Research Vision & Supervisors
The Amsterdam Shoulder and Elbow Center of Expertise invests in scientific research by supporting projects that try to get a better understanding of the biology and biomechanics of shoulder and elbow pathology. As well as a multidiciplinary clinical setting, the center encourages multidiciplinary research. In addition, the projects are not limited to a single institution. Collaboration between multiple institutions is the key ingredient to facilitating exchange of expertise and high quality research. On this page we introduce our current projects, PhD students and research support:
Projects & PhD students
Recurrence risk in shoulder instability
Introduction of PhD student and project coordinator Lukas Verweij:
Lukas started out as a research assistant at the Department of Orthopedic Surgery of OLVG during his bachelor of Medicine. After obtaining the bachelor degree, a collaboration between the Amsterdam Shoulder and Elbow Center of Expertise (ASECE), the Department of Orthopedic Surgery of the Amsterdam UMC and Biomedical Engineering Department of the Amsterdam UMC was started to apply for the AMC MD-PhD scholarship (https://www.amc.nl/web/leren/graduate-school/phd-1/mdphd-scholarship.htm). The application was successful and he is currently working on the project at the Amsterdam UMC, which primary focus is recurrence risk in shoulder instability.
Determining recurrence risk is a difficult task, as there are a lot of factors that contribute to the stability of the shoulder. For example, glenoid bone loss, a Hill-Sachs lesion, neuromusculair control and muscle strength are factors that play an important role in stabilizing the shoulder. Currently, glenoid bone loss is used as a parameter to predict recurrence risk. However, this is not the only factor that determines this risk and how do you measure something that is not there? Advances in technology create the opportunity to analyze (dynamic) 3D-models of humerus and scapula. By analyzing the interaction between these bony structures, this project looks for parameters that can predict recurrence risk more accurately by taking more of the factors that determine stability into account.
Improvement of treatment protocols and decision making
Introduction of PhD student and project coordinator Hassanin Alkaduhimi:
After Hassanin finished his medical degree in 2014, he started performing research regarding shoulder instability. As part of his PhD project he traveled to perform research projects in the Massachusetts General hospital. After returning to the Netherlands he also worked as a resident in general surgery and orthopedic surgery resulting in the start of his orthopedic surgery resident training in April 2019.
There are many challenges regarding the diagnosis and management of shoulder instability. To be able to treat shoulder instability one must be able to determine the chance of recurrence and thus be able to determine associated lesions. It is also essential to know how to manage a dislocation, when to perform a surgical procedure, and if you decide for surgery which surgical procedure you would perform. The project of Hassanin addresses these problems and contributes to improvement of treatment protocols and uniform decision making.
Identification, prevention, and rehabilitation of ulnar collateral ligament injuries in throwing athletes
Introduction of PhD student and project coordinator Rik J. Molenaars:
After obtaining his medical degree at the University of Amsterdam/Academic Medical Center in 2017, Rik has been working at Massachusetts General Hospital’s Sports Medicine Center (Harvard Medical School, Boston, USA), focusing on overuse injuries of the elbow in throwing athletes. His main research targets the identification, prevention and rehabilitation of ulnar collateral ligament (UCL) injury in baseball pitchers. His work was supported by the Hendrik-Muller Foundation, the Anna Fonds|NOREF and an MGH Research Stipend. In 2020, Rik started his residency in Sports Medicine at the Canisius-Wilhelmina Hospital in Nijmegen.
UCL injuries are increasingly common among overhead throwing athletes in the USA, especially in young baseball pitchers. The anterior bundle of the UCL is the main stabilizer of the elbow during the overhead throwing motion (regarded by many as ‘the most violent motion in sports’) and injury to this ligament often requires surgical reconstruction. Furthermore, insufficiency of the UCL has been suggested to be the underlying cause of a variety of other elbow complaints. In his projects, Rik has covered a variety of topics, including the pathoanatomy of the anterior bundle of the UCL, the clinical value of an acute popping sensation for significant UCL injury, and the usefulness of stress radiographs in the assessment of UCL injury severity. With his background in both physical therapy as well as (sports) medicine, the focal point of Rik’s future endeavors will be on pathological biomechanics of the throwing motion and clinical prevention and rehabilitation programs for overhead athletes.
