If persistent pain, stiffness and limited range of motion are affecting your ability to use your shoulder due to arthritis or injury, your physician may recommend surgery. But instead of undergoing a total joint replacement, some patients may benefit from a technique called shoulder humeral head resurfacing or hemicap resurfacing.

 One of the biggest advantages of shoulder resurfacing is that less bone is removed compared to a more traditional shoulder replacement procedure. That means only the humeral head or “ball” of the shoulder joint is treated, rather than the surgeon replacing the entire shoulder joint. Shoulder resurfacing is often called a “bone-preserving” surgery. A partial or full resurfacing can be performed.

 If you and your physician choose this option, here’s what you can expect.

The surgeon will use an arthroscope to determine the extent of damage to the cartilage that surrounds and covers the humeral head. Then special instruments are used to prepare the surface of the humeral head and an implant is placed over the area, covering it like a cap. The implant takes the place of the damaged cartilage, allowing the ball of the shoulder to once again move smoothly and seamlessly without causing pain.

If you are considering surgery to relieve your shoulder pain, it is important to educate yourself about the various options. For more information, go to www.kaganortho.com/learn-more/.

When it comes to acute or chronic shoulder pain, many patients want to know about nonsurgical treatment options before they consider surgery. Injections with an anesthetic and steroid solution are one of the most common nonsurgical treatments for shoulder pain. It can be a very effective solution for reducing inflammation, improving range of motion and relieving pain.

Injections are done on an outpatient basis with only local anesthesia so you will go home the same day. Depending on the procedure, X-ray and a contrast dye may be used to help guide the physician in correct placement of the needle into the shoulder joint.

 A variety of shoulder conditions respond well to treatment with injection. For example, it is useful for bursitis, which is an inflammation of the bursa, a small fluid-filled sac that serves as a cushion and reduces friction between the bones and muscles in the shoulder joint. When the bursa becomes inflamed, moving the shoulder can be very painful, even to comb your hair. A corticosteroid medication injected into the bursa will reduce inflammation and discomfort.

Injections can also be effective for nonsurgical treatment of rotator cuff injury, frozen shoulder, early-stage arthritis and for trigger points, the small knots that can form in the muscles and connective tissue around the shoulder and upper back.

In addition, a nerve block is often used to treat pain and inflammation from impingement of the nerves in the shoulder joint. A corticosteroid solution is injected into the nerve to soothe the tissues and reduce inflammation.

For more information about treating shoulder pain with nonsurgical options, go to

www.kaganortho.com/learn-more/animations/educational-animations-orthopedics-pain-management.

Physical therapy is essential for a successful recovery from hip replacement surgery. Physical therapists are trained to help people who have been injured or ill improve their ability to walk, handle daily activities and regain their independence.

Under the guidance of the therapist, you will perform specific exercises to help strengthen the joint and muscles. Participating in therapy will allow you to return to everyday activities faster and stronger.

Physical therapy begins while you are still in the hospital. Medication will reduce discomfort as you gradually learn to put more weight on the joint, balance without falling and walk with an assistive device such as a walker. You may also be asked to do simple exercises while you are in bed, such as tightening the muscles in your legs and pointing your feet.

When you are ready to leave the hospital, the therapist will give you certain exercises that are to be performed daily at home. The therapist will also teach you how to get in and out of the car, tie your shoes, sit in a chair and get in and out of the bathtub without damaging the new joint. For a while you will need to avoid putting too much stress on the joint. You will also attend therapy sessions at the doctor’s office or outpatient center until you have made sufficient progress and can resume an active lifestyle.

For more information about rehabilitation after orthopedic surgery, go to http://www.kaganortho.com/services/therapy

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 http://www.kaganortho.com/learn-more/.

When your doctor orders an MRI Scan you may have many questions. What will it feel like? What will it show? How do you prepare?

MRI stands for magnetic resonance imaging. It is one of many important diagnostic tests that doctors use today to look inside the body without making an incision. It is especially useful for evaluating pain in your knee, hip or shoulder and to determine the extent of damage after a car, work or sports-related injury.

Unlike an X-ray or CAT Scan, MRI does not use radiation. Instead, a powerful magnetic field, along with radio waves and a computer are used. The images produced by an MRI are extremely clear and precise with much more detail than is possible with many other tests. MRI is very safe and effective.

The scan is painless and takes about 30 to 45 minutes to complete. You will be asked to lay down on a special table that slides into a large white cylinder. The cylinder houses the magnet. As the machine directs the magnetic field and radio waves at the body, you won’t feel anything, but you will hear a repetitive tapping or thumping. Earplugs or music can help reduce the background noise.

Looking at your MRI test results can help the doctor diagnose many orthopedic-related conditions, including arthritis, cartilage problems, torn ligaments or tendons and broken bones. With this knowledge, the doctor will then be able to plan the most effective treatment for your situation.

For more information about the use of MRI to diagnose orthopedic conditions, go to www.kaganortho.com/learn-more/

What is arthritis?
Arthritis is a medical condition that causes inflammation of the joints, the areas in the body that make it possible for us to move, bend, twist and turn. Over time arthritis can lead to deterioration of the cartilage, bone and connective tissue of the joint. Cartilage is a vital component of a joint. This tough fibrous tissue covers and cushions the bones, preventing them from rubbing against each other.

What’s the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis (OA) is sometimes called the “wear and tear” disease because it is a degeneration condition that causes the joint to break down and the cartilage to wear away. While there is no way to reverse the loss of cartilage, orthopedic surgeons can relieve pain and prevent disability with a range of surgical and nonsurgical options.

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s white blood cells mistakenly attack the lining of a joint, causing inflammation and pain. RA usually is found first in the hands, fingers and feet. A rheumatoid specialist usually treats this type of arthritis.

