New Techniques and Research
THE RESULTS OF NEARLY 15,OOO PATIENTS UNDERGOING THE BROWN PROCEDURE ENDOSCOPIC CARPAL TUNNEL PROCEDURE over a 12 year period has been published in the prestigious Journal of Reconstructive and Plastic Surgery, December, 2007. The paper titled: "A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Syndrome" was authored by Michael G. Brown, M.D., Randolph A. Lopez, M.D., Andrew K. Lee, M.D., Joseph Dang, M.D., R. Dougla s Harper, M.D. and Christopher L. Hankins, M.D.
The landmark study shows that some people with carpal tunnel syndrome develop irreversible and permanent nerve damage after only eight weeks duration of symptoms, non-operative treatment with anti-inflammatory drugs or steroids is 98% ineffective over 5 years, and the Brown Procedure is highly efficacious and safe with return to unrestricted hand use after seven days. This is in sharp contrast to the results following open carpal tunnel release (developed in 1947) where patients may have persistent pain for weeks, months, years or even permanent pain after surgery. Therefore, we believe this paper provides irrefutable and conclusive data showing that The Brown Procedure is the treatment of choice for carpal tunnel symptoms of eight weeks duration or more and is in fact the most “conservative” treatment to avoid permanent nerve damage. For more information refer to the carpal tunnel syndrome section of this website.
THE BROWN HAND CENTER’S ARTHROSCOPIC INTERPOSITION ARTHROPLASTY PROCEDURE for treatment of basilar thumb joint arthritis. Continuing with Dr. Brown’s tradition of developing minimally invasive techniques to reduce patient pain, suffering and minimize recovery time (The Brown Procedure endoscopic carpal tunnel technique, Brown Endoscopic Trigger Release, BETR) Randolph Lopez, M.D. and the other Brown Hand Center surgeons have developed a modified minimally invasive arthroscopic technique for treating the very common problem of basilar thumb joint (metacarpal-trapezial) arthritis which commonly causes pain at the base of the thumb.
Using a simple two-portal technique, the joint is resurfaced arthroscopically, and an acellular dermal matrix allograft or a type 1 collagen graft is interposed, acting as a much needed cushion in the joint. This is an outpatient procedure requiring NO stitches. The patient is placed in a removable thumb spica splint avoiding an uncomfortable cast and may resume normal activity in six weeks.
This procedure has revolutionized treatment of basilar joint arthritis, sparing large incisions, painful removal of bone and debilitating bone fusions.
Minimal Incision Procedure for Thumb Arthritis.
Percutaneous Ligamentous Reconstruction for the basilar thumb joint instability and arthritis. The stretching or tearing of the volar beak ligament, due to injury or simply aging, is known to cause arthritis of the basal thumb joint. Traditional reconstruction of the ligament requires big incisions and prolonged recovery. Dr. Andrew K. Lee, Dr. Nur Nurbhai and the team of doctors at The Hand Center are developing a new minimally invasive ligamentous reconstruction technique. This procedure requires only two tiny incisions and utilizes an anchor device (Instratek, Inc., Michael G. Brown, M.D. … Hav-lok device); therefore, there is no donor site morbidity, hardly any scarring and leads to earlier recovery. This procedure can also be done concurrently with any basal thumb arthroplasties, including arthroscopic interposition arthroplasty to prolong and maintain the long term good result.
Endo Ulnar/Pronator Release
Endoscopic Cubital Tunnel (Ulnar Nerve) Release and Pronator (Median Nerve) Release. Although not as common as Carpal Tunnel Syndrome, the Cubital Tunnel Syndrome and the Pronator Syndrome are compression neuropathies that cause numbness, weakness and pain in the arms and hands. Traditionally, these types of nerve compression syndromes were treated by making a long incision at the elbow and forearm. Following the precedent set by Dr. Michael G. Brown (first to develop the successful Brown Procedure: Endoscopic Carpal Tunnel Release), Dr Lee, Dr. Lopez and other doctors at the Brown Hand Center have developed an improved way of endoscopically treating these conditions with a less than 2 cm incision. This means less scarring, earlier motion and a faster recovery. Just as The Brown Procedure has revolutionized endoscopic hand surgery, with perhaps the single most important advancement since hand surgery began, these techniques will prove to be the revolutionary procedures for the 21st century.