Shoulder fractures and implementation of Artificial Intelligence (AI)
Introduction of PhD student and project coordinator Reinier Spek
In 2019, Reinier Spek graduated from medical school at the University of Utrecht. He did his last internship at the department of orthopedic surgery at OLVG Amsterdam and was involved in several research projects. After his graduation he started with his PhD on shoulder fractures at OLVG Amsterdam and moved to Adelaide, Australia, a few months later to continue his projects at Flinders Medical Center.
As part of his PhD, Reinier currently manages a study at OLVG about the outcomes of non-operative treatment of shoulder fractures. His PhD thesis will also focus on the application of Artificial Intelligence (AI) algorithms and 3D virtual planning in the field of shoulder surgery. He works on AI- driven prediction models to estimate the probability of unsatisfactory outcomes after complex shoulder fractures, as well as estimating the probability of revision surgery in patients with shoulder arthroplasties. Furthermore, he started with the development of a convolutional neural network for automated detection of shoulder fractures and is going to evaluate the effect of a new virtual 3D planning software for surgical treatment of complex shoulder fractures.
The Latissimus Dorsi Transfer for irreparable rotator cuff tears
Introduction of PhD student and project coordinator Navin Gurnani:
Navin completed his medical training at the Leiden University Medical Center and started his orthopaedic training in 2016 at the Vrije Universiteit (Amsterdam, NL). The training continued in the OLVG (Amsterdam, NL), Spaane Gasthuis (Hoofddorp, NL), Radboud University Medical Center (Nijmegen, NL). He is currently working at the Noordwest Ziekenhuisgroep (Alkmaar, NL). He started as a research fellow in 2019 with thesis; the Latissimus Dorsi Transfer for irreparable rotator cuff tears. This project is a collaboration of 5 centers; OLVG, Vrije Universiteit, Spaane Gasthuis, READE (Rehabilitation Center, Amsterdam, NL) and Delft University of Technology (Delft, NL).
The Latissimus Dorsi Transfer (LDT) is reported to increase motion and decrease pain in patients with a clinical pseudoparalysis and a massive posterosuperior rotator cuff tear (MPRCT). However, there are still controversies with regard to the kinematics, Latissimus Dorsi activity (LDA) and the effect on function. Our aim is to evaluate the thoracohumeral (TH) and scapulohumeral (SH) motion, muscle activity, strength and clinical outcome after a Latissimus Dorsi Transfer (LDT) in comparison to the asymptomatic contralateral shoulder. In addition, the LDT will be assessed by ultrasound and MRI.
Improving dynamic ultrasound examination, treatment protocols and uniform decision making
Introduction of project coordinator Marianne Larsen van Gastel.
Marianne is a physical- and manual therapist working with in- and outpatients suffering from shoulder pathology in the Ziekenhuis Amstelland. In 2016 she graduated as Clinical Epidemiologist from University of Amsterdam and has since then been involved in several research projects.
After both conservative and surgical treatment of shoulder instability, re-dislocations and subluxations are frequently seen. That leaves us with a paucity in the visualisation and treatment of instability of the shoulder. Also when preparing the patient for return to play there is little consensus regarding the criteria leading to a safe return to play. The project of Marianne addresses these challenges and contributes to improvement of dynamic ultrasound examination, treatment protocols and uniform decision making.
Physical examination in elbow pathology
Introduction of PhD student and project coordinator Elisa Zwerus
During her medical training at Maastricht University, Elisa started performing research at the OLVG hospital (Amsterdam, The Netherlands). Her research focusses on the range of motion and physical examination of the elbow and is a collaboration between the OLVG hospital, the Amsterdam University Medical Centre and Amphia Hospital (Breda, The Netherlands). In 2019 she started her Orthopedic training at Maastricht University Medical Centre, currently working in VieCuri Medical Centre (Venlo, The Netherlands).
The first and yet finished part of the project focused on determining normative values and reliability of measurements for the elbow range of motion. Our current work focusses on physical examination tests in the elbow. If physical examination is reliable enough to rule in or rule out pathology, sometimes additional diagnostic imaging such as MRI could be omitted. However, without adequate performance of the tests and knowledge on diagnostic accuracy, an examiner is not able to interpret physical examination of the elbow.
