January Employee of the Month- Kelsey D.

The physicians and staff are proud to announce Kelsey D. has been named employee of the month for January 2017.

Kelsey joined OCI in 2015.

Kelsey was nominated by a co-worker, who said, “Kelsey always represents herself, and OCI, with a positive attitude and smile. These traits along with the team player outlook she has makes her a perfect example of the ideal OCI employee.”

Congratulations Kelsey! 


Finding Your Balance

What are you afraid of? For those with balance problems, fear of falling is a very real and scary problem. Emergency rooms nationwide treat a patient every 15 seconds for a fall related injury (most of whom are in the 65+ age range). These falls frequently result in injuries that can have a lifelong impact. For those who fracture a hip, 20% end in death within the next year.

Balance is a very complex series of constant adjustments that help us stay upright. There are 3 systems that work together to maintain balance. Vision, sensory input from the legs and feet and the vestibular system of the inner ear all function in tandem to allow adaptation for changes.

The eyes help us stay oriented to the horizon ahead. When vision is impaired or if we have to function in the dark, the brain has decreased input to process for balance. As an example, if a person stands with their eyes open, it is usually easy to maintain quiet stance with no wobbling. If the same person closes their eyes and tries to stand quietly for 20-30 seconds, they will sense their body swaying slightly to try to adjust balance without visual input.

Sensory information from the legs and feet is critical for adjusting to changes in surface. Walking on a firm, flat concrete driveway is fairly simple. Crossing the yard requires constant alterations in balance to accommodate the bumps, slopes and holes that are common. If the sensation from the feet is impaired, the brain does not get clear messages about the surface under the feet. Sensation from the feet can decrease due to problems such as peripheral neuropathy, back problems and diabetes. Weakness in the lower extremities can also slow or decrease the balance reactions. Strengthening and proprioceptive training in physical therapy can help improve awareness and reaction time for the legs.

The vestibular system is located in the inner ear. Its primary job is to send information to the brain about where our head is positioned in relation to both the body and the ground. As we move our head, the vestibular system provides information about current position. During transitions from lying down to sitting, the inner ear is responsible for sensing when the body is erect. This prevents tipping over from sitting or overshooting the desired upright position. Conditions in which this system does not function correctly can cause dizziness with positional changes or head movements.

The staff at Midwest Rehab are trained to work with patients who have balance and dizziness problems for a variety of reasons. Often times treatment techniques include strengthening and stretching for the lower extremities. Balance and proprioceptive exercises help improve awareness of sensation from the feet and improved reactions to correct missteps and changes in the surface under the feet. Vestibular exercises and treatment can decrease dizziness with changes of position and head movements.

Physical therapy can help to address balance and dizziness issues. So, don’t get scared, get STEADY with help from Midwest Rehab’s physical therapy staff. Call (217)547-9108 to schedule an appointment today!

Rotator Cuff Tears

By Ron Romanelli, MD

The shoulder is a very interesting joint. It has the most motion than any other joint in your body. If you think about it we use our shoulder every day for almost any activity that we need to do. We really don’t even notice that we have a shoulder until it becomes hurtful.

The shoulder joint has a global motion, what I meant by that is it allows us several degrees of freedom of movement. Our shoulder girdle consists of the shoulder blade (socket), the upper humerus (ball) and the clavicle. The shoulder and arm is essentially suspended from our body. There are some large muscles around the shoulder and then there are the rotator cuff muscles which have to do with the rotation and elevation of a ball within our socket.

The four muscles that make up the rotator cull include the supraspinatus, infraspinatus subscapularis and Teres minor muscles. There is also ligaments and the glenoid labrum ring or O-ring in the joint that helps render stability to our shoulder.

During shoulder movement, typically a synchronous movement of the scapula along with the humerous allows the muscles to work together to move the arm in a nice smooth delicate motion. Overuse of the shoulder as well as imbalance of the muscles contribute to tendon tears and internal derangement of the shoulder.

