Save our Hands! Brown Hand Center
Reflections on the Austin Licensed Massage Meetup on May 5, 2011, in the office of Andres Lerner, M.D. and Rebecca Zupo, LMT, Financial Counselor of The Brown Hand Center, Austin
The Austin Licensed Massage Therapists were warmly welcomed by Andres Lerner, M.D., and Rebecca Zupo, LMT, at the Brown Hand Center in northwest Austin on May 5, 2011. Once we comfortably settled in, we participated in an informative guided tour of the hand center.
Rebecca Zupo is a valuable and well-respected member of the Austin massage community. Her remarkable presence adds significantly to our profession. She graduated from the Austin School of Massage and has taken advanced training courses in massage therapy at Ariana Institute. Not only is Rebecca an expert massage therapist, but she is also highly skilled in accounts management. She serves as the Financial Counselor for the Austin office of the Brown Hand Center. Dr. Andres Lerner comes from a highly respected family of physicians and has consistently been ranked in the top ten of his class throughout his career. After receiving his Doctorate of Medicine from Maimonides University, he spent over a year at Georgetown University in Washington, DC, conducting neuroscience research and microsurgery. After residency, Dr. Lerner pursued further training in Hand and Microsurgery at the University of California San Francisco. Following this extensive training, he completed a course in Minimally Invasive Hand Surgery at the Brown Hand Center in Houston, Texas. During our informative Meetup, Dr. Lerner enthusiastically narrated a fascinating Power Point Presentation. He passionately shared his knowledge and expertise about hand physiology and corrective surgical procedures for the hand.
We focused on three major topics: (1) Carpal Tunnel Syndrome, (2) Basilar Thumb Joint Arthritis and (3) the Cubital Tunnel Syndrome and the Pronator Syndrome.
Carpal Tunnel Syndrome
We were well informed about the causes of carpal tunnel syndrome, which are multifactorial. They may include genetic construct, in other words, the patient was born that way and environmental factors such as a patient’s occupation. One occupation that is the cause of carpal tunnel syndrome is an occupation that requires the use of a jackhammer. If a person is born with small carpal tunnels, that could mean potential problems with carpal tunnel syndrome later in life. There are risk factors and conditions associated with carpal tunnel syndrome, including obesity, smoking, alcohol, age, gender (females are more likely to develop carpal tunnel syndrome), hypothyroidism, and pregnancy. Approximately fifty percent of pregnant women get carpal tunnel syndrome.
We discussed the symptoms of classical carpal tunnel syndrome, which may include clumsiness, a weak grip, tingling and numbness in the thumb, index and middle finger and aching in the forearm which can radiate to the shoulder. Other symptoms may include tingling in all fingers, tingling only in the thumb or the middle finger, aching and pain in the hand and/or radiating pain to the shoulder or back. We discussed the phenomena of thoracic outlet syndrome and how it may mimic carpal tunnel syndrome. That emphasizes the importance of obtaining an expert opinion from well-educated hand care professional.
We saw slides of the carpal tunnel as exactly that – a tunnel inside your hand, formed by a semi-circle of carpal bones on three sides. The fourth side of the tunnel is the transverse carpal ligament, which cannot stretch. The carpal tunnel is a defined space that cannot enlarge. Through the tunnel’s opening passes the median nerve, nine tendons, and spongy tissue around the tendons called tenosynovium. The tenosynovium swells for a number of reasons – when you run out of extra space because of this swelling, then pressure is placed on the median nerve. There is no longer enough room for everything to fit comfortably inside the carpal tunnel, there will be suffering. The goal is to relieve the pressure entirely, reduce the chance of permanent nerve damage and offer patients an entirely comfortable, entirely safe experience. The procedure that is utilized at the Brown Hand Center is a minimally invasive endoscopic (“from the inside”) carpal tunnel release. Patients have the Brown Procedure done in a short period of time in the hand center and return to work the following day. They can remove the dressing themselves in seven days and resume normal activities. The most important benefits are reduced pain and suffering as well as reduced risk of permanent nerve injury. This is drastically different from the experience with “open” carpal tunnel release. Patients benefit from the Brown Procedure by avoiding the cost of ineffective, so-called “conservative” non-operative treatments, the cost of therapy and long delays in returning to work.
Basilar Thumb Joint Arthritis
As massage therapists, we were particularly interested in basilar thumb joint arthritis, since that could mean the end of a career for a massage therapist if left untreated. We learned about The Brown Hand Center’s Arthroscopic Interposition Arthroplasty Procedure for the treatment of basilar thumb joint arthritis. We were pleased to learn about the emphasis on minimally invasive techniques to reduce patient pain, suffering and minimize recovery time. Unfortunately basilar thumb joint arthritis is a very common problem in which the basilar thumb joint (metacarpal-trapezial) develops arthritis, which commonly causes pain at the base of the thumb. It was interesting to hear Dr. Lerner’s descriptions and see slides showing a simple two-portal technique in which the joint is resurfaced arthroscopically, and an acellular dermal matrix allograft or a collagen graft is interposed, acting as a much-needed cushion in the joint. It was astounding to learn that this is a relatively brief outpatient procedure requiring no stitches. The patient is placed in a removable thumb splint, avoiding an uncomfortable cast. Normal activity may be resumed in six weeks. We were happy to learn that this procedure has revolutionized the treatment of basilar joint arthritis, sparing large incisions, painful removal of bone, debilitating bone fusions, and long recovery time.
Cubital Tunnel Syndrome and the Pronator Syndrome
We also talked about and saw slides of, 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, this types of nerve compression syndrome was treated by making a long incision at the elbow and forearm. The Brown Hand Center physicians have developed and refined 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.
The Austin Licensed Massage Therapists’ educational evening at the Brown Hand Center was definitely time well spent. The procedures we learned about have revolutionized endoscopic hand surgery, which is perhaps the single most important advancement since hand surgery began. No longer do people have to suffer as a result of painful, invasive surgery that requires hospitalization, anesthetic, scarring and long periods of recovery. The solution, endoscopic hand surgery, is safe, easily performed on an outpatient basis, leaves no scarring, and, best of all, the patient can use his or her hand without restriction within seven days. We witnessed a presentation that showed us a modern miracle.
As massage therapists, we have a heightened awareness of the importance and value of, having hands that are strong, flexible, and fully functioning. We benefited from the knowledge we gained as a result of Dr. Lerner’s presentation in terms of being better able to offer therapeutic massage services and referrals to a hand specialist for our clients who are suffering from pain, stiffness, discomfort and disfigurement of the hands and wrists. Being at the Brown Hand Center changed the way I offer therapeutic massage for my clients with hand and wrist issues. This valuable learning experience significantly deepened my knowledge regarding the complex and miraculous mechanisms of our precious hands.
This article was written by Ariana Vincent, LMT, MTI, NCTMB with research assistance regarding technical information and descriptions of protocols from the Brown Hand Center website. Ariana Vincent, LMT, MTI, NCBTMB, is the CEO and founder of Ariana Institute https://arianainstitute.com. For additional information regarding the Brown Hand Center, visit http://www.brownhandcenter.com/.