including golfer Tiger Woods, Pittsburgh Steeler Hines Ward and Baltimore Ravens Chris Canty, have used PRP therapy to help get them recover from sports injuries and get back in the game faster.

For more information about PRP therapy or other nonsurgical treatments offered by Dr. John Kagan, go to

7 Tips For Avoiding Overuse Injuries and Joint Pain



runner trainingWith our beautiful spring weather, everyone is outside enjoying the sunshine before it gets too hot here in Southwest Florida. But it’s important to remember not to do too much too soon or the nagging pain from an overuse injury will stop you from having fun.

An overuse injury simply means you’ve overworked your arm, shoulder, knee or hip, stretching the muscles, ligaments or tendons beyond their capability. The American Orthopaedic Society for Sports Medicine  says overuse injuries are often subtle, occur gradually over time and are the result of repetitive micro-trauma to the tissue. The symptoms are a nagging pain, tenderness and stiffness.

Here are seven tips from the experts for avoiding overuse injuries this spring:

  1. Cross-train: Participating in just one type of sports activity every day can increase your risk of overdoing it. It’s better to work different muscles groups on occasion. If you run, balance it with strength training or stretching classes.
  2. Know your limits: Don’t overdo it. Working through pain is never a good idea, it simply increases your potential for getting injured. Listen to your body and know when it’s time to stop.
  3. Use proper technique: Get tips from a pro or take a lesson to make sure your technique and body alignment are correct.
  4. Wear the right type of athletic shoe to support your feet.
  5. Be sure to warm up and cool down.
  6. Don’t take on too much, too quickly. Use common sense when training or taking on a new sports activity.
  7. If you’ve returning your fitness routine or sport after injury, begin slowly and pace yourself to avoid re-injury.

Many medical experts recommend an overall fitness program that incorporates range of motion exercises to increase the flexibility of your joints; strengthening exercises to build strong muscles to support and protect the joint; and aerobic exercise to build heart health, control weight and increase your stamina.

Minor aches and pains from overuse can be handled with rest, ice and over-the-counter anti-inflammatory medications. But anything more serious may need medical evaluation. Learn more about how orthopedic surgeon such as Dr. John Kagan can help at or contact us at 239-936-6778.

Steroid Injections for Joint Pain



Injections with corticosteroid medication, commonly called cortisone shots, can be helpful in reducing inflammation in the soft tissues and joints, which makes them a very effective nonsurgical treatment for many orthopedic-related conditions.

In addition to improving the quality of life for people with osteoarthritis, the injections are often prescribed for bursitis and tendon-related injuries such as tennis elbow, frozen shoulder and rotator cuff injury, meniscus tears in the knee and inflammation of the patella, or kneecap, commonly known as runner’s knee.

Although corticosteroids can be taken orally for some conditions, in treating orthopedic conditions, it is injected directly into the area of discomfort. The injections provide fairly rapid relief and allow you to regain mobility in a joint or limb that previously felt too stiff and tender to move without considerable pain.

What exactly is cortisone?

Cortisone is a steroid hormone that is naturally produced by the body. It’s released by the adrenal gland when the body is under stress. The medication used in a cortisone injection is synthetically produced but similar in function to natural cortisone. Unlike all the controversy surrounding steroid use, a cortisone injection is beneficial and an appropriate medical treatment.

Is there any downside to cortisone injections?

Although many people are concerned that cortisone injections can be painful, when given by an experienced doctor, there is generally only minimal discomfort. Usually an anesthetic medication is included in the injection to help with immediate pain relief. The procedure is quick and is performed in the doctor’s office.

According to the American Academy of Orthopedic Surgeons, there is some concern that frequent, long-term use of cortisone shots could cause damage to the cartilage or weaken the tendons at the injection site.  Because of this, the total number of injections a patient can receive is usually limited to about four per year per joint.

After the procedure is done, some people may experience a temporary flare-up of discomfort, which should go away within a short time. Application of ice at the injection site can be helpful to reduce any pain. Refrain from physical activity for a day or two. For example, don’t lift anything if the shoulder joint has been treated, stay off your feet if the knee was treated and don’t plan on playing golf or tennis if the elbow was treated.

