142 NEUROTOMY OF THE MEDIAN NERVE. 



Instruments. Razor, scissors, convex scalpel, artery 

 and compression forceps, tanacula, aneurism needles, suture 

 material. 



Technic. The operation is performed on the median 

 surface of the anterior limb immediately below the hurnero- 

 radial articulation on the recumbent horse after the affected 

 foot has been fully extended on the operating table or in de- 

 fault of this removed from the hobbles and bound upon the 

 extension splint as shown in Plate XVII. Anaesthetize. 

 The foot is drawn out firmly from the shoulder, inclined 

 somewhat forward. The operator places himself between 

 the neck and the forearm and, after the median region of 

 the elbow joint has been washed with soap and water, 

 searches for the median nerve where it glides over the pos- 

 terior part of the joint to disappear behind the radius. 

 Shave the skin at and below this point, disinfect it with 

 soap, sublimate or creolin solution and 50^ aclohol. The 

 nerve, n, lies as a rule somewhat in front of the middle of the 

 median side of the forearm against the postero-internal 

 margin of the radius and can be felt, about 5 to 6 mm. in 

 diameter, lying somewhat deeply. The position of the nerve 

 varies with the different attitudes of the forearm. In fat 

 and fleshy horses the identification of the nerve is more 

 difficult. It may be felt upon the standing animal. 



With the nerve lying between the thumb and index finger 

 of the left hand, at the point where it begins to disappear 

 behind the radius after having passed over the humero-radial 

 articulation stretch the superposed skin and immediately 

 upon and parallel to it make an incision 5 cm. long, first 

 through the skin, then through the sterno-aponeuroticus 

 muscle. Any hemorrhage from the skin, subcutis, or mus- 

 cle, is checked. The tenacula are inserted cautiously in the 

 lips of the wound, and these being drawn apart the white 

 anti-brachial fascia is brought into view and a search is 

 made with the index finger to determine the exact location 