Clinical- and patient reported outcomes of acromioclavicular injuries
Introduction of PhD student and project coordinator Daniël Verstift:
While finishing his medical degree at Amsterdam Medical Centre (AMC) Daniël started doing research on the acromioclavicular joint, and in particular acromioclavicular joint dislocation and osteoarthritis. He worked as a resident in general surgery for one year before he returned to OLVG hospital to start as an orthopaedic resident and to continue his research.
There are many controversies regarding the optimal treatment of acromioclavicular joint injuries. For example when it comes to the indication and optimal surgical technique for high-grade acromioclavicular joint dislocation. Also, most outcomes in research on the acromioclavicular joint is based on outcomes generated for overall shoulder pathology. One of his current projects is to validate a specific acromioclavicular outcome score to contribute to the uniform reporting of clinical outcomes. In his research Daniël targets clinical- and patient reported outcomes of acromioclavicular injuries to aid in the treatment decision making process and to guide patient- and practitioner expectations.
Safety and complications of elbow arthroscopy
Introduction of PhD student and project coordinator Nick Hilgersom:
My name is Nick Hilgersom and I obtained my medical degree at the Academic Medical Center/University of Amsterdam in 2015. After my graduation, I started working on my research regarding elbow arthroscopy besides my clinical work. In 2018 I was fortunate to be able to broaden my research skills at the Massachusetts General Hospital’s Sports Medicine Center (Harvard Medical School, Boston, USA), with an additional focus on distal biceps and triceps tendon injuries. In 2019, I started my Orthopaedic training at OLVG (ROGO Midden-West).
My PhD project is about elbow arthroscopy with a specific focus on safety and complications (in particular nerve injuries). Elbow arthroscopy can be used for a wide variety of elbow pathology. However, due to the small work space inside the elbow joint, as well as the close proximity of nerves, a high degree of technical skill is required to perform it safely. My PhD aims to investigate the occurrence of neurological complications after elbow arthroscopy and how to safely perform elbow arthroscopy.
Patient orientated management of anterior shoulder instability
Introduction of PhD student and project coordinator Ted van Iersel:
Ted started in May 2020 as a research student at the Shoulder & Elbow unit of the Department of Orthopedic Surgery of OLVG during his master of Medicine at the Vrije Universiteit Amsterdam. He started the SPORTS-study, a multicentre collaboration between OLVG, Deventer Ziekenhuis, Medisch Centrum Jan van Goyen, Spaarne Gasthuis, Bergman Clinics and CMH lead by Dr. van Deurzen. In 2021 he finished a review about bone augmentation (revision) procedures and the FOCUS study. For this patient centered research he received the Prof. Dr. René Marti price from the Dutch Orthopedic Association (NOV).
Ted recently finished his masters degree and is currently working on the SPORTS study, a review about patients considerations to return to sport and the MATASI trial lead by Prof. Dr. van den Bekerom. This randomised controlled study, expected to start in 2022, wil compare the current protocol with a new rehabilitation protocol focussing on fear reduction for (re)dislocation of the shoulder. This will be done in collaboration with multiple hospitals and many physiotherapists throughout the Netherlands. For the MATASI trial Ted and his research group received the SECEC-ESSSE (European Society for Surgery of the Shoulder and Elbow) clinical research grant of 20.000 euros.
His main focus in these projects is to gain more insight in sports related shoulder instability and patient perception of this subject. Interested in these project? Contact Ted using: email@example.com
Risk factors for recurrence of shoulder instability
Introduction of PhD student and project coordinator Sanne van Spanning:
During her master’s degree of Medicine at the University of Amsterdam, Sanne started doing research in the OLVG hospital in Amsterdam. After graduating in 2021, she started working on her PhD project, focussing on risk factors of recurrent shoulder instability. Currently, she is working on developing a machine learning algorithm for recurrence after Bankart repairs together with Dr. Lafosse, a pioneer of shoulder surgery, in Annecy, France.
Shoulder instability is a common condition that limits patients in activities of daily living and sport and is associated with long term complications, such as osteoarthritis. There is still an ongoing debate on the most effective treatment. Several risk factors contribute to the failure of these treatments. With the help of a machine learning algorithm, patient specific risk of recurrence following a Bankart repair can be calculated pre-operatively and may help in further decision making of the most suitable treatment.
