Median nerve block: find the fascicles, then build a soft halo

Question 1Where does the median nerve lie in the mid forearm?

1. aBeside the radial artery under brachioradialis
2. bBeside the ulnar artery under flexor carpi ulnaris
3. cBetween flexor digitorum superficialis and flexor digitorum profundus
4. dOn the back of the forearm with the extensor tendons

Question 2How do you tell the median nerve from a tendon?

1. aThe nerve is always deeper than the bone
2. bSlide up the forearm: tendons become muscle while the nerve keeps its honeycomb look
3. cTendons pulsate
4. dThe nerve is always black

Question 3Why do you block above the wrist rather than at the wrist crease?

1. aThe block works only in the upper arm
2. bThe radial artery crosses the nerve at the wrist
3. cThe nerve is too deep at the wrist
4. dThe palmar cutaneous branch leaves above the wrist, so a wrist block misses the skin of the thenar palm

Question 4Which area does a median nerve block numb?

1. aThe little finger
2. bThe radial side of the palm and the palmar surfaces of the thumb, index and middle fingers
3. cThe back of the thumb and first web space
4. dThe whole forearm

Question 5The patient reports sharp electric pain during injection. What do you do?

1. aContinue, as this confirms the right spot
2. bAdd a larger volume
3. cStop, withdraw slightly and reposition
4. dInject faster