Thursday, 17 of January of 2019

Tag » American Academy of Orthopedic Surgeons

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.

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

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

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.

AAOS Co-Sponsors Distracted Driving Campaign



Photo Credit: IntelFreePress/Flickr

Photo Credit: IntelFreePress/Flickr

This week, as Florida bans texting and emailing while driving, Dr. Kagan joins the American Academy of Orthopedic Surgeons in raising awareness about the dangers of driving while distracted.

For the past few years, the AAOS has co-sponsored a major national campaign titled, “Decide to Drive,” that emphasizes how easy it is to be distracted and how quickly accidents can occur.

“If you’re doing something else while you’re driving, you’re not focused on the road, and orthopedic surgeons would much rather keep bones strong them put them back together after a traumatic accident,” says an AAOS spokesperson about why the national medical organization has put so much effort into education about this important safety issue.

According to the Florida Department of Transportation, nearly 5,500 people have been killed since 2009 and an additional 448,000 injured from motor vehicle crashes related to distracted driving The National Safety Council (NCS) estimates that nearly 28 percent of crashes — about 1.6 million a year — can be attributed to cell phone talking and texting while driving.

While texting, emailing and talking on the phone are a major cause of distracted driving, they are not the only concerns.  Reaching over to adjust radios ,portable music players or navigation systems, eating and drinking, applying makeup, brushing your hair, reading a map or newspaper, and children and pets in the backseat are all potential distractions that can cause drivers to take their eyes off the road, hands off the wheel and mind off the task at hand, says the AAOS.

Here are some recommendations from the AAOS to make sure you arrive safely at your destination.

Before Starting Your Car:

  • Put on sunglasses and other accessories such as Bluetooth ear pieces
  • Adjust seats, headrests and mirrors
  • Fasten your seat belt
  • Adjust the music volume
  • Enter address in your GPS navigation system
  • While You’re Driving
  • Don’t talk on the phone, text or email
  • Don’t eat or drink, change your clothes or groom yourself
  • Pull over any time there is a major distraction such as disciplining a child, retrieving an item, or looking at printed directions

Dr. Kagan strongly supports the AAOS slogan, “Behind the wheel, there is no such thing as a small distraction.” For more than 30 years, the doctor has been serving the orthopedic needs of Southwest Florida.  For information on the practice, go to or call 239-936-6778.

What is Trigger Finger?



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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

The Latest Info on Treatment of Osteoarthritis of the Knee



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Photo Credit:

Earlier this summer, the American Academy of Orthopedic Surgeons released new guidelines on treating osteoarthritis of the knee, the disabling chronic condition in which damage to the knee joint occurs when cartilage begins to break down, the tissues become inflamed and bone spurs may develop. Did you know that:

  • More than 30 percent of people over age 50 have knee osteoarthritis
  • The most common average for people with osteoarthritis is 65
  • Some 33 million Americans have osteoarthritis
  • Osteoarthritis is the leading cause of physical disability

New AAOS 2013 guidelines for nonsurgical treatment of knee osteoarthritis include the following recommendations:

Based on new FDA guidelines, the recommended dose for acetaminophen, a mild pain-relief medication commonly sold as Tylenol, has been reduced from 4,000 mg per day to 3,000 mg per day.

Non-steroidal anti-inflammatory drugs, commonly sold is Celebrex, Ibuprofen, Motrin or Advil, are effective in reducing inflammation and relieving mild to moderate pain.

Intra-articular corticosteroid injections are effective for short-term pain relief. The steroid medications is injected directly into the joint space of the knee to help reduce inflammation in the tendons and ligaments of the joint.

Intra-articular hyaluronic acid injections are no longer recommended after a 14-study review showed no measureable improvement in the majority of patients.

Hyaluronic acid, a natural substance made by the body that helps lubricate the joints, can become “thin” due to osteoarthritis. The goal of injections was to counteract the depletion of this fluid.

Results are also inconclusive whether glucosamine, chondroitin sulfate or hydrochloride are effective in knee osteoarthritis. These over-the-counter supplements are often recommended for joint pain.

Patients with knee osteoarthritis should participate in low-impact aerobic exercise, such as walking, swimming and bicycling to improve their muscle tone and bone strength. In addition, individuals with a body mass index greater than 25 should pursue a diet and exercise plan to help lose weight to reduce stress on their knee joints.

Because every patient’s situation is unique, the AAOS advises individuals suffering from knee pain to consult an experienced orthopedic surgeon for a treatment plan that is tailored to their specific needs.