How common is arthritis?
Some estimates show that arthritis may affect more than 46 million adults in the U.S. It is the leading cause of disability. According to the Arthritis Foundation, evidence of arthritis has been found from as early as 8,000 B.C. and has even been identified in dinosaur bones. Osteoarthritis is more common than rheumatoid arthritis.

What causes osteoarthritis?
Osteoarthritis can result from injury to the joint related to a work or car accident, from repetitive stress on the joint caused by sports activities or certain occupations, or it can simply be a function of age. It is more common in older people than younger people.

What are the symptoms of osteoarthritis?
Typical symptoms include stiffness, swelling or tenderness in a joint, as well as limited range of motion and loss of flexibility. Some people may experience a crunching sensation or sound because the loss of cartilage causes the bones to rub together, creating pain.

 For more information about osteoarthritis and treatments to relieve pain and disability, go to www.kaganortho.com or call 239-936-6778.

Joint resurfacing is a relatively new orthopedic treatment for patients who have pain and limited mobility due to arthritis or other degenerative conditions of the knee, hip or shoulder. In some cases, it may be a good alternative to total joint replacement.

What’s the difference between the two? Total joint replacement replaces all of the damaged arthritic bone and cartilage in the knee, shoulder or hip joint with an implant. Joint resurfacing is just what it implies – it replaces only the surface of the joint. That allows more of the bone to be conserved. Because of that, some orthopedic surgeons feel joint resurfacing can be performed at an earlier stage of disease than is usually recommended for total joint replacement.

What can you expect during a joint resurfacing procedure? For shoulder resurfacing, the head of the arm bone is reshaped and a cap or implant is placed over it, leaving the shoulder socket in place.

With hip resurfacing, the head of the high bone is trimmed and covered with an smooth metal implant. Then, damaged tissue within the pelvic socket is removed and replaced with a metal shell implant, similar to a total hip replacement.

Partial knee resurfacing treats only the damaged surface of the knee joint in one compartment in the knee rather than replacing the entire joint.  For example, during patellofemoral knee resurfacing, only the worn patella (kneecap) and the trochlea, a groove at the end of the thighbone, are treated. Unicompartmental knee resurfacing repairs only the damaged arthritic tissue in the femur and tibia.

There are both advantages and disadvantages of joint resurfacing. Selecting the right patients for the procedure is one of the most important considerations. Often patients who are younger, with healthy bones, are considered the best candidates.

If you have arthritis pain in your knee, hip or shoulder and it with your normal daily activities, you might want to consider joint resurfacing. For more information, or to discuss your treatment options, please call 239-936-6778 or visit http://www.kaganortho.com/.

If you’ve ever overused your arm and shoulder when you’ve been gardening, painting the house, lifting something too heavy, or during sports, you know the achy feeling that can result. The shoulder may feel stiff, sore and inflamed. 

What’s going on? The rotator cuff has been strained beyond its normal capacity. The rotator cuff is a group of muscles and tendons that cover the bone in the shoulder and hold it in place in the shoulder socket. An acute severe injury can tear the tendons, making it painful to raise the arm. Over time, constant misuse can cause the tissue to break down or even pull away from the bone. In extreme cases, the shoulder joint may become unstable.

Who’s at risk for rotator cuff injuries? People who work as carpenters and painters, as well as athletes who play sports such as tennis, baseball, archers and swimming. These activities require repetitive motion that can stress the shoulder joint. Age can also be a risk factor due to general wear and tear on the joint.

When should you consult a doctor? If the shoulder pain persists for more than a week or it hurts to raise your arm, despite a regimen of rest, ice and anti-inflammatory medication, schedule a consultation to determine the cause. Treatment may include physical therapy and a steroid injection to relieve inflammation and pain. Surgical repair with arthroscopy may be needed for a significant tear.

During arthroscopic surgery, the surgeon can stitch torn tissue and if necessary, reattach the tendons to the bone. Calcium deposits and bone spurs can be removed. After surgery, you will need additional physical therapy to help strengthen the shoulder muscles and speed up recovery.

For more information about orthopedic-related conditions, go to www.kaganortho.com.

As an orthopedic surgeon, I know all too well the damage that years of wear and tear can do to the joints of the body. Sports can also be a major challenge to the joints, tendons, ligaments and muscles, especially if you don’t take time to properly condition your body. While advances in orthopedic medicine and the introduction of minimally invasive techniques offer excellent results and a faster return to activity, whenever possible, it is always preferable for patients to take steps to prevent those injuries in the first place.

Here are some tips from the American Academy of Orthopedic Surgeons to help you stay in shape to enjoy Florida’s year-round warm weather and avoid placing too much stress on those joints!

#1 Gradual is Better Than a Jump-Start
Easing into the activity with a gradual warm-up will give time for the blood to get moving and for your heart rate and respiration to steadily increase. Stretch the muscles to get them ready for more intense activity. Breathe deeply and hold the stretch for a few seconds. Stretch slowly, don’t bounce or jerk the body.

#2 Don’t overdo any activity at first or work through the pain, even if you’re just gardening. Stop when you feel strain and soreness. Apply ice to joints, muscles or tendons that are achy.

#3 Flexibility and range of motion of critical for success most sports, and especially for golf and tennis. Keep the hips and shoulder limber with appropriate exercises and stretching.

#4 Rotate the type of exercise or activity you do daily. Don’t work the same muscles every day. For example, balance aerobic activity with strength training using weights or fitness machines.

#5 See your doctor or call our office for an appointment when you have acute pain from a sports activity that can’t be relieved with rest, over-the-counter medications and ice.

For more information on orthopedic-related conditions and how to treat them, check out our patient education videos at http://www.kaganortho.com/learn-more/animations/educational-animations-orthopedics-pain-management/.

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.