Assessment and Treatment of Elbow Fracture Dislocations and its sequelae
Introduction of PhD student and project coordinator Huub de Klerk:
My name is Huub de Klerk, and I started conducting research at the Department of Orthopedic Surgery of OLVG (Amsterdam, the Netherlands) during the second year of Medicine. After obtaining my bachelor’s degree, I started a PhD trajectory with promotors at Flinders Medical Centre (Flinders University, Adelaide, Australia), UMC Groningen (Rijksuniversiteit Groningen, the Netherlands), and VU University Medical Center (VU Amsterdam, the Netherlands). For the upcoming two years, I will continue my research at Massachusetts General Hospital’s SORG Orthopaedic Research Group (Harvard Medical School, Boston, USA).
As part of my PhD, I will develop decision support through intercontinental studies to determine the most appropriate treatment for each individual patient with a dislocating elbow fracture. It is of utmost importance to recognize the general pattern of complex elbow fracture-dislocations, as concomitant ligamentous injuries can be predicted based on the morphologic characteristics of the fracture fragments. Treatment algorithms in fracture care could help assess these fracture patterns. However, these have so far been based on small series of dozens of patients treated by a single surgeon, which also involves a selection bias of surgeons. The developed decision support will be incorporated into an Artificial Intelligence-driven algorithm (based on a Convolutional Neural Network augmented by Machine Learning). Implementing this algorithm into clinical practice will ensure that the correct treatment for both bone and soft tissue will be chosen more often.
Associations of Shoulder Functionality with Mental and Social Health factors
Introduction of PhD student and project coordinator Melle Broekman
After Melle finished his bachelor of Medicine he started as a researcher at the the Department of Orthopedic Surgery of OLVG. This resulted in a PhD candidateship for which a collaboration between the Vrije Universiteit van Amsterdam, Rijksuniversiteit Groningen and Dell Medical Centre (The University of Texas at Austin) was set up. In September 2021 he moved to Austin to continue his research there.
Patient Reported Outcome Measures (PROMs) are widely used determining both functionality and mental health. Evidence shows that mental health factors may have a greater association with functionality in surgical conditions than pathophysiology, but are not yet being implemented in treatment options. Melle’s research primarily focusses on the associations of pathophysiological, mental and social health factors with magnitude of capability in shoulder conditions measured by PROMs.
Lesions associated with anterior shoulder dislocations
Introduction of PhD student and project coordinator Cain Rutgers:
During his bachelor of medicine at the Vrije Universiteit (VU), Cain wrote a thesis regarding shoulder instability that was considered to be best of the bachelor and was pre-nominated for the VU thesis awards. Alongside a career in middle-distance running as two-times national champion (under 18 years and as university student), he continued his research efforts by coordinating interdisciplinary projects at the OLVG departments of orthopaedic surgery and radiology. He is currently working on an innovative project that entails the accurate visualisation of bone tissue in the shoulder with MRI imaging through a deep-learning software.
In the instable and osteoarthritic shoulder, bone and soft tissue lesions are common. These lesions play an important role in the risk of a recurrent dislocation and the failure of operative treatment. In order to accurately visualise bone and soft tissue in and around the shoulder, both an MRI and CT scan are desired. However, undergoing two scans is a burden for patients and leads to high costs. Deep-learning software, trained to visualise bone on MRI scans, may allow for accurate visualisation of bone and soft tissue with just a single modality. By comparing these so-called synthetic CT (sCT) images to conventional CT, this project aims to determine the accuracy of sCT in the instable and osteoarthritic shoulder.
Techniques in shoulder and elbow arthroplasty
Introduction of PhD student and project coordinator Arno Macken:
Arno started his scientific career with a research internship at the Hand and Upper Extremity Service of the Massachusetts General Hospital (Harvard Medical School, Boston, USA) in 2019. During his master of Medicine at the Vrije Universiteit he continued working on several studies focussing on total elbow and shoulder arthroplasty with the Orthopaedic Department at the Amphia Hospital in Breda and the Dutch National Arthroplasty Registry (LROI), which led to a PhD position at the Erasmus Medical Centre in Rotterdam under the supervision of Prof. Denise Eygendaal. In June 2022, Arno finished his master’s degree with a senior internship at the Orthopaedic Department of OLVG Hospitals in Amsterdam. Currently, he works as a research fellow at the Alps Surgery Institute in Annecy, France, where he coordinates two randomised controlled trials alongside many other projects.
