These are our specialty. These are our focus. These are why we’re known as The Brown Hand Center.

Every part of your body is unique in form and function. In your life, perhaps there’s no other, more misunderstood and taken for granted as your hands: they make your house a home, make dinner for your family, make your living. With carpal tunnel syndrome, your hand may no longer be capable of doing any of these things.

At The Hand Center, they are the focus of years of study and attention – and then we focus on helping you, our patient. For almost 20 years, thousands of people have come here for problem-free relief from carpal tunnel syndrome. Your hands are important to you. Your health is important to us. We developed the patented Brown Procedure and have become the experts in treating Carpal Tunnel Syndrome.

Brown Hand Center Experts in Carpal Tunnel Brown Hand Center

Carpal Tunnel

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Experts in carpal tunnel syndrome treatment.

Come to The Brown Hand Center for proven treatment.

We use the patented Brown Procedure to treat carpal tunnel endoscopically – from the inside. 

  • Outpatient procedure - takes just a few minutes
  • Little or no pain – minimal discomfort
  • No stitches – no unsightly scars
  • No restrictions in seven days
  • Exceptional patient care: 15 years of outstanding safety. 

Our physicians are fully trained in the Brown Procedure

Michael G. Brown, M.D.
Michael G. Brown, M.D., Founder (retired)
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Experts in carpal tunnel syndrome treatment.

A native of the Houston area, the founder of The Brown Hand Center graduated from Southwest Texas State University with highest honors, with a 3.97 grade point average. He majored in biology and chemistry with a minor in physics. He returned to Houston to attend Baylor College of Medicine and graduating three years later with a Doctor of Medicine degree.

He was personally asked by Dr. DeBakey to stay at Baylor affiliated hospitals in The Texas Medical Center in preparation for the cardiovascular heart surgery program. After three years in the Baylor surgery program, he informed his mentors that instead of heart surgery, hand surgery was to be his calling. He considered the hand “more challenging” and allowed for greater advance in a critical field. Brown completed his hand fellowship training at St. Luke’s Hospital in Houston and his microsurgical training under the auspices of the Baylor Plastic Surgery department.

He then moved to California and completed the final two years of the rigorous five-year general surgery training. He also served as Chief of Hand Surgical Service while at San Joaquin General Hospital.

Brown founded The Hand Center in Houston, TX, in 1988. He was Board Certified by the American Board of Surgery in general surgery and obtained the Certificate of Added Qualifications in Hand Surgery.

Dr. Brown has gone on to invent many new techniques, including the Brown Procedure, an endoscopic (“from the inside”) carpal tunnel procedure for which he holds two U.S. patents; the endoscopic trigger finger procedure; and other pioneering reconstructive techniques. Dr. Brown’s procedures have revolutionized care for some hand problems, drastically reducing recovery time with minimally invasive procedures.

Dr. Brown has trained hundreds of other surgeons from across the U.S. and from foreign countries who seek out his skills, particularly in the endoscopic carpal tunnel procedure. His patients number in the tens of thousands. He co-directed the Pan-American Hand and Foot Project in Honduras which won him accolades from President George H. W. Bush. He has published his work in surgical journals and the textbook of Endoscopic Plastic Surgery.

World Renowned Hand Surgeon

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Our physicians and your trust.

At The Hand Center, you are surrounded by a truly amazing group of professionals. The doctors, nurses, therapists, medical assistants, receptionists and business office staff are indeed highly trained, highly skilled and very experienced. That is not all that makes your care special however. They all firmly believe there’s no greater honor than for you to put your trust in us for your health care.

They welcome this responsibility. That’s why their dedication to providing you with the highest quality care possible began decades ago in classrooms, medical schools, residency training programs and laboratories. They have been fully trained and are deeply experienced in the Brown Procedure. Their dedication continues to you, their patient, by listening to you and recognizing your needs.

They constantly endeavor to improve methods of diagnosis, treatment and service to you. That is why they are here, to provide a service to you in a comforting, confident and happy atmosphere. Because they enjoy taking good care of people.

In plain talk they are committed to providing you with care that’s second to none in every way. Your health is important to us.

Houston Location Physicians

Dr. Randolph LopezDr. Randolph Lopez is from New York, N.Y. where he received his Doctorate of Medicine from the University of Medicine & Dentistry of New Jersey in Newark, N.J. He then completed his General Surgery residency as Chief Resident at Monmouth Medical Center, Long Branch, N.J. and Newark Beth Israel Medical Center where he received the Cyril Arvanitis Award in surgery. Dr. Lopez then went on to complete his Hand Fellowship at Oklahoma University Medical Center and Integris Baptist Medical Center in Oklahoma City, OK, and is now highly accomplished and experienced in minimally invasive techniques, including the Brown Procedure and the Brown Endoscopic Trigger Release (BETR). While accompanying Michael G. Brown, M.D., to an international orthopedic conference in Barcelona, Spain designed to train European hand surgeons in the Brown Procedure, he had the chance to train other surgeons in the techniques with which he is so familiar.

Dr. Mark D. KhorsandiDr. Mark D. Khorsandi is a native of Staten Island, New York and is now a Board Certified General Surgery and Fellowship trained Hand Surgeon with Brown Hand Center. He recieved his B.S. in Biology from Boston College in Massachusetts, and Doctorate from Nova Southeastern University in Ft. Lauderdale, Florida. Upon graduation he worked at P.C.O.M. as a rotating intern for 1 year, and then completed his General Surgery residency at Peninsula Hospital Center in Queens, New York. Dr. Khorsandi completed his Hand Surgery Fellowship at Beth Israel Medical Center, in New York, N.Y. He was trained by Dr. Charles P. Melone, a pioneer in sports injuries of the hand. Dr. Khorsandi continues to specialize in sports related injuries of the hand, including boxing, basketball, baseball, football, golf, and tennis. He has taken care of many high school, amateur, and professional sports players. He is also actively involved in treating patients with scleroderma related hand problems. He is a member of the American Medical Association, Scleroderma Foundation, American College of Osteopathic Surgeons, American Osteopathic Association, and is a member of the strategic planning committee of the ACOS. Dr. Khorsandi continues to participate in research projects as he has in the past at Sloan Ketterring, New York Medical College, New England Medical Center and Beth Israel medical center. He is an accomplished Hand Surgeon personally trained in the Brown Procedure and BETR by Michael G. Brown, M.D.

