' MEDIAN NEUROTOMY 165 



managed remain sound and useful for. a whole life-time at 

 light occupations, while others will become lame again 

 under the strain of hard or fast work. 



ACCIDENTS AND SEQUEUE.— While digital neu- 

 rotomy is much less hazardous than any of the other 

 neurotomy operations, it is not entirely free from adverse 

 elements, (i) During the operation there is some" danger 

 of accidentally opening the inferior cul-de-sac of the sesa- 

 moidean synovials with the scalpel. A sudden jerk of the 

 poorly secured leg or a slip of a sharp scalpel when this sac 

 is highly distended is sometimes the cause of this unfor- 

 tunate incident. If the wound thus made is aseptic and no 

 septic matter is permitted to enter it afterwards no bad re- 

 sults will follow, but on the other hand, if the sac becomes 

 the seat of an intense purulent inflammation, severe lame- 

 ness of long duration, the formation of numerous abscesses 

 at different parts of the sheath with a final tumefaction of 

 the fetlock are certain to follow. (2) Wounding or division 

 of the plantar artery or vein occasionally occurs during the 

 dissection, or by deliberately cutting them through when 

 mistaken for the nerve. When this accident occurs the cut 

 vessel should be dissected loose and ligated proximally and 

 distally, leaving the ends of the ligature threads to protrude 

 through the incision to facilitate their removal. (3) Neu- 

 romas and painful scars sometimes supervene. The former 

 is prevented to some extent by stretching the nerve well be- 

 fore dividing it, and the latter by promptly healing the 

 wound. (4) Break down, so-called, does not often follow 

 this operation, although it does occasionally occur, in the 

 form of a partial dissolution of the plantar aponeurosis from 

 the semilunar ridge, manifesting itself in the form of a very 

 acute lameness, and a pronounced tumefaction of the 

 tendinous structures at the heel of the foot. Loss of the 

 foot has never been reported from this operation. 



Median Neurotomy. 



DEFINITION. — Median neurotomy is the surgical divi- 

 sion of the median nerve at the level of the humero-ra'dial 

 articulation, (the point where the nerve passes superficially 

 over the internal tuberosity of the radius). 



DISTRIBUTION OF THE MEDIUM NERVE.— The 

 medium nerve is a radicle of the great brachial plexus, al- 

 though its course in a dissection is easily traced beyond 

 this aggregation of nerve trunks, to the eighth cervical and 



