The Elbow

The patient sits with the elbow on the couch. The joint is flexed at a right angle and held in full supination.
Resisted extension of the wrist must be completely painless in order to prove the anaesthesia has reached the correct spot.

A small thin double-edged tenotome is thrusted in through the skin into the dens tendinous tissue in the same way the needle was introduced: vertically.
The small lancet is then moved further down until it hits bone.
By moving the tip of the tenotome up and down along the bone of the epicondyle in a perpendicular way, the tendon of the extensor carpi radialis brevis is divided transversely across its entire width.
Skin and subcutis move with the tenotome so the superficial wound remains small.