Dr. Joseph DangDr. Joseph Dang received his B.A. from the University of Texas and his Doctorate of Medicine from the University of Texas Medical School in Houston. His post graduate training included internship at the University of Texas and completed his residency in Physical Medicine and Rehabilitation at the prestigious Southwestern University Medical School in Dallas, Texas. He is Board Certified by the American Board of Physical Medicine and Rehabilitation. He is further trained in spinal procedures for pain management under the auspices of the Physiatric Association of spine, sports and occupational rehabilitation. Dr. Dang is regarded as a physician with exceptional electrodiagnostic skills and conducts ongoing research at The Hand Center.

Dr. Andrew LeeDr. Andrew K. Lee is double Board Certified in Orthopedic Surgery and Added Qualifications in Surgery of the Hand. He received his Bachelor of Science degree from the University of California at Los Angeles in 1988 and earned his Doctorate of Medicine at Howard University in 1992 with honors. He completed his residency in orthopedic surgery at Howard University Hospital in 1997 and also received training at George Washington University affiliated hospitals and Sinai Hospital in Baltimore. Dr. Lee completed his fellowship in Hand Surgery at The Hand Center in Houston and his microvascular training at Baylor College of Medicine. He received numerous academic accolades including Scholar’s Award for outstanding leadership in residency. Dr. Lee is an active member of American Society for Surgery of the Hand. Dr. Lee is an accomplished surgeon, musician, and has devoted much of his time over the years to medical missionary work abroad.

Dr. Jamie Lynn GuydenDr. Jamie Lynn Guyden Dr. Jamie Lynn Guyden, a native of New Jersey, holds a Bachelor of Science degree from Rutgers University in Brunswick, New Jersey. Before entering medical school, Dr. Guyden participated in AIDS research in Kampala Uganda which facilitated the initiation of molecular research by Ugandan physicians. She received her Doctorate of Medicine from University of Medicine and Dentistry of New Jersey-New Jersey Medical School in Newark. Dr. Guyden completed her internship at St. Vincent's Medical Center in Bridgeport, Connecticut and her residency in Physical Medicine and Rehabilitation at Baylor College of Medicine/University of Texas-Houston Medical School Alliance. Dr. Guyden is a member of the American Academy of Physical Medicine and Rehabilitation and the Harris County Medical Society. As a teenager, Dr. Guyden was diagnosed with the autoimmune disease Lupus. One of her life-long passions is counseling young Lupus patients.

Dr. Mark Ciaglia was born in Chicago, Illinois where he later attended Illinois Wesleyan University and graduated with tri-beta honors in biology and chemistry. He was accepted at Nova Southeastern University in Ft. Lauderdale, Florida, obtaining his medical degree and then completing his surgical training at Lutheran Medical Center, in Brooklyn, New York. While there, he was awarded the prestigious Sampath Kumar Excellence in surgery award and completed several research projects that have been recognized at national meetings and published in prominent surgical journals. Dr. Ciaglia completed his hand surgical fellowship at Beth Israel / Albert Einstein in Manhattan, NY. There he trained under the world renowned hand surgeon, Dr. Charles P. Melone and was involved in providing care for many professional athletes. He has lectured at state and national hand society meetings. When not in the office or operating room, Dr. Ciaglia enjoys traveling the world with his wife. He also is an avid aviator, having obtained his private pilot's license at age 17.

Dr. Baher Maximos comes from a family of physicians. He received a Bachelor of Science in Biochemistry from La Sierra University in Riverside, California. Immediately after receiving his undergraduate degree, he continued his education at Saint George's University and was accepted in the prestigious combined Medical Doctorate and Master of Science program. While attending medical school, he studied the effects of sleep on memory at the University of Washington and attended a summer externship in Prague, the Czech Republic. He graduated with a Medical Degree as well as a Master of Science in Neuroscience. Dr. Maximos completed his General Surgery residency at State University of New York at Buffalo and continued his medical education in the same program with fellowship training in hand and microsurgery. While at SUNY, he served as chief resident of General Surgery in his final year. He enjoys research, teaching and received the SUNY Buffalo resident teaching award in 2009.

Dallas Location Physicians

Dr. Pedro J. Loredo IIIDr. Pedro J. Loredo III grew up in Dallas in a working class family with his parents and his one brother. Before graduating from Thomas Jefferson High School in Dallas, he obtained the highest rank of Eagle Scout that is attainable in the Boy Scouts of America.  He received his Bachelor of Arts in Biochemistry/Biology with a minor in Chemistry from the University of North Texas in Denton, Texas. The first in his family to graduate from college, Dr. Loredo was very involved in student government and held several positions while at college.  While attending UNT he participated in several triathlons and achieved third place in the southwestern region. He also underwent training as an emergency medical technicians by careflight instructors at Methodist Dallas Medical Center. His experience as an EMT ignited his desire to become a physician. He received his Doctorate of Medicine from the University of Texas Medical School at Galveston.  While at UTMB he worked very closely with the world renowned Dr. David Herndon at the Shriners Burns Hospital as a research burn fellow.  Where he helped with cutting edge burns research that was used to improve the lives of burned patients. He obtained his General Surgery residency training at St. John Hospital Medical Center in Detroit, Michigan, where he became the Chief Resident. During his residency he was elected graduate medical education committee representative for the surgery department where he helped with the improvement of the residency program. He then completed his Hand and Upper Extremity Surgery Fellowship at the Christine M. Kleinert Institute of Hand and Microsurgery at the University of Louisville in Louisville, Kentucky. Where he worked with one of the early pioneers of hand surgery Dr. Harold Kleinert before he retired in 2008. Currently, Dr. Loredo is a candidate member of the American Society for Surgery of the Hand and a member of several organizations, including the American Medical Association and The American College of Surgeons. Dr. Loredo and his wife, an ob/gyn physician, are the proud parents of a son and three daughters.  They enjoy spending time at home with family and friends. In his spare time, he enjoys playing indoor/outdoor soccer, golf, football, and softball. He also enjoys weightlifting, swimming and hunting.

