On October 29, 2015, the Swiss State Secretariat for International Financial Matters announced that the double taxation agreement  (DTA) with respect to taxes on income and capital between Switzerland and Argentina will enter into force on November 27, 2015. It replaces the agreement of 1997 and is in line with the current international standard on the exchange of information.

The purpose of the new agreement is the avoidance of double taxation with respect to taxes on income and on capital, particularly those on dividends, interest and royalty payments. It adopts the majority of the provisions of the former agreement and complies with the current international standard on the exchange of information upon request. The new agreement will be applicable from January 1, 2016, with the exception of taxes withheld at source, for which relief will already be applied in 2015 according to the agreement.

The new agreement sets the maximum withholding tax rate for dividends at 15 percent, and provides for a ten percent rate where the beneficial owner is a company that holds directly at least 25 percent of the capital of the company paying the dividends. The withholding tax rate for interest payments is capped at 12 percent. The maximum withholding tax rate for royalties is 15 percent, with reduced rates of ten, five, and three percent applicable in certain circumstances.

Who is Mossack Fonseca?

Shoulder Impingement Surgery

One of the most common causes of shoulder pain is shoulder impingement syndrome. The cause of the pain generates from an inflammation of the rotator cuff tendons narrowing the space between acromion. With each shoulder movement, the narrowing space becomes irritated and inflamed which generates pain. Along with the pain, limited range of movement and weakness often occurs which effects normal daily routines.

In many cases, shoulder impingement surgery may be the only way to eliminate the pain and other symptoms. Starting with an accurate diagnosis, a highly qualified orthopedic surgeon will approach each person’s shoulder impingement in an individualized manner. Consider these five aspects of shoulder impingement surgery.

5 Things about Shoulder Impingement Surgery

1. Prior to shoulder impingement surgery, the doctor will often try non-surgical methods, including rest, physical therapy, cortisone injections and anti-inflammatory medications to help relieve the symptoms.

2. The shoulder impingement is assigned a grade based on symptoms, physical exam and multiple tests. The shoulder impingement surgery is generally not an option until a patient has experienced symptoms for at least six months.

• Grade I refers to the inflammation of the shoulder’s tendons and bursa sac. The inflammation limits the space under the acromion. As the bursa sac continues to swell, pain will be more noticeable.
• Grade II has the bursa sac beginning fill more with fluid and scarring will occur. The bursa sac will create a dull ache and limit movement.
• Grade III occurs when the rotator cuff tears or has degenerated.

3. Shoulder impingement surgery is done as an outpatient procedure. An overnight stay in the hospital is not required.

4. Shoulder impingement surgery is generally performed with one of two techniques to help create more space for the restore space for the rotator cuff to function properly.

• Arthroscopy technique is done by inserting surgical instruments through tiny incisions around the shoulder area. The orthopedic surgeon will use a scope to help perform the procedure to remove the bursa sac or repair the damaged area.
• Open surgery is performed by creating an incision along the front of the shoulder to allow the surgeon to view the damaged area. The open surgery option is usually performed on patients with severe damage or degeneration.

5. Shoulder impingement surgery requires a fair amount of recovery time to allow the newly attached tendons to heal properly to the bone.ACL surgery

• For approximately six weeks, the shoulder will be immobilized as much as possible to help protect the surgical area and promote the healing process.
• Physical therapy is used to help rebuild strength and regain full range of movement.
• Recovery time may take six months or in some cases over a year.

What To Know About Shoulder Impingement Surgery

In California, Dr. Howard Marans can answer all questions concerning any type of shoulder surgery. Dr. Marans strives to give each patient an individualized, complete explanation of all the treatment options including surgery prior to proceeding. He will go over the expectations and the desired outcome of each procedure.

Being in the same location for over 20 years, Dr. Marans understands the need to get back to a normal active lifestyle. He accepts PPO and will work with other insurance companies to give each patient the highest level of care without creating a financial burden. Please click below to schedule your consultation or call us at 714.979.8981.

Although athletes are in peak physical condition, the rigors of their physical training and competition mean that they are also at a greater risk of developing orthopedic problems, especially stress injuries. When athletes seek medical care for an injury, it is important to always consult with a sports medicine surgeon, who has the skills and experience to provide the best treatment possible.

Unique Needs of Athletes

As compared to the general population, athletes have unique needs. As mentioned above, they are more prone to certain injuries. It is important for the doctor to be aware of the factors that lead to sports injuries, and the factors that can prevent sports injuries.

