Thursday, 17 of January of 2019

Category » Seminars

Shoulder Replacement

For people with severe shoulder pain, shoulder replacement surgery is usually the right choice once more conversation options such as injections and physical therapy fail to provide relief. Although not as common hip or knee replacement (about 900,000 patients every year versus 53,000 per year according to the Agency for Healthcare Research and Quality), shoulder replacement is a very successful and effective procedure.

Who is  a candidate?

The typical candidate for shoulder replacement is someone whose shoulder joint has been severely damaged with osteoarthritis. Symptoms include shoulder weakness and loss of motion, pain that wakes them up at night and difficulty with even simple daily activities that require you to lift or use your arm.

What exactly is replaced?

The shoulder joint includes two bones: the upper arm bone, called the humerus, and the shoulder bone, or scapula. The tip of the humerus, which is shaped like a ball, fits into the part of the scapula that is shaped like a socket. During surgery, the ball of the humerus is replaced with a metal implant, and a plastic “cup” is inserted into the shoulder socket of the scapula. 

As the American Academy of Orthopedic Surgeons points out, patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for this procedure.

But patients who have osteoarthritis and a large rotator cuff tear that can’t be repaired by other methods, may find that traditional shoulder replacement may not be as effective. They may continue to have pain when they try to use their shoulder because of the poor condition of the rotator cuff muscles. Instead, those patients may benefit from a newer procedure called reverse shoulder replacement.

What is a reverse shoulder replacement?

Granted FDA approval in 2004, reverse shoulder replacement is done by “reversing” the implants.  This means attaching the metal ball implant to the shoulder socket and fixing the plastic socket to the end of the arm bone — the exact opposite of the traditional method.

Reverse shoulder replacement allows the shoulder joint to function using the deltoid muscles instead of relying oh the damaged rotator cuff muscles. The “delts” are the triangular muscles that form the rounded outer area on the upper arm.

Deciding who is a good candidate for shoulder replacement or reverse shoulder replacement requires the skill and knowledge of an experienced orthopedic surgeon, one who remains current with the latest technology. If you are having shoulder pain and would benefit from a consultation, call Dr. John Kagan at 239-936-6778 or go to

Shoulder Resurfacing: An Alternative, Bone-Conserving Technique

For younger, active adults with osteoarthritis of the shoulder, a procedure called a shoulder resurfacing may be a good alterative to total joint replacement. Shoulder resurfacing is considered an innovative bone-sparing procedure. Rather than replacing the entire joint, the goal of resurfacing is to “cap over” the damaged area and conserve as much of the bone and surrounding tissue as possible.

Another advantage of resurfacing is that patients can still undergo a total shoulder replacement at a later date if their osteoarthritis continues to do further damage to the cartilage and bone.

While the technique is still relatively new and is not appropriate for all patients, a 2010 study in the Journal of the American Academy of Orthopedic Surgeons, noted that “most patients were very satisfied with the result and 85 percent were able to return to sports at their desired level of participation.”

Shoulder Anatomy

The shoulder joint is actually comprised of two joints. The glenohumeral joint is where the humerus, or upper arm bone, and the glenoid, or socket meets. The acromioclavicular joint is where the shoulder blade and collarbone meet. If the glenoid is still healthy, with an intact cartilage surface and there are no fractures of the humerus, shoulder resurfacing is an option.

During the procedure, the surgeon shaves down the rough, worn-out joint surface of the humeral head and covers it with a new, smooth metal covering that allows the joint to glide smoothly without friction or pain.  

After the procedure, patients may remain overnight at the hospital or go home the same day.  Physical therapy is usually prescribed to help patients regain strength and full range of motion.

If you are suffering from chronic shoulder pain due to osteoarthritis, find out if you may be a candidate for shoulder resurfacing. Call 239-936-6778 to schedule a consultation or go to for additional information.

Rotator Cuff Injury

It’s not surprising that Baltimore Ravens wide receiver Anquan Boldin and San Francisco 49ers wide receiver Mario Manningham complained of shoulder pain in the weeks prior to Super Bowl XLVII. A reported 11 players from both teams were “nursing” shoulder injuries before the big game this past Sunday.

High-impact sports like football can damage the shoulder joint, causing a number of injuries, including damage to the rotator cuff, a group of muscles and tendons that cover the head of the shoulder bone and hold it in place in the socket. 

But it’s not just football players who feel the pain and stiffness of shoulder problems. Golfers and tennis players often have similar complaints.

