SHOULDER, ARM, FOREARM, AND HAND. 167 



The median basilic vein lies on the brachial artery, which latter would be 

 endangered were this vein selected. 



Suppose you employ the median basilic vein in venesection, and accidentally cut 

 the brachial artery, and your patient dies from hemorrhage: In this case w mat 

 ground for action for damages would relatives of deceased liavc that you could not 

 possibly circumvent ? 



The ground of want of ordinary care. The cephalic vein would have 

 answered the venesection purpose, and its employment would not have endan- 

 gered your patient's life. Under the law, a physician must possess ordinary skill 

 and exercise ordinary care. 



Can you say anything regarding any cutaneous nerves liable to be injured in 

 phlebotomy of the median cephalic and median basilic veins f 



The internal cutaneous nerve crosses the median basilic vein ; the musculo- 

 cutaneous nerve terminal crosses the median cephalic either may be injured. 



Name the great nerve-trunks that supply the skin of the hand with sensation. 



The median gives palmar and digital branches to 3.5 fingers, radial side. 



The ulnar gives palmar and digital branches to 1.5 fingers, front and back. 



The musculo-spiral, radial nerve, supplies 3.5 fingers dorsally. 



Have the median, ulnar, and musculo-spiral nerves any articular distribution in 

 the joints of the hand ? 



Yes ; they supply joints between the phalanges the metacarpo-phalangeal, 

 the carpo-metacarpal, the intermetacarpal, the medio-carpal, and the radio-carpal. 



Is there any systematic distribution of articular nen>es f 



Yes ; a nerve-trunk that supplies a muscle that moves a joint supplies the 

 joint as well. The inferior radio-ulnar joint is pronated by the pronator quad- 

 ratus, and supinated by the supinator longus. To determine the nerve-supply to 

 this joint, you ascertain the nerve-supply to the muscles that move the joint. In 

 this particular case the median and musculo-spiral nerve-trunks supply the 

 pronator quadratus and supinator longus muscles respectively ; these same nerves 

 supply the joint. 



Give attachments of the anterior annular ligament and tell ivhat structures pass 

 under the same. 



This ligament is a specialized part of the deep fascia. It is attached exter- 

 nally to the scaphoid bone and os trapezium ; internally to the pisiform bone and 

 the unciform process of the unciform bone. Under this ligament pass the 

 median nerve, with its median artery, the flexor longus pollicis, the flexor prp- 

 fundus digitorum, and the flexor sublimis digitorum. 



Name, locate, and give importance of three surgical areas of the fingers. 



(i) The central, in which are found the tendons of the flexors in their synovial 

 sheath, called theca. (2) On each side of this tendinous area is a neuro- vasal area, 

 in which are found the digital arteries and nerves that supply the fingers with 

 blood and sensation respectively. 



Why is infection of the little finger or thumb more dangerous than infection of 

 the fingers between these two extremes. 



The vaginal thecal sheaths of synovial membrane of these extremes are in 

 communication with the great palmar bursae under the anterior annular ligament. 

 Give the symptoms in paralysis of the ulnar nerve. 



There would be loss of sensation and motion in those parts to which this 

 nerve is distributed, as follows : (i) Loss of sensation in the skin of the little 

 finger and the ulnar half of the ring finger and in the corresponding articulations ; 

 (2) loss of motion in the flexor carpi ulnaris and in half of the flexor profundus 

 digitorum muscles ; (3) loss of motion in all the interossei muscles and in the 

 two lumbricals on the ulnar side of the hand ; (4) loss of motion in the flexor brevis 

 minimi digiti, in the abductor minimi digiti, and in the opponens minimi digiti ; 