Additionally, the goal of treatment for sports injuries is to return the client to peak physical condition, so that they are able to train and compete at their previous level if at all possible. In contrast, the goal of treatment for older or more sedentary individuals is to control symptoms and prevent further damage. Therefore, treatment for athletes is often more aggressive and more precise.

Preventing Injury and Maximizing Health

A major goal of a sports medicine surgeon is to not just treat the current injury, but prevent further injuries and maximize the health of the patient. For example, many athletic injuries occur due to over-training, which can place strain on certain joints or parts of the body.

The surgeon should carefully evaluate the factors that led to the injury and work with the patient to develop a plan to prevent future injuries. For example, one common solution to over-training is to do cross-training, in which a different type of training is alternated with the traditional training. The doctor will also advise on how to recognize and deal with early signs of joint stress.

Arthroscopic Surgery

Arthroscopic surgery is often used to treat sports injuries that cannot be treated with non-surgical methods. During arthroscopic surgery, the sports medicine surgeon is able to operate on a joint without having to open it up. The doctor makes several small incisions, and a camera is inserted through one of the incisions, allowing the doctor to see the inside of the joint. Tools inserted through the other incisions are used to perform the operation.

Top California Sports Medicine Surgeon

Dr. Howard Marans of OC Orthopedic is the top sports medicine surgeon in California. Throughout his two decades of experience in orthopedic medicine, Dr. Howard Marans has treated many high-achieving athletes, including Olympians. Dr. Marans understands the unique needs of athletes, and works with each client to return to the previous level of activity as soon as possible.

Dr. Marans would be happy to meet with you about your orthopedic health. To schedule your consultation today, please click below and enter your information or call OC Orthopedic at (714) 979-8981.

My partner and I had just moved in to our new home a year ago after a long renting scheme but it was almost 2 years since we had actually bought the house. We underwent a lot of paper works and legalization processes before finally reaching a final decision. As first time buyers, we have consulted a lot of advices and reviewed countless of guide articles on what initial steps to take before buying a house.

After meeting with Mark, an agent working with The Petersen Group which we hired as custom home builder, we have learned a few friendly tips which really helped us in choosing the best home for us:

1. Think of the Long Term Circumstances

If you are living together like me and my partner, you should ask yourself of your plans for the future which, in time, is inevitable. Are you planning to have kids? Are you expecting family members and friends to stay over every now and then? You may be planning to stay in your new home for only a few years. If the time comes to sell your home, who is your target audience? What are the key areas around which are accessible?

2. Make a list

When buying a pre-furnished home, you may not agree with one design but like how the placement of things is in the other room. Make sure to list your preferences before visiting houses. You can just cross out your list and compare later on which house is the most compatible with your likings.

3. Consider the Expenses

It makes a lot of difference if you are planning to buy a house in the developed city of Los Angeles, California than a house in Jakarta, Indonesia. When budgeting for the house, don't stop with principal, interest, taxes and insurance; add in utilities, cost of commuting and upgrades.

4. Better to Buy in Cash

One of the advantages of cash is you get discounts but it fairs more than that. In today’s competitive market where buyers are getting aggressive to owning a house within prime locations, purchasing a house in cash gives an edge in securing the home before any competitor can. Bottom line is, a seller wants to know how quickly they can gain money and paying in cash assures faster processing. However, you don’t have to force yourself if you don’t have ready cash or you’ll end up with bank complaints. 

OC Orthopedic will use the latest and most thorough diagnostic exams available to determine if surgery is the best answer for eachpatient, or if an issue or injury should be treated with more conservative non-surgical treatments. If it is determined that a patient needs surgical intervention in order to improve function, quality of life, or return to sports following an injury, OC Orthopedic specializes in minimally invasive surgical techniques that return the patient to activity quickly and without breaking their bank.

OC Orthopedic Surgical Specialties

Arthroscopic Surgery - This is a minimally invasive surgery where small incisions are made near a joint for the purpose of a surgeon to insert a camera and instruments into the area for diagnosis and repair. When knee pain, for example, is due to an injury to the meniscus, ligaments, or other soft tissues, the tissues can be repaired or removed with arthroscopy. Other joints with complex soft tissue problems that respond well to arthroscopic surgery in addition to the knee include the hip, shoulder, spine,or wrist. Recovery happens more quickly than with major invasive surgeries, due to the smaller incisions and fewer side effects. It does not even require a hospital stay. In most cases, arthroscopic surgery is used when conservative treatment options such as physical therapy, lifestyle changes, or medications to decrease inflammation have failed to improve measureable pain or quality of life.