Dr. Garrison WhitakerDr. Garrison Whitaker Dr. Garrison Whitaker received his Bachelor's of Science degree from University of Michigan. His M.D. is from Howard University in Washington, D.C. He is a graduate of the Kleinert-Kutz/University of Louisville Hand Fellowship where the first American Hand transplant was performed. At Louisville, he assisted in multiple digit replantations and complex hand reconstructions. Highlights of his training include the surgical management of Thoracic Outlet Syndrome, which he spent additional time pursuing and toe-to-thumb transfer. In his spare time he enjoys jogging, lifting, film, theater and military history.

Dr. Igor RakovchikDr. Igor Rakovchik moved to the U.S. with his family at a young age from St. Petersburg, Russia.  Always having a strong interest in science, he graduated Cum Laude with a Bachelor of Science degree in Biology from the University of Texas at Dallas while participating in research on the Human Genome project at the Southwestern School of Medicine.  He then went on to complete his Doctorate degree at the University of North Texas and his residency training in Physical Medicine & Rehabilitation at the Baylor College of Medicine in Houston, TX.  Dr. Rakovchik holds a fellowship in Spinal Cord Injury rehabilitation from Mount Sinai School of Medicine in New York, NY where he was involved in resident teaching on Neurorehabilitation and contributed several chapters to a book on functional and medical management of patients with spinal cord injury.  He is a Board Certified Diplomate in the field of Physical Medicine and Rehabilitation and continues work in electrodiagnosis of nerve problems.  In his spare time, he enjoys reading about psychology, philosophy and cosmology as well as spending time cycling and swimming.

Dr. Dustin RayDr. Dustin Ray, born in South Carolina, is a Phi Beta Kappa, magna cum laude graduate of Howard University in Washington, DC. Dr. Ray graduated with honors with a Bachelor of Science degree in Biology, earning a full tuition scholarship to Howard University College of Medicine where he finished among the top of his class. He then completed his general surgery residency at Howard University Hospital where he was awarded “Intern of the Year” and as chief resident earned “Resident of the Year” honors. Dr. Ray completed his hand surgical fellowship at the Kleinert Institute for Hand and Microsurgery in Louisville, Kentucky. During his fellowship, Dr. Ray assisted in numerous complex soft tissue reconstructive surgeries of the upper extremity. These included microsurgical free flaps, digit replantations, and revascularizations. Following this intensive training, he completed a course in Minimally Invasive Hand Surgery at the Brown Hand Center in Houston, Texas. Dr. Ray is a Candidate Member of the American Medical Association, the National Medical Association, the American College of Surgeons, and the American Society for Surgery of the Hand. He is committed to providing quality patient care and looks forward to meeting you in our Dallas, Texas office. Away from work, Dr. Ray enjoys relaxing to classical music, fishing and playing the piano. 

San Antonio Location Physicians

Dr. Kyle HerronDr. Kyle Herron received a Bachelor of Science in Biology from Murray State University and completed medical school at Ross University School of Medicine. Dr. Herron performed his General Surgery Residency at York Hospital in York, Pennsylvania, where he made many presentations at local and national surgical meetings, and then completed his hand and microsurgery fellowship training at the University of Alabama at Birmingham. He served as an instructor in a Human Anatomy course for York College premedical students. During his residency, he participated in a surgical mission trip to Honduras with The World Surgical Foundation. In his spare time, Dr. Herron enjoys triathlons, biking, swimming, running, golf, chess, and traveling.

Dr. John William MathewsonDr. John William Mathewson received his undergraduate degree in Bio-Science from Schiller University in his native country, England. He then went on to St. George's University School of Medicine in Grenada where he received his Medical Degree and induction to the international honor society, graduating in the top 5% of his class. During his early training, Dr. Mathewson had the opportunity to work as an assistant to a Plastic Surgeon and Hand Specialist, inspiring his future career. His Surgical Residency was completed at York Hospital in York, Pennsylvania where he received the Gil Rothrock award, followed by a Fellowship in hand and microsurgery at University of Minnesota in Minneapolis, Minnesota. Dr. Mathewson enjoys skiing, soccer, scuba diving, sailing, mountain biking, swimming, squash, golfing and travel and welcomes the opportunity to take care of you and your family in our San Antonio office.

Dr. Ivan EdwardsDr. Ivan Edwards received his medical degree from Midwestern University of Glendale, Arizona. He completed his internship at Eastern Virginia Medical School, Norfolk, Virginia and his residency in Physical Medicine and Rehabilitation at the University of Texas Health Science Center, San Antonio. He graduated with honors with a Bachelor's degree in Biology from Rivier College. Dr. Edwards has a special interest in electrodiagnostics, musculoskeletal medicine, minimally-invasive pain management (for which he has been specially trained to do ultrasound-guided procedures), manipulation medicine, sports-related injuries, and muscle and joint pain. He is board certified by the American Board of Physical Medicine and Rehabilitation. Dr. Edwards has varied skills and interests. He is also a Flight physician with the US Air Force Reserve, loves martial arts (earned a black belt in Korean Taekwondo) and once ran a dojo. He has written a few articles on various topics, e.g. investing, medical contracts, and the power of positive thinking. He loves to travel, work out, and spend his leisure time with family and friends.

