MEDIAN NEURECTOMY 



S7 



3. A long branch is given off about midway down the shaft of 

 the humerus, which represents a portion of the musculo-cutaneous 

 nerve of human anatomy. It passes beneath the biceps (coraco- 

 radialis) muscle, and ultimately splits into two divisions, one of 

 which is expended in the brachialis anticus muscle, and the 

 other supplies the skin of the forearm, terminating on the inner 

 aspect of the limb just below the knee. 



4. At various situations in the forearm, but particularly in close 

 proximity to the elbow joint, branches are given off which are 

 distributed to the internal flexor of the metacarpus and the super- 

 ficial and deep flexors of the digit. 



MEDIAN NEURECTOMY 



From the above outline it will be seen that the nerve is deeply 

 seated from its origin until it reaches the inner aspect of the elbow, 

 and during this part of its course is quite inaccessible for the ordinary 

 purposes of operation. It again becomes deeply seated throughout the 

 middle and lower thirds of the forearm. In dealing with the operation 

 of median neurectomy the upper third of the inner aspect of the forearm 

 is the area to be considered. Upon examination of this part the outline 

 of the inferior edge of the posterior superficial pectoral muscle is 

 distinctly seen, and should be carefully noted (Plate XXX.), as should 

 also the inner edge of the radius, which causes a bulging which may 

 in some animals be seen, and in all distinctly felt. 



This operation was first performed as high up as possible on the inner 

 aspect of the limb. To this seat there are several objections. Firstly, 

 the pectoral muscle is here of considerable thickness, and hence in cutting 

 through it there will inevitably be a considerable amount of hemorrhage. 

 Another objection is that, should a neuroma subsequently form on the 

 proximal end of the divided nerve, a complication which is by no means 