Roator cuff tears can occur due to several factors. Mechanical impingement from bone spurs and overuse rotator cuff tendinitis can lead to tendon degenerative changes over time. Acute injury to the shoulder can lead to failure of the rotator cuff. Next we have to consider aging and genetics that also contribute to degenerative tears in the rotator cuff tendon. Next, if the combination of all these factors working together which can cause degenerative rotator cuff tears and pathology.

Rotator cuff tears can be partial or complete. The complete tears are classified as small, medium, large, and massive. The most common rotator cuff tear is the supraspinatus tear. This is the muscle that elevates the arm forward and upward.

Just like fractures every rotator cuff tear seems to have its own personality. Therefore we treat those injuries based on the personality of the tear and injury as well as the situation of the patient. What I mean by this is that not all rotator cuff tears are alike nor not all rotator cuff tears need to have surgery.

Surgery is reserved for people who have persistant pain and/or weakness of the shoulder that is not able to be treated with conservative measures. We typically start with the history of the injury and the evaluation of the patient. Initial treatment consists of medications and occasionally cortisone injections, and physical therapy. If our conservative treatment fails then surgical treatment will be needed. This again depends on the age of the patient as well as the type of tear that is present.

Most of the time when patients come in with shoulder pain we can diagnosis and treat them with conservative methods and approximately fifty to seventy-five percent of the time the patient will get better. If patients fail conservative treatment and are unable to perform the tasks they desire, then shoulder surgery is needed.

Historically, rotator cuff tears have been treated with open surgical techniques. Currently the majority of orthopedic surgeons utilize arthroscopic surgical techniques for rotator cuff pathology. These techniques are performed in an outpatient facility such as the Orthopedic Surgery Center of Illinois using a specialized team of nurses and nurse anesthetists and anesthesiologists. We utilize a very light minimal general anesthetic as well as a shoulder pain block and local anesthesia typically to perform these procedures. The shoulder blocks and local anesthesia typically will numb up the shoulder for approximately 24 hours after the procedure. This way patients can have this procedure performed as an outpatient and then utilize ice and take pain medications for just a few days after the procedure.

We typically utilize cutting-edge techniques for performing these procedures. The orthopedic surgeons at OCI have under taken specialized training to perform this procedure. Most of us utilize a double row rotator cuff tear technique which is able to repair the tendon to the bone more securely, which we feel is the best way possible for the best recovery and outcome.

When dealing with rotator cuff surgery the patient needs to understand that there is a physiological healing process that must occur before we load the tendon. It takes approximately six weeks time to have the bone and tendon bond together. Then the next six weeks we work on range of motion and strengthening progress to achieve success.

Patients need to understand though that getting an unhealthy rotator cuff tendon to heal back to the bone is somewhat of a lengthy process. Approximately three to six month after the injury we still recommend strengthening program to continue. Typically the maximum healing will occur six months to a year after the surgery. This is not to say that patients don’t feel better soon after the procedure. Patients usually can tell a difference within a week or so after surgery because they do not experience as much pain as they had preoperatively. What I’m trying to say is that we need to understand that rotator cuff tendon healing may take a little bit longer time to heal before we allow unlimited use. Certain people tend to heal faster than others and certain people can have some complications associated with the rotator cuff surgery. The typical problems that occur after a rotator cuff surgery would be stiffness and the need for more physical therapy than usual. Infection, bleeding, and nerve injury are all very rare.

The prognosis of rotator cuff surgery is sometimes dependent on the personality of the tear and the age of the patient. Remember there are small tears, medium tears, large tears, and massive tears. Of course the small and medium rotator cuff repairs usually have an excellent prognosis, especially when we perform this on younger individuals. Small and medium rotator cuff tears can still heal in older individuals, but this depends on how long the tear has been present as well as the physiological age of the patient. When we deal with a massive rotator cuff tear the prognosis is not always as good.

