[Illustration: FIG. 52.--Point at which the needle is introduced in paraneural injection of brachial plexus.] The individual nerves of the upper limb can be readily injected. The _median_ can be exposed at the bend of the elbow for an intraneural injection, or a needle may be passed under the tendon of the palmaris longus at the wrist for a paraneural injection. The _ulnar_ can be easily reached as it lies on the posterior aspect of the medial epicondyle of the humerus for a paraneural or intraneural injection. The _superficial radial_ can be reached for a paraneural injection about two inches above the wrist to the lateral side of the tendon of the brachio-radialis (supinator longus). The injection is made into the deep fascia, and carried across the lateral border of the forearm for about an inch, to ensure reaching all the branches of the nerve. The _medial antibrachial_ (internal) _cutaneous_ can be blocked on the front of elbow by a paraneural injection about half an inch medial to the biceps tendon, and the _lateral antibrachial cutaneous_ (musculo-cutaneous) at a corresponding point on the other side of the tendon. ANÆSTHESIA OF THE ARM BELOW THE ELBOW.--In operations below the elbow, in conditions in which a general anæsthetic is not permissible, as in diabetes, nephritis or advanced cardiac disease, a full anæsthesia can be obtained by intraneural injection of the median, ulnar, and radial (musculo-spiral) nerves, combined with paraneural injection of the medial and lateral antibrachial cutaneous. The median and radial are each exposed by an incision under infiltration anæsthesia, the radial being exposed in the groove between the brachialis and brachio-radialis. The infiltration to expose the median nerve usually blocks the anterior branch of the medial antibrachial cutaneous. To make certain that the posterior branch is also anæsthetised, it is advisable to inject a little anæsthetic solution over the front of the medial epicondyle. The intraneural injection into the ulnar nerve can often be made without exposing it. ANÆSTHESIA OF FINGER.--The paraneural method applied to the digital nerves at the root of the finger gives perfect results. A circle of anæsthetic solution is first injected round the root of the finger. The needle is then passed through the infiltrated skin on each side of the finger, and a few drops of ½ per cent. novocaine solution injected around the nerves. Complete anæsthesia of the finger results in a few minutes.