. Regional anesthesia : its technic and clinical application . s of the there lies beneath the deep fascia and corresponds to the intervalbetween the tendons of the flexor carpi radialis and palmaris passing beneath the anterior annular ligament, it spreads out inthe hand and contributes with the ulnar nerve to the innervation ofthe palmar region and part of the dorsal aspect of the index, middle,and ring fingers, occasionally the thumb. The median nerve may be blocked at the elbow or at the wrist,according to the needs of the operation. Median Block at the Elbow.—^The
. Regional anesthesia : its technic and clinical application . s of the there lies beneath the deep fascia and corresponds to the intervalbetween the tendons of the flexor carpi radialis and palmaris passing beneath the anterior annular ligament, it spreads out inthe hand and contributes with the ulnar nerve to the innervation ofthe palmar region and part of the dorsal aspect of the index, middle,and ring fingers, occasionally the thumb. The median nerve may be blocked at the elbow or at the wrist,according to the needs of the operation. Median Block at the Elbow.—^The hend oj the elbow is determinedby flexing the forearm on the arm, while the patient is in complete mus-cular relaxation, with a rigid probe or other thin instrument tightlyheld in the line of flexure. The forearm is then placed in extension, andthe probe maintained in the position it occupied during flexion. The REGIONAL ANESTHESIA Musculospiral n. _ ^ Brachioradialis Brachial a. I ^ teres in. j rad m. Palmaris median n y a| Fig. 164.—The median nerve at the elbow and wrist, (.^fter Hirschfeld and ) bend thus determined, which is higher than the line joining the con-dyles of the humerus, is traced on the skin by means of a sterile dermo-graphic pencil or an applicator moistened with tincture of iodin. BLOCKING OF SPINAL NERVES 205 The tendon of the biceps is then defined and its inner side marked onthe first tracing. The tendon is easily felt in lean patients. In stoutindividuals it can be located by a simple device described by A. Brocain the following manner: The forearm is placed in 90 degrees flexionand the soft structures of the arm at the bend of the elbow deeplygrasped and firmly held between the thumb and index-finger. Whenextension is restored to the forearm, while the hand is held in supina-tion, the tendon of the biceps, which had been grasped owing to its iceps tend f^^^mti
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