Open Reduction/Internal Fixation - When a bone is fractured, many times surgical intervention isn’t necessary. A simple fracture, where abone is cracked but remains in place, will usually heal on its own with casting or bracing. When a bone is broken into several pieces or moves out of place upon breaking, internal fixation surgery is necessary in order to prevent future complications. During surgery, a device such as a rod, pin, screw, or plate will be fixated to the bone in order to hold the bone in place to promote healthy healing. All fractures, regardless of whether they need surgical intervention or not, are a medical emergency and need to be addressed immediately. X-rays and other imaging tests will be done to help a surgeon know how to best treat the injury.

Non-Surgical Treatment Options

Sometimes, after an initial examination, it will be determined by the doctor that surgery isn’t the first, best, or only option fora patient. At OC Orthopedic, non-surgical treatments are available forconditions including arthritis, injuries, and pain. Non-surgical treatments mayinclude physical therapy, lifestyle changes, medication, steroid injections, and more.

OC Orthopedic is also the best orthopedic surgery center inTustin for Sports Medicine. Understanding that athletes have the need to returnto full function as soon as possible after an injury, surgical and non-surgicaloptions are used to treat injuries quickly and effectively.

All patients receive comprehensive patient education as partof their treatment. Empowering patients with knowledge that they need tounderstand their injury or condition and how to avoid and prevent future injuryis always an important part of the goals and philosophy of patient care at OC Orthopedic.

Best Orthopedic Surgery Center in Tustin

When searching for the best orthopedic surgery center inTustin, you do not have to look further than Dr. Howard Marans’ OC Orthopedic. Dr. Marans’ expertise, extensive diagnostic exams, and use of minimally invasive surgical techniques are the winning ingredients that provide every patient with the highest quality care. The office is always happy to take your calls or answer your questions, so please click below to schedule your consultation or call us at 714.979.8981

The clavicle, or collarbone, connects the breastbone (sternum) to the shoulder blade (scapula). Clavicle fractures are one of the most common sports injuries among cyclists, frequently occurring after a fall in which the shoulder breaks the fall.

Clavicle Fracture Identification & Intervention

Since clavicle fractures normally occur after a fall or some other type of trauma, it’s arthritis-pain-shoulder-casually immediately obvious that something is wrong. Clavicle fractures cause severe pain, and typically make it impossible to lift the arm. It’s usually possible to feel that the bone is broken by touching it.

After falling off a bike, the immediate priority is to ensure the victim’s safety – checking for spinal cord injuries, moving away to a safe space if possible. If only the shoulder is affected, it is important to get to a hospital as soon as possible for diagnosis and treatment. A broken bone is a medical emergency, and it is always better to err on the side of having it looked at than on the side of not getting necessary treatment.

Even though doctors can feel that the clavicle is broken in the majority of cases, it will still be necessary to do an x-ray to see exactly how severe the break is.

Clavicle Fracture Surgery

Often, clavicle fractures can be treated without surgery. Keeping the shoulder in a sling allows the shoulder to heal, although there will still be a bump where the fracture occurred. Even without surgery, full function can often return to the surgery.

On the other hand, sometimes the shoulder fractures in multiple places or the fractured parts become widely separated. In addition, surgery is necessary if the bone breaks through the skin. During surgery, the clavicle fracture surgeon will set the bone into an appropriate position (open reduction), then fixate it using plates, rods, or screws (internal fixation). After surgery, the treatment process will be similar to any other clavicle fracture.

Surgery takes place in the hospital, usually on an emergency basis. After surgery, patients usually stay in the hospital for at least a day, and up to several days. During the hospital stay, the nurses and doctors will carefully monitor the clavicle’s healing and the patient’s reaction to surgery. When discharged, the patient will receive detailed information about how to care for the collarbone.

Top Clavicle Fracture Surgeon

Dr. Howard Marans of OC Orthopedic is the top clavicle fracture surgeon in Orange County. Dr. Marans is a skilled sports medicine doctor with over 20 years of experience in the field. He has helped hundreds of patients recover from fractures.

Dr. Howard Marans would be happy to meet with you about your clavicle fracture or other sports injury. To schedule a consultation with Orange County’s top clavicle fracture surgeon, please click below and enter your information or call us at 714.979.8981.