For more information about orthopedic-related conditions and treatments, go to

Glucosamine & Chondroitin Supplements



Glucosamine and chondroitin supplements have been widely publicized for their use in helping relieve the discomfort of osteoarthritis. What are these supplements and do they work?

Both glucosamine and chondroitin are substances that are found naturally in the body. Glucosamine stimulates the formation and repair of articular cartilage. Chondroitin prevents certain enzymes in the body from damaging the tissue in cartilage and it helps build new cartilage.

Taking oral supplements boosts the body’s natural supply. The supplements are made from either natural sources, such as animal products, or from chemical compounds.

Do they work? Although the scientific evidence is still not conclusive, many orthopedic experts, including researchers at the Mayo Clinic and Harvard Medical School, suggest that randomized controlled trials support the use of glucosamine sulfate in the treatment of mild to moderate osteoarthritis.   

Glucosamine may help reduce pain due to its anti-inflammatory effect.  The jury is still out about whether it can strengthen the cartilage and stimulate the production of hyaluronic acid in the synovial fluid to help lubricate the joint.

It definitely does not help joint pain caused by bursitis, tendonitis or muscular aches and strains. In addition, it is thought that the body may better absorb the sulfate form of glucosamine than glucosamine hydrochloride.

As far as chondroitin sulfate, the scientific evidence is less conclusive.

Should take you one or both supplements if you have osteoarthritis? The American Academy of Orthopedic Surgeons recommends talking with your doctor first about whether the supplement would be of benefit to you.

For more information on treatment for osteoarthritis of the knees, hips and shoulders, visit out website at or call our office for a consultation at 239-936-6778.

Early Stage vs. Advanced Disease for Osteoarthritis

For most people, it can take years before the pain and disability from osteoarthritis becomes extreme. That means treatment options for early stage disease are typically very different from late stage, advanced disease. Most of the time a variety of nonsurgical treatment options will be tried before surgery is recommended. Here’s what can you expect as the disease progresses.

Early Stage Disease

In early stage osteoarthritis, this degenerative disease is just beginning to damage the cartilage that covers and cushions the bone. The cartilage itself doesn’t have nerve endings, but as it thins and wears away, it leaves the bones unprotected, which causes friction when the bones rub together.

During this stage, if you’ve played a strenuous game of tennis, spent the day working in the yard or gone on a long run, you might feel some tenderness in your joints afterwards. Generally rest and over-the-counter anti-inflammatory medication like ibuprofen will take away any lingering discomfort.

Moderate Stage Disease

At this stage, there is more pronounced damage to the cartilage and inflammation of the tissues. You may have developed bony spurs, a benign bony growth that the body naturally creates in response to pressure, rubbing or stress, but which can also cause discomfort. Joint pain may be worse first thing in the morning or at the end of the day, especially after physical activity.

Your doctor may want to perform outpatient arthroscopy to evaluate the extent of damage to your cartilage and bone.  Besides taking non-steroidal anti-inflammatory drugs (NSAIDIs) such as Motrin, Advil, Aleve or Celebrex, the doctor also may suggest glucosamine and chondroitin supplements.  Steroid injections can help too, as can injections with hyaluronic acid or platelet-rich plasma (PRP) therapy.

To reduce pressure on your joints, switch from sports like tennis or running to swimming and walking.

Advanced Disease

By now, there is most likely considerably friction from “bone on bone” since the cartilage has been destroyed. Wearing a brace, applications of hot or cold, water therapy, as well as the treatments suggested for moderate level disease may offer limited relief. However, these treatment options are designed to reduce symptoms – not fix the problem. At this point, surgery may be the best solution if pain and stiffness limit your lifestyle.  Surgical options include arthroscopy to “clean the joint” and remove bone spurs and repair torn cartilage; partial joint replacement; or full joint replacement.  

For more detailed information about how joint replacement surgery is performed, go to

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