Thursday, 17 of January of 2019

Tag » Dr. Kagan

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.

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

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

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

Arthritis of the Hand, Wrist & Fingers





Think of the demands we place on our hands, wrist and fingers nearly every waking moment. From grasping, pulling, twisting, turning and bending to texting and typing, our hands are constantly busy. Over the next few weeks, we’ll talk about medical conditions like osteoarthritis, ganglion cysts and trigger finger and how they can affect our hands and interfere with quality of life. Today’s blog will be about osteoarthritis: causes, symptoms and how to live with it.

The joints in the hand, wrist and fingers, just like the knees, hips and shoulders, can be damaged by osteoarthritis. The  loss of cushioning cartilage creates pain, stiffness and swelling, making it hard to bend the fingers or turn the wrist. Did you know that swelling results from the body’s attempt to make up for the loss of cartilage by producing extra fluid in the joint lining? However, the swelling stretches the joint covering, which is uncomfortable. The swelling may also make the joint hot to the touch.

What causes all of this to happen? Age can definitely be a factor, but so can heavy usage and an injury like a fracture. The American Academy of Orthopedic Surgeons reports that an injured joint is seven times more likely to become arthritic, even if the injury is properly treated.


The main goal of treatment is to relieve pain and swelling. Anti-inflammatory drugs such as Tylenol and Advil and prescription drugs such as Celebrex can be helpful. So can the use of finger or wrist splints; application of hot or cold, topical creams, special therapeutic exercises and steroid injections.

Surgical treatment is less common for hand, wrist and finger osteoarthritis. However, the AAOS reports that the development of tiny instruments make arthroscopy of the small joints of the hand and wrist now possible. In addition, some orthopedic surgeons specializing in hand surgery are performing joint fusion or joint replacement of the wrist and finger knuckles.

The first step in diagnosing osteoarthritis of the hand is to schedule a consultation for a physical exam and X-rays. For more information, go to or call 239-936-6778.

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.

Summer, Baseball & Sports Injuries




shutterstock_51758455What could be more all-American than hot dogs and baseball in the summertime? We’re fortunate in the Fort Myers area to have our own home team, the Fort Myers Miracle playing at Hammond Stadium.

Summer is also a big time for Little League games. Whether your son or daughter is playing baseball on a Little League team or a professional athlete is playing ball for one of your favorite Major League teams, baseball is a sport that has the potential for injury.

It’s unlikely that your child would be at risk for the same level or intensity of injury that challenges professional ball players, like New York Yankees captain Derek Jeter, who broke his ankle in 2012 and continues to have problems with it, or Henley Ramirez of the Los Angeles Dodgers who tore a ligament in his thumb and had to have surgery.

But STOP Sports Injuries, a safety and public awareness campaign organized by the American Orthopaedic Society for Sports Medicine, wants parents to know that injuries in young athletes are on the rise.

The most common Little League-related injury, says AOSSM, is a tear in the UCL, or ulnar collateral ligament, the ligament that stabilizes the elbow. Typically injury to the UCL is caused by overuse – “throwing too hard, too much, too early and without rest.”

What can you do as a parent to make sure your child’s summer is healthy and fun? Here are some tips from AOSSM. Be sure the coach rotates players so your son or daughter isn’t just pitching. Don’t allow your child to play despite pain or pitch on consecutive days.  And, be sure that the coach teaches players about both control and good mechanics.

Rest, ice and over-the-counter medications will most likely take care of the pain. But if not, examination by a physician and diagnostic tests, such as an X-ray or MRI might be needed. For expert advise, call Dr. John Kagan. Dr. Kagan offers more than 30 years of experience as a successful orthopedic surgeon offering both surgical and non-surgical treatments for sports injuries. 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

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