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in this cross-sectional image the position of the median nerve can be seen at a level proximal to the carpal tunnel it lies between the flexor carpi radialis and the palmaris longus tendons and deep to them both more towards the palmaris longus note particularly there is only four millimeters beneath the skin surface at this level a block administered at this level reduces the risk of an acute carpal tunnel syndrome which is a possibility if the injection is given into the carpal tunnel the surface anatomy landmarks for the median nerve and the flexor carpi radialis and palmaris longus tendons proximal to the wrist crease the needle is inserted at 45 degrees pointing distally and 2 centimeters proximal to the wrist crease to no greater than the depth of the under surface of palmaris longus around four millimeters maximum five milliliters of locally honest is injected in the vicinity of the median nerve you