Dr. Ivan EdwardsDr. Richard Treviño was born and raised in San Antonio, Texas. He graduated from the University of Texas in 1988 with a B.A. in Biochemistry and B.S. in Zoology, and then joined the workforce as a chemist for EPA testing of water sources for contamination. In 1990, he changed direction and entered medical school at Texas Tech School of Medicine, being inducted into the AOA Honor Medical Society and graduating in 1994 with honors. Dr. Treviño was then accepted into the orthopaedic Surgery residency program at the Mayo Clinic in Rochester Minnesota. After finishing his 5 year residency he pursued his interest in hand and upper extremity, completing an additional fellowship at the Medical College of Wisconsin. Dr. Treviño then entered private practice in Wisconsin where he treated general orthopaedic and upper extremity pathologies. He returned to San Antonio after completing additional minimally invasive surgery training at the Brown Hand Center in Houston, Texas to be closer to his extended family. He and his wife enjoy outdoor activities and sporting events with their four young children. They are also interested in physical fitness and nutrition. Dr. Trevino's goal is to provide every patient with the highest quality medical and surgical care.

Dr. Jackson M. OmbabaDr. Jackson M. Ombaba graduated from college with honors where he majored in chemistry with a minor in mathematics. He then joined Jackson State University, Jackson, Mississippi to pursue a master's degree in chemistry before proceeding to the University of Massachusetts where he graduated with a Ph.D. degree in analytical chemistry. For several years after graduating from the University of Massachusetts, Dr. Ombaba was a professor of chemistry at Jackson State University, Jackson, Mississippi and a visiting researcher at Walter Reeds Army Medical Center, Washington, DC where he conducted research in Marine biochemistry. It was at Walter Reeds Army Medical Center, while working with prominent theoreticians, scientists and medical doctors, that Dr. Ombaba realized his calling was in medicine. Dr. Ombaba received his Doctorate of Medicine degree from the University of Cincinnati College of Medicine, Cincinnati, Ohio before proceeding for his general surgery internship, residency and chief residency at State University of New York at Buffalo, New York. After graduating from general surgery residency, Dr. Ombaba joined Texas Tech University health science center, El Paso Texas as a trauma surgeon. His responsibilities included patient care, teaching residents and medical students in addition to conducting scientific research. It was at Texas Tech University health science center during the care of trauma patients in conjunction with the orthopedic department where Dr. Ombaba fell in love with managing upper extremity ailments and trauma. To further his expertise in upper extremities, Dr. Ombaba pursued additional training in Hand and Microsurgery and completed a Hand Surgery fellowship at Integris Baptist Medical Center/Oklahoma University under the tutelage of world renowned Ghazi M. Rayan, M.D. During his Hand Surgery fellowship, Dr. Ombaba gained extensive experience in adult upper extremity pathology, microsurgery, microvascular flap reconstruction, and diagnosing and management of congenital and pediatrics upper extremity anomalies. After joining Brown Hand Center in Houston, Texas, Dr. Ombaba completed a course in Minimally Invasive Hand Surgery where he was personally trained in The Brown Procedure and the Brown Endoscopic Trigger Release (BETR) by Michael G. Brown, M.D. In his spare time, Dr. Ombaba enjoys visiting the Houston Opera, symphony and performing arts, in addition to exercising, traveling and spending time with his family and friends.

Phoenix Location Physicians

Dr. Michael J. FitzmauriceDr. Michael J. Fitzmaurice  received his Bachelor of Science degree from Northern Illinois University and M.S. degree from Barry University. He was ranked in the top 5% of his class and was on the Dean’s List at St. George’s University School of Medicine, where he received his Doctorate of Medicine. Dr. Fitzmaurice is a member of the Iota Epsilon Alpha International Honor Society. He completed his General Surgery residency at the University of South Carolina in Columbia, South Carolina during which time he spent one year in the study of Plastic Surgery and ongoing research projects. Dr. Fitzmaurice went on to further training including his Hand and Microsurgery Fellowship at the University of Louisville, Kleinert Hand Program. Dr. Fitzmaurice has had numerous publications in medical journals and has lectured extensively. He is the recipient of the American Medical Association Physicians Recognition Award. Dr. Fitzmaurice has a wide range of personal interests including skiing, fitness training, and athletics.

Dr. Paul MahoneyDr. P. Stephen Mahoney graduated cum laude from Southern Methodist University in Dallas, Texas with a Bachelor of Science degree in Biochemistry.  He received his Doctorate of Medicine from Tulane University School of Medicine, New Orleans, Louisiana.  He completed his General Surgery residency at Boston University Medical Center, Boston, Massachusetts and at Akron General Medical Center.  Dr. Mahoney completed his hand surgical fellowship at the Kleinert Institute for Hand and Microsurgery in Louisville, Kentucky and served as Clinical Instructor in hand surgery at the University of Louisville.  Dr. Mahoney is a recipient of the American Medical Association Physician’s Award in 2002 and has received numerous other academic accolades. He is the author of scientific and medical research articles too numerous to mention.  Dr. Mahoney is a Candidate Member of the American Medical Association, the American College of Surgeons, and the American Society for Surgery of the Hand.  His hobbies include scuba diving, skiing and golf.

Dr. Jenpin WengDr. Jenpin Weng is a Distinguished Graduate of the U.S. Air Force Academy in Colorado Springs, Colorado, with a Bachelor of Science degree in Biology.  He received his Doctorate of Medicine from the University of Texas Medical Branch in Galveston, Texas.  After his preliminary residency at Good Samaritan Hospital in Baltimore, Maryland, he completed a residency in Physical Medicine and Rehabilitation at the University of Virginia in Charlottesville.  He holds a musculoskeletal rehabilitation/pain fellowship from the Mayo Clinic in Scottsdale, Arizona.  He is professionally certified in Medical Acupuncture for Physicians from the Helms Medical Institute and UCLA.  He is the author of a number of medical research articles on the subject of hip arthroplasty and rehabilitation. Dr. Weng has served as a Board Member of Camp Holiday Trails, a camp for children with special health needs.  He is a member of the American Academy of Physical Medicine and Rehabilitation, PASSOR and the American Medical Association.