Any sport that requires repetitive use of the shoulder joint – think of the overhead serve in tennis and the swing required in golf – can stress the rotator cuff and lead to tendinitis (inflammation of the tendons), bursitis (inflammation of the bursa sack) and tears to the ligaments or muscle.

Because the rotator cuff helps keep the shoulder stable and allows for full range of motion, injury causes pain, stiffness and loss of mobility. Generally the pain will be felt along the outside portion or side of the shoulder, rather than deep inside the joint as is the case with osteoarthritis. The pain may wake you up at night and it may hurt to reach overhead.

The first step in treatment is usually conservative. Rest the shoulder, apply ice and take anti-inflammatory medication.  Your doctor may prescribe physical therapy with gentle stretching and strengthening exercises.  Injections with cortisone or other medications can be helpful, too.

More serious injuries, such as a full rotator cuff tear, will not heal by itself and may require surgery.  For more information about the rotator cuff, along with a diagram of the shoulder anatomy, go to

Choosing The Right Orthopedic Surgeon – 4 Things To Know

Choosing the right doctor is an important part of your treatment process, especially if you’re looking for a orthopedic specialist. But how do you make the decision about which physician is best? Here are a few guidelines to keep in mind.

1. Check The Doctor’s Educational Background

The first step in learning more about the doctor’s qualifications is to ask about education and training, which includes medical school, internship and residency training. The surgeon should also be board-certified, which means he or she has achieved a certain level of expertise by passing a rigorous national examination and demonstrating in-depth knowledge in a particular specialty. In addition, ask about ongoing training and certification, which ensures that the doctor values staying at the forefront of advances, such as minimally invasive and computer-assisted techniques.

2. Ask About Expertise

How do you determine the doctor’s level of expertise? Years of experience in practice is one indication. Just as important is how often the doctor performs the particular type of procedure that you are considering. Practice makes perfect. The more frequently the doctor undertakes the procedure, the better he or she will be at it and the better the outcome will be for you.

3. Find Out The Doctor’s Reputation in the Community

Chances are someone you know – friends, family member or co-workers may have first-hand experience with the physician you are considering. Another good source of advice is your primary care physician. Although it’s not essential, you might also find out if the physician participates in the community outside his or her private practice. For example Dr. Kagan and his partners are involved with Florida Everblades minor-league hockey team and the Minnesota Twins Baseball Team during spring training in Fort Myers.

4. Evaluate Your Comfort Level

Once the physician’s credentials have been established, you’ll want to make sure that you have a certain level of comfort, confidence and trust in the physician – that the doctor-patient relationship works for you and the doctor has your best interests in mind. For example, does the doctor take time to listen, answer your questions, address your concerns and explain exactly what will take place during the procedure? Patients today are more educated about their healthcare and most want to feel they have an important voice in their treatment options.

In addition to feeling confident about your doctor, you’ll also want to make sure that the office staff is friendly, professional and caring. When you call the office, is the receptionist pleasant? Are you placed on hold for very long? Are your messages returned? Is there a process for reaching the doctor after hours during an emergency? And finally, is your time respected? While you may occasionally wait longer than expected to see the doctor because of an unexpected emergency or other situation, an hour-long wait in the lobby gets tiresome very quickly.

Want to learn more about orthopedic surgery or find out Dr. Kagan’s scope of practice and expertise? Go to


Free seminar Dec. 15 on treatment options for joint pain

Orthopedic surgeon Dr. John C. Kagan is offering a free seminar to provide surgical and non-surgical options for treating joint pain including minimally invasive options for hip and knee replacement. The public is invited to attend the free seminar and ask questions on Saturday, Dec. 15 from 10 a.m. to noon at Gulf Coast Medical Center, 13681 Doctors Way in Fort Myers.  For reservations, call 239-936-6778 ext. 2227.  To register online and for more information, visit Space is limited.

Dr. John C. Kagan is a board-certified orthopedic surgeon specializing in joint replacement surgery including minimally invasive hip and knee surgery, sports medicine, arthroscopic surgery of the knee and shoulder, hand surgery and general orthopedics.

Kagan attended theUniversityofAlabamaon a full scholarship and was the Jimmy Moore Memorial Scholar Athlete recipient prior to attending medical school at theUniversityofSouth FloridainTampa. He completed a surgical internship at theUniversityofFlorida, and his orthopedic surgery residency at theUniversityofAlabamainBirmingham. He is board certified by the American Board of Orthopedic Surgery.