The focus of this project is to address several gaps in the literature with regards to shoulder and elbow arthroplasty. In several currently completed studies the use and outcomes after shoulder and elbow arthroplasty were mapped and reported. Through the currently ongoing projects, we aim to shed light on several techniques and choices which remain a point of discussion, such as the surgical approach, use of a bone graft, repair of the subscapularis tendon, the amount of radial mismatch, and the method of pre-operative disinfection.
Optimizing patient outcomes for proximal humerus fractures
Introduction of PhD student and project coordinator Stijn Mennes
After obtaining his Bachelor’s degree in medicine at the University of Utrecht, Stijn Mennes started conducting research at the department of Orthopaedic Surgery at OLVG (Amsterdam, The Netherlands). As part of his PhD, he manages a study at OLVG on non-operative treatment for surgical neck fractures (SURF study). In September 2023, he will move to Adelaide (Australia) to work on other projects at Flinders Medical Centre.
Stijn’s PhD focusses on the implementation of Artificial Intelligence (AI) in surgical care for shoulder fractures. He works on developing a machine learning driven prediction model that can accurately predict mortality in geriatric patients suffering from a proximal humerus fracture. This prediction model may aid orthopaedic surgeons and patients in clinical decision-making. Moreover, he will work on the development of an algorithm that can detect shoulder fractures on CT scans. With his research, Stijn hopes to reduce unnecessary complications and costs, and improve outcomes for patients suffering from a shoulder fracture.
Tim Kraal – Treatment options for frozen shoulder
My name is Tim Kraal and I finished my medical training at the VU University and completed my orthopedic training in Amsterdam (Slotervaart and AMC) and Amphia hospital Breda. I was lucky to have the opportunity to fulfill a fellowship in orthopaedic sports medicine at UBC – Vancouver. My thesis focused on frozen shoulders, a unique and challenging condition. It is seen in around 2-5% of the general population. The thesis gives more insight into pathophysiology, non-surgical treatment with injections and physiotherapy and a surgical intervention called “manipulation under anesthesia”. A link to the thesis can be found here: Thesis (uva.nl).
Jan Louwerens – Evaluating treatment options for calcific tendinopathy of the rotator cuff
My name is Jan Louwerens and I started working as a junior research doctor at the Spaarne Ziekenhuis in 2013 after graduating from medical school at the VU University in Amsterdam. I was lucky enough to extend these first steps in shoulder research to a PhD project under supervision of dr. Arthur van Noort (Spaarne Gasthuis) and dr. Michel van den Bekerom (OLVG). The thesis focussed on improving the care for patients with calcific tendinitis of the rotator cuff, with an emphasis on evaluating the effectiveness of extracorporeal shockwave therapy (ESWT) and ultrasound-guided needling. First, by giving insight in the prevalence and radiographic assessment of the condition. Second, by providing a comprehensive literature overview exploring all minimally invasive treatment options, and to compare these results with surgical treatment. Finally, by evaluating the outcome of a randomized controlled trial comparing high-energy ESWT and ultrasound-guided needling in patients with refractory rotator cuff calcific tendinitis (RCCT). All clinical studies were conducted in the Spaarne Gasthuis Hoofddorp. I succesfully defended my thesis at the University of Amsterdam in November 2020 and expect to complete my orthopaedic training (Noordwest Ziekenhuisgroep, Radboud University Medical Centre, Spaarne Gasthuis Hospital) in June 2021. In the summer of 2021 I intend to move temporarily to Adelaide, Australia, to start a one-year orthopaedic trauma fellowship at Flinders Medical Centre. A link to the thesis can be found here: Thesis.pdf (uva.nl)
The research of the Faculty of Behavioural and Movement Sciences is characterized by high quality, innovation, collaboration with other disciplines and social relevance. The faculty is is leading in research that provides new insights into the foundations of human behaviour and movement. These foundations may be both biological and social and everything in between. Behavioural and Movement Sciences beliefs that good research requires a multidisciplinary approach. This multidisciplinary approach is evident in the cooperation with research institutes, national research schools and other academic partnerships. With their research they respond to social developments and look for outcomes that will bring them further.
The research institute Joint Research of OLVG facilitates and supports development and execution of scientific research within the Department of Orthopedics. Furthermore, Joint Research guarantees the quality of scientific research. Currently, there are two research coordinators that work at Joint Research: Nienke Willigenburg and Sigrid Vorrink. They support research of the Shoulder and Elbow that is being performed in the OLVG or is associated with the OLVG.