Dr. John Kagan has more than 30 years experience as an orthopedic surgeon treating patients in Southwest Florida. He specializes in treating patients with knee, shoulder and hip pain, as well as general orthopedics and hand surgery. For more information go to

7 Tips To Staying Safe and Injury-Free While Cycling



shutterstock_116062120With Southwest Florida’s year-round sunshine, bicycling is a popular way to get exercise and enjoy the fresh air. Of course with the summer heat, it’s always wise to bike in early morning or early evening, to wear sunscreen and a hat, and to remain hydrated by drinking plenty of water.

Here are some excellent tips from the American Academy of Orthopedic Surgeons to help cyclists stay safe and avoid injuries, which can range from the minor cuts, bruises and sprains, to fractures and even head injuries. Don’t let an accident ruin your fun.

Purchase a bike that is the right size for your body. Some bike shops even offer a professional fitting for avid cyclists. Why is this important? A bike frame that is too large, or handlebars and seat heights that are not adjusted properly can make it hard to control the bike, which will increase your risk of injury. Don’t forget to keep your bike in good condition by checking the brakes, tires and gears regularly.

Wear a helmet, all the time. National statistics show that wearing a bike helmet reduces the risk of head injury by 85 percent. Buy a helmet that is approved by the American National Standards Institute (ANSI). A good fitting helmet should be snug, which means it won’t slide forward, back or to the side. It should cover the top of your forehead and the chin strap should keep the helmet from rocking or moving in any direction.

Don’t overdo it. For many people, cycling can be a fast-paced sport. Be sure to pace yourself to avoid overuse injuries or even heatstroke in the summer. On long rides, be sure to bring water with you. Change positions occasionally to avoid putting too much pressure on one part of the body or straining muscles.

Follow the rules of the road. Cyclists riding on the street must follow the same traffic laws as drivers, including stopping at lights and stop signs, riding with the flow of traffic, using lights at night, yielding to pedestrians at a crosswalk and yielding the right-of-way when entering a roadway. Ride defensively, be aware of your surroundings and be careful of uneven or slippery surfaces and riding next to parked cars.

Don’t text and bicycle. Avoid listening to music with head phones, talking on a cell phone or texting. Be careful of doing anything that will distract you.

Wear appropriate clothing, especially appropriate footwear. Flip flops or sandals may be popular in Florida, but could put your toes at risk should you fall off the bike. You may want to consider padded gloves and shorts for longer bike rides. Also be careful of loose clothing that could become entangled in the gears.

Lights are essential for night visibility. Make sure drivers can see you. Wear bright fluorescent colors, put rear reflects on the bike and have both tail lights and headlights that are visible from 500 feet away.

Sometimes injuries happen, despite the best precautions. If rest, ice, elevation and compression aren’t enough, call an orthopedic specialist for an evaluation. For more information go to or call 239-936-6778.

Celebrating July 4th



Happy 4th of July to you and your family from Dr. John Kagan and staff!  For most people, the 4th of July celebration means cookouts with family and friends, perhaps a day at the beach and certainly fireworks in the evening.

As we celebrate the anniversary of our country’s independence, it’s also a good time to celebrate just how far we’ve come in creating a better quality of life, free of pain and disability, for people with musculoskeletal injuries.

Did you know that the term orthopaedic comes from two Greek words, orthos for correct or straight and paidion for child?  It was a French surgeon named Nicholas Andry who first used the term in the mid 1700s when he published a medical journal on treating children’s skeletal deformities.

But references to treatment of musculoskeletal injuries go back thousands of years. In fact, Hippocrates, often called the “father of  medicine,” describes treating dislocated shoulders, knees and hips. The Egyptians used splints made from bamboo, reeds and bark; many of which been found with mummies discovered in Egyptian tombs.

If you enjoy history, the American Academy of Orthopedic Surgeons, which celebrated its 75th anniversary in 2008, published an interesting timeline of historical achievements, which can be viewed online at

Some of the highlights of the timeline include: the first use of antiseptic in 1865 on a patient with an open fracture, the discovery of the X-ray for diagnosing skeletal injuries in 1895 and the introduction of stainless steel for orthopaedic implant devices in 1926. Jump to more present day with the first total hip replacement in 1960, the first artificial tendon in 1965 and the first use of bone cement in 1970.

Every age has brought new discoveries that have advanced science and medicine and created the specialty of orthopedic surgery that we practice today. But it’s still fascinating to think about how far we’ve come and what is yet to be discovered.

Dr. Kagan has more than 30 years experience as a board-certified orthopedic surgeon. For more information on his services, go to or call 239-936-6778.

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 

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