Thursday, 17 of January of 2019

Category » Osteoarthritis

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

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

New Study Shows Knee Replacement Surgery Offers Major Economic & Social Benefits

Orthopedic surgeons and patients have long known that knee replacement surgery offers tremendous help to people suffering from end-stage osteoarthritis of the knee. Now a new study sponsored by the American Academy of Orthopedic Surgeons confirms it.

“There is no doubt that knee replacement gets people back to work, improves their quality of life and allows them to be productive and active again, “ said John Tongue, M.D., the past president of the AAOS, in commenting about the study results. “But until now, that value has always been hard to quantify.”

Researchers looked at Medicare claims data, collected patient-reported outcomes and reviewed the literature to compare direct and indirect costs of surgical treatment versus non-surgical treatment. The result was a “quantitative look at the overall cost benefits of knee replacement relative to the societal and economic savings” or what Dr. Tongue calls “the big picture of how the procedure impacts patients’ lives, both daily and in the long-term.”


Photo Credit:

Photo Credit:


The study, published in the August 2013 issue Journal of Bone and Joint Surgery confirms that knee replacement surgery is a cost-effective treatment for people with end-stage osteoarthritis, giving patients an indirect savings of nearly $40,000. Researchers also calculated an estimated lifetime societal savings of about $12 billion from the more than 600,000 total knee replacement surgeries performed in the U.S. at the time of the study, which was in 2009.

Having the procedure allows patients to stay on the job and in the workforce longer. It also reduces absenteeism – the number of days that patients missed work due to pain – and it lowered the number of people who stopped working and applied for disability payments.

The study results are very positive for baby boomers, who are staying in the workforce longer and expecting to remain active throughout their lifetime, but their knee joints can’t always keep up, says Dr. Tongue. Now rather than cutting short their employment or giving up enjoyable physical activities like tennis and golf, they can turn to knee replacement as a viable, cost-effective option. Demand for the surgery is expected to exceed 3 million by 2030.

For more information about knee replacement surgery or other orthopedic-related concerns, visit or call Dr. John Kagan at 239-936-6778.

Osteoarthritis vs. Osteoporosis vs. Rheumatoid Arthritis



Many people frequently confuse the terms osteoarthritis, osteoporosis and rheumatoid arthritis. They each affect the musculoskeletal system, but they are very different medical conditions.

Orthopedic surgeons treat osteoarthritis, which is a degenerative condition of the cartilage, a rubbery tissue that covers the ends of the bones and cushions the joints in the hips, knees, shoulders and other parts of the body. As osteoarthritis wears away the cartilage, the bones rub together, causing inflammation, tenderness, pain and stiffness. Bone spurs can also develop.

Initial treatment for osteoarthritis may include medication, hot or cold treatments, physical therapy and steroid injections.  At more advanced stages, patients can find relief through arthroscopy or joint replacement surgery.


Photo Credit: Medicine Net Inc.


Rheumatoid arthritis is an autoimmune disorder that causes painful inflammation of the lining of the joints – the synovial membrane, whose function is to protect and lubricate the joint. Rheumatoid arthritis tends to affect the fingers, hands and toes first before the larger joints in the knees, hips, ankles, elbows and shoulders. In advanced cases it can cause severe joint deformity. Internists and physicians specializing in rheumatology treat rheumatoid arthritis. If surgery is required, an orthopedic surgeon may perform a joint fusion or joint replacement.

Osteoporosis is a crippling bone disease that primarily affects the elderly and causes bones to become porous, brittle and weak. Over time, the bones can be so fragile that that it doesn’t take much for them to break – even bending over to pick something up, sneezing or twisting can be a problem. Primary care physicians generally treat this medical condition, but an orthopedic surgeon may need to surgically repair fractures, especially hip fractures.

For more information about musculoskeletal conditions and treatment options, call 239-239.936.6778 or visit

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


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.

Warning: Illegal string offset 'status_txt' in /home/content/53/6203553/html/Kaganorthoblog/wp-content/plugins/share-and-follow/share-and-follow.php on line 1938

Warning: Illegal string offset 'status_txt' in /home/content/53/6203553/html/Kaganorthoblog/wp-content/plugins/share-and-follow/share-and-follow.php on line 1938

Warning: Illegal string offset 'status_txt' in /home/content/53/6203553/html/Kaganorthoblog/wp-content/plugins/share-and-follow/share-and-follow.php on line 1938