146 MEDIAN NEURECTOMY 



fault of this, removed from the hobbles and bound upon the 

 extension splint as shown in Fig. 54. Apply a local anaes- 

 thetic with adrenalin. 



The foot is drawn out firmly from the shoulder, inclined 

 somewhat forward. The operator places himself between 

 the neck and the forearm of the patient 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 posterior part of the joint to disappear behind the 

 radius. Shave the skin at and below this point, disinfect 

 it with sublimate or creolin solution and 50% alcohol. The 

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

 the median side of the forearm against the postero-interaal 

 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 thumb and index finger, stretch the skin over 

 the nerve at the point where it begins to disappear behind 

 the radius after having passed over the humero-radial 

 articulation. Make an incision 5 cm. long, first through 

 the skin, then through the expansion of the sterno- 

 aponeuroticus muscle down upon the nerve. Check any 

 hemorrhage from the skin, subcutis, or muscle. The tena- 

 cula 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 of the nerve, the fascia 

 is divided with the scalpel and an oval piece immediately 

 over the nerve excised with the scissors. If much fatty 

 tissue is found beneath the fascia, it may be dissected away 

 carefully with the scalpel or cut away with the scissors. 

 There now comes into view a delicate reddish colored fascia- 

 like membrane, the nerve sheath, behind which a dark cord. 



