. Regional anesthesia : its technic and clinical application . 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 d
. Regional anesthesia : its technic and clinical application . 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. IVw ^Pronator radii teres [ ^H ~^; If 1 ^p^ I rljnierus Extensor carpi radiali ^ liniiercond_yle) Hi yy/ 3 (outt Anc oneu., .Wp. tendon i^/Olecranon Brachialis anticus — Fig. 165.—Cross-section of the left arm through the elbow (seen from above): 1,Median nerve; 2, musculospiral nerve; 3, ulnar nerve. relaxed conchtion, suddenly escapes from the fingers, thus revealingitself. With the patient lying on his back, arm placed in 90 degreesabduction and forearm in extension and supination, a wheal is raisedmidway between the medial aspect of the internal condyle and theinner side of the tendon of the biceps, at the bend of the elbow. NeedleNo. 2 (S--cm.) is inserted through the wheal and advanced past theskin, the superficial fascia and the deep fascia, in a direction perpen- 2o6 REGIONAL ANESTHESIA dicular to the surface of the skin. The nerve is approached gently andgradually; and, as soon as paresthesias are obtained, 3 of the 2 percent, solution are injected without displacing
Size: 1679px × 1488px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookidregionalanes, bookyear1922