Austin Location Physicians

Dr. Christian PetrulioDr. Christian Petrulio received a Bachelor of Arts with honors in Biology from Harvard University in Cambridge, Massachusetts. After five years of research in New York and Africa, he decided to continue his education at New York University School of Medicine from where he received his Doctorate of Medicine in 2002. He completed his General Surgery training at Columbia University, during which time he did a year of research as the Chiron Surgical Oncology Fellow. During this year, he published several articles and developed a tumor vaccine. After six years at Columbia University, he went on to complete a Hand and Microvascular Surgery fellowship at Kleinert-Kutz in Louisville, Kentucky where he participated in three hand transplantations. Dr. Petrulio occupies his time by closely following professional tennis and playing himself when he is not working on his first full-length screenplay, playing with his dogs or doing the New York Times crossword puzzle. A project very dear to him is his ongoing involvement with the study and conservation of the wild African cheetah population, which began with a tenure in Namibia and brings up his favorite activity of all, taking every opportunity to travel the world. Dr. Petrulio continuously works to improve his ability to care for his patients with a strong desire to fully appreciate human life and experience.

Dr. Andres LernerDr. 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 his research experience, he began his General Surgery residency at Graduate Hospital in Philadelphia, PA and after that, completed a chief resident year at Lanquenau Hospital in Wynnewood, PA. During his residency, Dr. Lerner had the opportunity to work in prestigious hospitals, such as Temple University Hospital and Hanneman University Hospital as well as Jefferson University Hospital where he gained experience in hand surgery under the mentorship of world renowned hand surgeons. After residency, Dr. Lerner pursued further training in Hand and Microsurgery and completed a combined plastics and orthopedics Hand Surgery fellowship at University of California San Francisco. During his Hand Surgery fellowship, Dr. Lerner gained extensive experience in hand and wrist pathology, elbow pathology and free microvascular flap reconstruction procedures. Following this extensive training, he completed a course in Minimally Invasive Hand Surgery at the Brown Hand Center in Houston, Texas, where he was personally trained in The Brown Procedure and the Brown Endoscopic Trigger Release (BETR) by Michael G. Brown, M.D. In his spare time, Dr. Lerner enjoys songwriting and recording, exercising and spending time with his family and friends. Dr. Lerner is looking forward to bringing you and your family the highest level of care and compassion.

Dr. Cayli NguyenDr. Cayli Nguyen received a Bachelor of Arts with honors from the University of Dallas in Irving, Texas.  During her undergraduate studies, she developed a passion for science, travel and exploring new cultures while studying abroad in Rome, Italy.   She went on to receive a Doctorate of Osteopathic Medicine from the University Of North Texas Health Science Center in Fort Worth, Texas, feeling osteopathy’s holistic approach to medicine, helping integrate the patient into the health care process, was best suited to her philosophy.  Her post-graduate training included serving as co-chief intern with the Department of Medicine at Plaza Medical Center of Fort Worth where she helped coordinate her class to assist with evacuees from New Orleans at a Hurricane Katrina Medical Relief Post.  She completed her residency in Physical Medicine and Rehabilitation at the Rehabilitation Institute of Chicago associated with Northwestern University in Chicago, Illinois, where she served as contributing editor for Rehab in Review-Association of Academic Physiatrists and received the RIC Scholl Recognition Award for Rehabilitation Research.  Her professional experiences include working as an instructor for the Department of Orthopedic Surgery and Rehabilitation for Loyola University Medical Center in Maywood, Illinois.  She is Board Certified by the American Board of Physical Medicine & Rehabilitation. Dr. Nguyen strives to promote healthcare excellence by serving as a guiding partner in her patient’s medical journey.

Las Vegas Location Physicians

Dr. Chris KhorsandiDr. Christopher Khorsandi comes from a highly respected family of physicians. He was born and raised in New York City and was accepted into the competitive B.S./M.D. dual degree program at Villanova University where he was a member of Alpha Epsilon Delta Medical Honor Society.  Following his undergraduate studies, he matriculated to Temple University School of Medicine in Philadelphia, where he was awarded the prestigious Laughlin Scholarship. While in medical school his commitment to excellence led him to serve on the admissions committee, act as vice president for the student surgical society and work to improve the quality of healthcare for the underprivileged.  He founded a chapter of the Operation Smile charitable organization on campus, and for his outstanding service to the community of Philadelphia, he was presented with a commendation from Senator Shirley Kitchen. Following his graduation from Medical School, Dr. Khorsandi received his training in General Surgery at the University of Pennsylvania -- an Ivy League institution consistently ranked as one of the nation’s best hospitals.  While there, he was inducted into the Thomas Bond society for Humanism in Medicine.  He then went on to the Cleveland Clinic Hospital in Weston, where he was trained in Plastic, Reconstructive, and Hand surgery and served as Chief Resident. Following this training, he completed a course in Minimally Invasive Hand Surgery at the Brown Hand Center in Houston, Texas. He has co-authored a peer reviewed study on muscle transfers and reconstruction, presented at professional meetings, and has participated in research related to the field.  Throughout his training and education, Dr. Khorsandi’s interest in Hand, Plastic and Reconstructive surgery has led him to surgical rotations at some of the nation’s best hospitals including:  New York University Hospital, Mount Sinai Hospital, Children’s Hospital of Philadelphia (CHOP), Western Pennsylvania-Allegheny Hospital, UPENN Hospital, Cleveland Clinic, Temple University, and Lehigh Valley hospitals.  He has accomplished all this so that he may bring to you and your family the highest level of skill, professionalism, and compassion in treating your medical issues. He looks forward to meeting with you for a consultation in our Las Vegas Office.