Please remember that there may be acute tears in a normal shoulder that usually will heal well. That is the type of injury that happens when you had no problem with your shoulder and all of a sudden injure your rotator cuff. The patients that are difficult to treat have been having some shoulder pain for awhile and may have had some rotator cuff damage already and then go on to tear the rotator cuff completely and are unable to lift their arm. These cases are very difficult to treat and occasionally need to be treated with a reverse total shoulder replacement. This is a total joint procedure that is performed for older people who have extremely poor rotator cuff tendon tissues. This is a decision we have to make after we evaluate the patient and perform a MRI scan so we can see what is actually going on with the rotator cuff. If the rotator cuff has fat atrophy that means it has not been working normally for a long time, therefore the surgical results will not be good. Also people have a bad prognosis if they are smokers, because this will inhibit the healing of the tendon back to the bone.

One of the extremely important ways for you to recover after your rotator cuff surgery is by going to physical therapy. We know that the role of the physical therapist valuable in teaching the patients the proper techniques and protocols for success after rotator cuff surgery. Therefore we rely on our PT specialist at Midwest Rehab to come up with a custom treatment plan for each particular problem based on the patient’s surgical findings and individual rotator cuff tear.

The best way to deal with your rotator cuff problem or shoulder pain is to be evaluated by your orthopedic surgeon. We will be able to perform a special physcial examination on your shoulder, take x-rays, and decide whether a MRI would be needed. Once we evaluate the problem we can decide what the best treatment plan would be for your particular issue. We always start with a history and physical evaluation, the possibly anti-inflammatory medications, cortisone injections, and physical therapy before resorting to surgery.

The physicians at the Orthopedic Center of Illinois are always striving to do our best to give you the proper medical care and service you deserve.

OCIF to award $5,000 Scholarship for Health Care Studies

The Orthopedic Center of Illinois Foundation (OCIF) is now accepting applications for the $5,000 OCIF Scholarship. The scholarship will recognize a graduating high school senior in Sangamon County who is beginning college in the fall and majoring in a health-related field.  The scholarship is renewable up to four years ($1,250 per year) if the student is in good academic standing.

“The need for employees in health care continues to grow. Through this scholarship, we want to encourage students who are passionate about health care and who might need a little financial help to join the field and contribute in a meaningful way,” said OCIF Board President Ron Romanelli, M.D. “We also find it incredibly important to give back to a community that has supported us for more than 40 years.”

For more information about this opportunity or to download an application, please visit the OCIF website: www.ocif.net.  The deadline to apply is March 15, 2017, and the winner will be announced April 28, 2017.

The Orthopedic Center of Illinois Foundation supports projects promoting patient education, continuing medical education and regional charitable organizations. Since incorporation in 2005, OCIF has contributed more than $300,000 in scholarships and grants to Springfield area communities.


A letter from Dr. Romanelli

Dear friends of OCI,

I am writing in response to the recent article titled “Orthopedic Center requiring up-front payments from state workers” in the State Journal-Register. As the President of the Orthopedic Center of Illinois, I would like to clarify that this policy is not new and only applies to patients with certain State of Illinois insurance plans and only prior to elective procedures.  As always, we continue to care for all patients in emergencies and are on call and available 24/7.

At the Orthopedic Center of Illinois we take great pride in providing the best orthopedic care in the region, board certified physicians, top-notch nurses and medical staff,  state of the art equipment, as well as great customer service. With that being said, we are in the business of providing orthopedic care to our patients, which is a service with large overhead costs. We must be able to pay our employees in order to continually provide the quality orthopedic care that we are known for and very proud of.

Like many other healthcare providers in the state, the Orthopedic Center of Illinois is currently owed millions of dollars from the State of Illinois due to delayed payments. As soon as our office receives payment from the state, the patient is reimbursed.   Although we understand this policy can be frustrating to the patients it affects, we are also frustrated to be in this position with the State of Illinois.

At OCI, we also take great pride in working with all of our patients to offer payment options and plans. I encourage all current or potential patients to please call our office at (217)547-9100 with any questions in regards to this policy and our staff will be happy to work with you.


Ron Romanelli, MD