SPRAINS OF TENDONS.—NERF-FERURE.--TENOSITIS. 313 
which it passes, below the elbow, under the radius and the mass of the 
flexors muscles. 
The skin shaved and disinfected ; according to the quantity of cellular 
tissue and the thickness of the muscular layers, an incision 4 to 6 centi- 
meters long is made, on the course of the nerve, ona level with the inferior 
part of the articulation or immediately behind the superior extremity of 
the radius. A second stroke of the bistoury divides in the same direction 
and with the same length the sterno-aponeuroticus. If some hemorrhage 
occurs, it is stopped with affusions of boiled water or by plugging, torsion 
or ligatures being seldom required. The edges of the musculo-cutaneous 
wound kept open with spreaders, the antibrachial aponeurosis is exposed 
with a peculiar nacreous yellow coloration. “Feeling the bottom of the 
wound with the finger, be sure that the nerve is situated well on the line 
of the incision; in the contrary case, bring it there in carrying the leg 
slightly forward and backward. Then the aponeurosis is divided, or, 
Fig. 73.—Median neurotomy.—N, Median nerve ; A, radial artery ; V, one of 
the posterior radial veins. 
better still, a small incision is made through it on the lower angle of the 
wound, and a groove director introduced into it from downwards upwards ; 
the bistoury, guided by the director, incises the aponeurosis from inwards 
outwards. This incision can be made also witha blunt bistoury. By 
cutting with the scissors a semi-elliptic piece of each edge of the aponeu- 
rosis (Miller) the median is more widely exposed. 
The nerve is isolated by dissection of the connective tissue or by tearing 
it with the end of the director; the vessels and radial artery are carefully 
avoided. Should they be wounded, secure them with an hemostatic for- 
ceps. 