Dr. Nitin J. EngineerDr. Nitin J. Engineer is a Board Certified Diplomate of the American Board of Surgery and Fellow of the American College of Surgeons (F.A.C.S.). He graduated Cum Laude from Vanderbilt University in 1996 and completed his Doctorate of Medicine at Vanderbilt University in 2000. Dr. Engineer's postgraduate education includes a General Surgery internship at the University of Washington in Seattle followed by a General Surgery residency at Southern Illinois University in Springfield, Illinois. In 2007, he completed a fellowship in Hand and Microsurgery with the Division of Plastic Surgery at Southern Illinois University. During his residency and fellowship training, Dr. Engineer received numerous teaching awards and joined several academic societies of which he is now an active member including the American College of Surgeons (ACS), the American Association for Hand Surgery (AAHS), the American Society for Peripheral Nerve (ASPN), and the American Association for Reconstructive Microsurgery (ASRM). In addition, he has coauthored several research articles in the field of Hand and Microsurgery that have been published in peer reviewed medical journals. Immediately following fellowship training, Dr. Engineer joined the faculty at the University of Louisville School of Medicine and served as Clinical Instructor with the Department of Surgery, where he taught and directed medical students, residents, and fellows in the field of Hand and Microsurgery. Dr. Engineer subsequently moved his practice to Las Vegas, Nevada, and joined the Brown Hand Center, where he has been dedicated to treating patients with any ailment or injury involving the upper extremity. His particular surgical expertise and interests are minimally invasive hand surgery, including the Brown Endoscopic Carpal Tunnel Release (BECTR) and the Brown Endoscopic Trigger Release (BETR), peripheral compression neuropathies, degenerative and rheumatoid arthritis, joint reconstruction and replacement, and traumatic hand injuries. Dr. Engineer's extracurricular interests include playing the drums, inline skating, golf, photography, and travel.

Dr. Juan Martínez-MorenoDr. Juan Martínez-Moreno received his Bachelor of Science in Biological Sciences at the University of Puerto Rico, Mayaguez Campus. He graduated Doctor of Medicine from Ponce School of Medicine in Ponce, Puerto Rico where he received the prestigious award of Clinical Distinction in MD Graduation. He completed his residency in Physical Medicine and Rehabilitation at East Carolina University/Brody School of Medicine in Greenville, North Carolina. During his time there, he became the department’s first recipient of the Good Samaritan Award, for helping transport a disabled patient back to his country of origin to be reunited with his family. Dr. Martínez is a board certified Diplomate of the American Board of Physical Medicine and Rehabilitation. He is also an Associate Member of the American Academy of Physical Medicine and Rehabilitation. He has lectured extensively on a wide variety of rehabilitation medicine topics. Dr. Martínez is an accomplished competition sailor. He and his crew aboard the J-24 keelboat Exodus, sailed into top three positions in the fiercely competed Caribbean Ocean Racing Triangle (CORT) twice, and participated in the elimination series for the sailing event of the XVIII Central American & Caribbean Games. In his spare time, Dr. Martínez also enjoys surfing, hiking, and playing the guitar. He is regarded by his a patients as a gentle electromyographer and a very informative physician..

 

 

 

 

 

 

 

 

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What is a Hand Surgeon?

A hand surgeon is a physician specially trained in a hand fellowship program.  This specific training is above and beyond the minimal experience gained in orthopedic, plastic or general surgery residency programs.            

You should ask the doctor this important question: “Have you been trained in a hand fellowship program?”            

A hand fellowship program includes microvascular training, which gives the hand surgeon expertise to reattach amputated extremities at the arm, forearm, wrist, hand or finger level.  Hand surgeons treat all upper extremity problems including broken bones, injuries, carpal tunnel, other nerve entrapment problems of the upper extremities – as well as many other problems specific to the hand.  See “Beyond Carpal Tunnel – Winning treatments for other problems.” 

You get the most benefit from hand surgeons’ skills at the onset of a problem.  As hand surgeons, we prefer to be involved with an injury from the very beginning rather than have a non-hand surgeon care for you first, then come to us for reconstructive surgery when complications arise.  We do, however, see a great number of patients whom have had previous surgical interventions and have been under appropriate care.            

The human hand is unique.  Nowhere else in the body is there such an amazing and complex functioning of bones, joints, muscles, tendons, nerves, blood vessels and skin as your hand.  The proper function and balance of all these elements is required for your hand to function to its full potential.  Restoring maximal function is the goal of our specialists in treating hand injuries and diseases.            

Hand surgeons are trained in orthopedics, neurosurgery, vascular surgery, microvascular surgery and plastic surgery specifically for your upper extremities.  Yet the knowledge of any one of these specialties alone is not enough to deliver state-of-the-art care.  Hand surgeons understand how all of these different parts must function together – in balance and harmony.            

The field of hand surgery developed during World War II when Dr. Sterling Bunnell was assigned to care for wartime hand injuries.  He quickly realized that it was much more beneficial to have one surgeon with extensive knowledge, training and expertise in hand and upper extremity treatment, instead of calling on an orthopedic surgeon to treat the bone injury; a general or vascular surgeon to treat injuries to blood vessels; a neurosurgeon to treat the nerve injury; and a plastic surgeon to treat the soft tissue damage.            

This concept is as true today as it was in 1945.  Dr. Bunnell perhaps said it best: “To recondition these members successfully is difficult.  Surgical reconstruction of the hand requires special careful technique.  It is a composite problem requiring the correlation of various specialties – orthopedic, plastic, neurologic surgery – the knowledge of any one of which alone is inadequate for repairing the hand.  As the problem is composite the surgeon must also be.  The surgeon must face the situation and equip himself to handle any and all of the tissues of the limb.”            

That “special careful technique” is a defining characteristic of the surgeons at The Brown Hand Center.

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What’s the “tunnel” in Carpal Tunnel Syndrome?

If you have “classic” carpal tunnel syndrome, your symptoms are:

  • Tingling and numbness in your thumb, index and middle finger.
  • Aching in the forearm which can radiate to the shoulder and clumsiness or weak grip.

Not everyone shows classic, textbook carpal tunnel symptoms – you may be one of these. Instead, you may have:

  • Tingling in all fingers
  • Tingling only in the thumb or the middle finger
  • Aching and pain in the hand
  • Radiating pain to the shoulder or back.

Think of the carpal tunnel as exactly that – a tunnel inside your hand. This tunnel is formed by a semi-circle of carpal bones on three sides. The fourth side of the tunnel is the transverse carpal ligament. This ligament cannot stretch.

So the carpal tunnel is a defined space that cannot enlarge. There is only so much room in the tunnel. This roominess is critical to good hand health. Through the tunnel’s opening passes the median nerve, nine tendons, and spongy tissue around the tendons called tenosynovium. We start our lives with extra space in the tunnel.

