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.
Treatment options for a frozen shoulder
Introduction of PhD student and project coordinator Tim Kraal:
My name is Tim Kraal and I am currently working as a clinical fellow in shoulder and elbow pathology at Spaarne Gasthuis – Hoofddorp. I did 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 PhD project is on frozen shoulders, a unique and challenging condition with many questions still unanswered. A frozen shoulder is characterized by an insidious onset of pain and stiffness with significant disabilities in daily life. It’s a common condition, seen in around 2-5% of the general population, more common in women then in men. Patients are generally between the age of 40 and 65, and diabetes and thyroid disorders are strong risk factors for the development of a frozen shoulder. My PhD is focused on the pathophysiology, the non-surgical treatment with injections and physiotherapy, and on a surgical intervention called manipulation under anesthesia. We are currently running a randomized trial comparing manipulation under anesthesia with non-surgical treatment in Amphia hospital Breda.
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.
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.