Kagan returned toFort Myersin December of 1980 to begin private practice. He is founder and director of the Athletic Orthopedic and Reconstructive Center, a comprehensive orthopedic practice with four orthopedic surgeons and three locations in Lee County.

Devoted to serving the community and its residents, Kagan and his partners are team physicians for the Minnesota Twins baseball team during spring training, the Miracle baseball team and the Florida Everblades hockey team. In addition, he is team physician for the Fort MyersHigh Schooland ClewistonHigh Schoolfootball teams.

Kagan is a member of the Lee County Medical Society, Florida Orthopedic Society, Florida Medical Association,AmericanAcademy of Orthopedic Surgeons and the American Medical Association.

For more information, visit Also, visit Dr. Kagan’s blog at and follow him online on Facebook and on Twitter.

Arthroscopic Chrondroplasty

A thick tissue called articular hyaline cartilage covers the surface of the knee, acting like a shock absorber and preventing the bones from rubbing against each other.

However, osteoarthritis, sports injuries or a car accident can damage the cartilage and cause the surface to become rough, irregular and abrasive, which can lead to irritation, swelling and discomfort.

If you experience chronic knee pain, accompanied by a crackling, grinding or clicking sound, or a sensation of something “catching” when you flex your knee or walk, you may have cartilage damage.

To repair this type of injury, the orthopedic surgeon may opt to perform an outpatient procedure called an arthroscopic chrondroplasty. During the procedure, the surgeon will make several tiny incisions in the knee in order to access the joint. A small endoscopic tube with a camera on the end is inserted into the knee to enable the surgeon to see the damage and make repairs.

Here’s what you can expect. The cartilage will be trimmed, loose pieces of tissue or bone will be removed and the surface will be smoothed using an arthroscopic shaver – a technique called debridement. The goal is to create a smooth surface to prevent further irritation of the lining of the knee joint. As the knee heals, new “scar tissue” cartilage will grow and cover the surface of the knee joint.

For more information about the latest outpatient procedures to treat knee pain or other orthopedic-related conditions, go to

What is Knee Resurfacing?

Knee resurfacing is a new minimally invasive procedure that is a good alternative to total knee replacement. There are many advantages to knee resurfacing, including faster healing and return to an active lifestyle in just four to eight weeks, rather than 12 weeks for joint replacement surgery.

 Other benefits include:

Short hospital stay of just one to three days

A small incision

Only the damaged or arthritic parts of the knee are treated, rather than replacing the entire knee joint

 There are two types of knee resurfacing – partial knee resurfacing and full knee resurfacing. Which type is best for you will depend on the extent of your arthritis and the damage it has done to the cartilage, the fibrous tissue that cushions the bones and prevents them from rubbing together. In early stages of arthritis, only one side or compartment of the knee may be affected. For these patients, a partial knee resurfacing is usually recommended. Cartilage that is damaged on both sides of the knee will require a full knee resurfacing.

 During resurfacing, the surgeon will trim and reshape the ends of the bones, removing jagged edges or bony spurs caused by the arthritis. Then the damaged cartilage will be replaced with an implant, which is cemented into place on the reshaped bone.

 If your doctor has suggested you may need surgery to due to knee pain from arthritis, ask if you might be a candidate for resurfacing. For more information about joint resurfacing, go to

How to Prepare for Joint Replacement Surgery

Once you have made the decision to undergo joint replacement surgery, it will be helpful to plan ahead so you will be better prepared emotionally and physically. It’s often a good idea to write questions down as they arise so you can be sure to have them addressed by your doctor in advance of the surgery.

If you live alone, your doctor may recommend that you recover in a specialized rehabilitation facility rather than immediately return home after your surgery. Because your mobility will be limited at first, it is often helpful to have professional healthcare providers assist you.

If you do return directly home after the surgery, here are a few tips from the American Academy of Orthopedic Surgeons to make the experience easier for you.

1. Avoid climbing the stairs to get to your bedroom. Instead, set up a convenient temporary bedroom on the first floor.

2. Look around your home and remove any obstacles, especially throw rugs that might cause you to trip or fall. Eliminate clutter near walkways and rearrange furniture if needed. Make sure you can get around easily – remember you will be using a walker or crutches at first.

3. Stock your freezer with easy-to-prepare meals or cook food in advance and freeze it. You will want to eat healthy, but may not want to spend much time cooking during your recovery.

4. Designate a comfortable chair where you’ll spend time during recovery and place items that you may want within arm’s reach, such as the phone, reading materials, television remote control, laptop computer, water glass and footstool.