The tenosynovium swells for a number or reasons – when you run out of extra space because of this swelling, then pressure is placed on the median nerve. You develop carpal tunnel symptoms. There is no longer enough room for everything to fit comfortably inside the carpal tunnel. So you’re suffering.

At The Brown Hand Center, our treatment of carpal tunnel syndrome is not just to reduce pressure on the nerve so that your symptoms are tolerable, so you can live with it. Instead, the goal is to relieve the pressure entirely, reduce the chance of permanent nerve damage – and offer you an entirely comfortable, entirely safe experience.

The Specialists in Carpal Tunnel Syndrome

 

 

 

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The Anatomy of Carpal Tunnel Syndrome.

Carpal tunnel syndrome – CTS – symptoms were first described by Sir James Paget in 1863. The pathologic changes in the median nerve were noted by Marie et Foix in 1913. The term “carpal tunnel syndrome” was coined by Moersch in 1938.

The “open” carpal tunnel release operation was first performed in 1947 by Wright, Brain, and Wilkerson. Phalen brought attention to CTS in articles beginning in 1950s. Until the pioneering work by Michael G. Brown, M.D., there was no significant change in the surgical treatment of CTS for nearly 50 years, even though carpal tunnel release is thought to be the most commonly performed surgical procedure in the world. However, the open carpal tunnel procedure, while effective, is fraught with problems:

  1. Post-operative pain, from the open incisions, can persist for weeks, months or permanently. Doctors and patients have often opted for anti-inflammatory medication or steroid injections for fear of the post-operative problems associated with “open” carpal tunnel release. Unfortunately these treatments are usually ineffective or only provide temporary relief, delaying the inevitable surgical treatment.
  2. By the time the patient finally has surgical release of the carpal tunnel, there is often permanent damage to the nerve from longstanding CTS which results in permanent loss of sensation and possible loss of thumb function.
  3. There are additional risks of steroid injection: injury to the nerve upon injection, permanent loss of skin pigmentation and loss of soft tissue under the skin.

A host of “gimmick” treatments and preventions have further confused the public.

Finally, in 1990, 43 years after the first open carpal tunnel release was performed, Michael G. Brown, M.D., developed the minimally invasive endoscopic (“from the inside”) carpal tunnel release (the Brown Procedure). He holds United States patents on the Brown Procedure; as well as the surgical instruments he developed especially to perform the procedure. (With respect to the technique’s safety or results, there are other endoscopic carpal tunnel procedures that are not the same as the Brown Procedure.)

Patients have the Brown Procedure done in a short time 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 patient pain and suffering as well as reduced risk of permanent nerve injury from delaying treatment.

This is drastically different from the experience with “open” carpal tunnel release. Patients, employers and insurance carriers benefit from the Brown Procedure by avoiding:

  • The cost of ineffective, so-called “conservative” non-operative treatments
  • The cost of therapy
  • Long delays in returning to work.

Thousands of Brown Procedures have been performed safely and successfully at The Brown Hand Center, bringing long-term relief without drawbacks.

A landmark medical journal article, “A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Tunnel Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Release,” chronicles the work at The Hand Center.

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The Brown Procedure.

The Brown Procedure is our treatment of choice, safely and easily performed on an outpatient basis. A small 9mm incision (less than ½”) is made very near the wrist and a tiny 4mm (less than ¼”) incision is made in the palm. The instrumentation is inserted, isolating the transverse carpal ligament from the contents of the carpal tunnel. The ligament is then divided with endoscopic visualization as the surgeon watches the video monitor and the surgeon’s assistant holds the patient’s hand hyperextended and moves the endoscope.

A long-acting anesthetic is placed in the tiny incisions. This typically eliminates post-operative discomfort, numbing the hand for 4-48 hours after which time pain medication is rarely needed. The wounds are closed with Steri-Strip* adhesive skin closures, not stitches.

During the next seven days, the patient is able to use the hand. After seven days, the dressing and Steri-Strip* closures are removed and patient may use his or her hand without restriction.

After almost 20 years of safety, different from other endoscopic techniques, the Brown Procedure is the basis of the recent studies showing long-term patient safety and effectiveness. Compare the Brown Procedure to open carpal tunnel release – you will see immediate differences and our procedure’s benefits.

*”Steri-Strip” is a trademark of 3M.

 

The Specialists in Endoscopic Carpal Tunnel

 

 

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Compare – and see the benefits of the Brown Procedure.

Example of the Brown Procedure for endoscopic carpal tunnel treatment.

Brown Procedure

FROM THE INSIDE ™
This is a clear endoscopic view of the transverse carpal ligament, isolated, about to be released without injury to the overlying structures.  Typically, there are no restrictions after seven days.


Endoscopic Carpal Tunnel Treatment

After healing, the two tiny incisions are hardly visible.  There are no stitches.

 

Example of common open carpal tunnel release.

common open carpal tunnel release

This is the extent of surgical dissection of the hand required in an open carpal tunnel release.  Healing and recovery may require months.


extensive post-operative wound

The extensive post-operative wound persists as a scar in the palm, often permanently tender.

The Brown Procedure should not be confused with other endoscopic techniques which do not have the same safety and effectiveness, as has been shown in “A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Tunnel Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Release.” Other endoscopic techniques have been associated with significant complications.

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CTS: Scientific data and studies.
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Answers to your questions about Carpal Tunnel Syndrome.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) begins with numbness and tingling in the hand and may involve aching in the hand, forearm or shoulder. It is a very common condition that is caused by a pinched nerve in the palm of the hand. The symptoms may occur intermittently during the daytime and sometimes occur at night and awaken one from sleep. It is not uncommon for the sufferer to think that the hands have “poor circulation” and shake the hands in an attempt to restore circulation. See Carpal Tunnel Syndrome >

What causes CTS?

Repetitive motions may cause Carpal Tunnel Syndrome. Any activity that involves grasping, squeezing or clipping motions, such as using tools, using a computer, knitting or playing the piano, can lead to CTS. However, carpal tunnel often develops without repetitive motion.

Can I wait until it gets worse? Maybe it will just go away.

Doing nothing can possibly lead to irreversible damage. If you have CTS, the nerve that provides sensation to the hand and function to the thumb is being “pinched.” After remaining in the pinched stage for a period of time, permanent injury to the nerve will result. There is no treatment that can fully restore hand function and sensation once permanent damage is sustained.

Is surgery always necessary?

No. Your surgeon at The Brown Hand Center will first examine your hands and review your symptoms. If you have something other than Carpal Tunnel Syndrome, the doctor will suggest the appropriate treatment. If CTS is suspected, a test conducted on the nerve will positively determine whether or not it is pinched and if you have CTS.

What happens after consultation?

Non-operative treatment is recommended if the total duration of symptoms does not exceed eight weeks and symptoms disappear completely. Otherwise, the Brown Procedure, an endoscopic (“from the inside”) carpal tunnel technique, is recommended. The procedure is performed on an outpatient basis. No hospital stay is required. With this proven endoscopic technique, the recovery period is about seven days compared with several weeks or months with the older open carpal tunnel release technique of cutting through the palm to reach the right ligament.

Do I have a choice of surgeries?

Yes, you always have a choice. You can either have the traditional carpal tunnel release surgery in which a longitudinal incision is performed in the palm of the hand or have it done through the endoscopic Brown Procedure. Both are effective. But with the traditional technique, normal tissues are divided in the palm; the wound in the palm remains tender for several weeks or months and prevents a quick return to work or recreational activities. With the Brown Procedure, these structures are not injured. There are no stitches, and typically there are no restrictions after seven days.

Do you treat other hand problems besides CTS?

Yes. We are hand surgeons extensively trained in techniques of plastic, orthopedic, neuro-, microvascular, and reconstructive treatment of the upper extremity. Because of our extensive experience, sufferers with other hand problems can find effective treatment at The Brown Hand Center. See Other Hand Problems >

Why come to The Brown Hand Center?

We practice hand surgery exclusively. Our clinical and supporting staff members are not only exceptionally professional in every way, they are fully committed to your care.

What should I do now?

Call for appointment today: 1-866-4-MY-HAND. (In Houston, TX, you may call 281-440-HAND direct; in Phoenix, AZ, call Brown Hand Center at 480-585-HAND; in Las Vegas, NV, call 702-889-HAND.)

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Beyond Carpal Tunnel – Winning treatments for other problems.

Our hands are so important, they feature in virtually everything we do. “Give me a hand in the kitchen.” “I handed off that project.” “He’s a good hand with a wrench.” “Let’s hold hands.”

At The Brown Hand Center, the problems that afflict our patients’ hands go beyond Carpal Tunnel Syndrome. These problems are additional areas of concentration for us.

Because we focus on helping you, successfully managing every disease that affects the human hand has been carefully studied. Winning treatments have been developed and used for more than 15 years.

Your health is important to us, just as your hands are important to you. To discover how The Brown Hand Center treats other hand problems, review the range of diseases and treatments by clicking on the documents below.

The Specialists in Endoscopic Hand Surgery

Note: Photographs shown in these documents are very graphic and may not be suitable for all viewers.

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Othopedics, Foot, and ankle care including tennis elbow.

Our unique approach to patient treatment and care extends to other specialties which can increase your enjoyment of life by returning injured extremities to maximal function.  Here you’ll find the same attention to your treatment, the same high level of professionalism and skill, that are characteristic of The Brown Hand Center.

American Total Orthopedics

Houston Total OrthopedicsAt American Total Orthopedics, fully qualified orthopedic surgeons treat all bone and joint problems, and specialize in shoulder and knee reconstruction.  Like The Brown Hand Center philosophy of minimally invasive care, American Total Orthopedics’ surgeons use state-of-the-art arthroscopic techniques for the best possible outcomes. 

Contact American Total Orthopedics toll free at 1-866-59 ORTHO or visit www.americantotalorthopedics.com.

Barrett Foot & Ankle Centers

Barrett Foot & Ankle CentersBarrett Foot & Ankle Center physicians offer proven, state-of-the-art treatment and care for a wide range of foot and ankle problems.  The Centers’ founder, Dr. Stephen L. Barrett, DPM, is internationally recognized for patented procedures, including the Endoscopic Plantar Fasciotomy and the Endoscopic Neuroma Procedure.  He is one of the pioneers in the treatment of heel pain treatment, as well as treatment of the neurologic lower extremity problems associated with diabetes.

Like The Brown Hand Center, the emphasis is on minimally invasive treatment to minimize recovery time.

Current locations include Houston, Texas, and Phoenix, Arizona.  Contact Barrett Foot & Ankle Centers toll free at 1-866-482 FOOT, or visit www.barrettfootandankle.com for more information.

 

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How you can contact The Brown Hand Center.

For more information, or to schedule an appointment, call toll free: 1-800-214-4263.

Email: info@thehandcenter.com 

The Brown Hand Center

In Houston, call 281-440-HAND direct.

Brown Hand Center
3726 Dacoma St.
Houston, TX 77092
Map >

Brown Hand Center

In Phoenix, call 480-585-HAND direct.

Brown Hand Center
Desert Ridge Medical Campus
Building B, Suite 290
20940 North Tatum Blvd.
Phoenix, AZ 85050
Map >

Brown Hand Center

In Las Vegas, call 702-889-HAND

Brown Hand Center
9865 Siena Heights Dr. Suite 200
Henderson, NV 89052
Map >

Brown Hand Center

In Dallas, call 817-577-HAND

Brown Hand Center
1605 Airport Freeway
Bedford, TX 76021
Map >

Brown Hand Center

In Austin, call 800-214-HAND

Brown Hand Center
3107 Oak Creek Dr #120
Austin, TX 78727
Map >

Brown Hand Center

In San Antonio, call 210-224-HAND direct.
18518 Hardy Oak Blvd #205
San Antonio, TX 78258
Map >

 

Doing what is best for the patient - Brown Hand Center

The following contents of this website is for informational purposes and is not intended to substitute as a method for communication or dialogue between patient(s) and physician(s). Please contact your physician/staff directly.

Leading Endoscopic Carpal Tunnel Surgery