5. To avoid bending over or reaching during recovery, buy a long-handled grabbing device and place any items that you regularly use on the kitchen counter.

6. Consider acquiring an elevated toilet seat and shower bench, or have handrails installed by the toilet and shower.

Joint replacement surgery is a very common and successful procedure that can greatly relief pain and disability. With a good attitude and proper preparation you can look forward to a speedy recovery and return to an active life.

4 Components of a Good Exercise Program

Many people think of fitness only in terms of strength training and cardio, but flexibility and balance are critical, too. Here’s a look at what each of these four components bring to a well-rounded fitness program.

Strength Training: Resistance machines, lifting weights, pushups, sit-ups and pull-ups strengthen the bones and muscles, sculpt the body and decrease body fat. Core strength training, which refers to the muscles of the abdomen, lower back and pelvis, keeps the back strong and prevents injury.

Cardio: The vigorous, sustained action of aerobic exercise increases the heart rate, making the heart more efficient, and it improves the body’s ability to deliver oxygen and energy to the tissues. Swimming, running, dancing, brisk walking, climbing stairs, tennis and bicycling are good cardiovascular exercises.

Flexibility: Regular stretching improves muscle and joint flexibility, reduces tension in the body and enhances range of motion. Yoga and tai chi are good choices to improve flexibility. Always stretch with a gentle warm-up and cool down after any type of exercise to reduce the risk of injury.

Balance: Balance training improves the body’s stability and reduces the risk of falling, especially as we age. Our sense of balance can diminish over time so be sure balance exercises are part of your overall fitness plan.

For more information on maintaining healthy muscles and bones, please call 239-936-6778 or visit

Happy New Year, Happy New YOU!

Undoubtedly, the top New Year’s resolutions are focused on exercise, weight loss and staying active. To support these goals, I recommend incorporating exercise into your daily routine. Studies show that regular exercise enhances muscle and joint function, keeps bones strong, and decreases your risk of heart attack and stroke.

Here are some tips developed by the American Orthopaedic Society for Sports Medicine and American Academy of Orthopaedic Surgeons that can help you exercise safely.

Warm Up
Always take time to warm up and stretch before physical activity. Research studies have shown that cold muscles are more prone to injury. Warm up with jumping jacks, stationary cycling or running or walking in place for 3 to 5 minutes. Then slowly and gently stretch, holding each stretch for 30 seconds. Do not stretch cold muscles.

Cool Down
Just like warming up, it is important to cool down. Gentle stretching after physical activity is very important to prepare your body for the next time you exercise. It will make recovery from exercise easier.

Consistent Exercise Program
Avoid the “weekend warrior” syndrome. Compressing your exercise into 2 days sets you up for trouble and does not increase your fitness level. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks. Remember that moderate physical activity can include walking the dog, working in the garden, playing with the kids and taking the stairs instead of an elevator. Parking on the far end of a parking lot will increase the distance you have to walk between your car and your destination.

Be Prepared
Take sports lessons. Whether you are a beginner or have been playing a sport for a long time, lessons are a worthwhile investment. Proper form and instruction reduce the chance of developing an “overuse” injury like tendinitis or a stress fracture.

Lessons at varying levels of play for many sports are offered by local park districts and athletic clubs.
Invest in good equipment. Select the proper shoes for your sport and use them only for that sport. When the treads start to look worn or the shoes are no longer as supportive, it is time to replace them.

Listen to Your Body
As you age, you may find that you are not as flexible as you once were or that you cannot tolerate the same types of activities that you did years ago. While no one is happy about getting older, you will be able to prevent injury by modifying your activity to accommodate your body’s needs.

Use the Ten Percent Rule
When changing your activity level, increase it in increments of no more than 10 percent per week. If you normally walk two miles a day and want to increase your fitness level, do not try to suddenly walk four miles. Slowly build up to more miles each week until you reach your higher goal. When strength training, use the 10 percent rule as your guide and increase your weights gradually.

Balanced Fitness
Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility. In addition to providing a total body workout, a balanced program will keep you from getting bored and lessen your chances of injury.

Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout.

If you have or have had a sports or orthopedic injury like tendinitis, arthritis, a stress fracture, or low back pain, consult an orthopedic surgeon who can help design a fitness routine to promote wellness and minimize the chance of injury.

For more information on bone and joint health or to discuss your orthopedic care and concerns, please contact our office at 239-936-6778 or visit

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