al. contributed important clinical investigations while showing the value of different surgical procedures. According to Zancolli, transfer of the m. brachioradialis to the m. extensor carpi radialis tendons was proposed by Vulpius and Stoffel in 1920. In tetraplegia, this was first proposed by Wilson. and first described fully by Freehafer. In 1967, Alvin Freehafer of Cleveland, Ohio, contributed valuable ideas towards achieving independence in the arms of tetraplegic patients. He and his team published the results of six patients who underwent transfer of the m. brachioradialis to restore active wrist extension. In 1974, Freehafer et al. recommended opposition transfers and finger-flexion transfers. In 1971, surgery of the tetraplegic upper limb experienced a revival after Moberg’s clinical investigations. His main contributions were (1) to restore elbow extension through transfer of the posterior deltoid to triceps (the initial procedure); and (2) to reconstruct a key pinch. Moberg’s idea of posterior deltoid transfer to restore elbow extension has been used extensively by many surgeons, such as Bryan and DeBenedetti. In 1983, Douglas Lamb of Edinburgh, Scotland, gave great headway to surgery of the tetraplegic upper extremity when Lamb and Chan recommended reconstruction of elbow extension by transferring the posterior deltoid to the triceps according to Moberg’s technique, which was published in 1975. A publication by Friedenberg was the starting point for future indications of biceps-to-triceps transfers, including those of Zancolli, Hentz et al., Kuts et al., Allieu et al. and Revol et al. Another major change was the change to one-step procedures, reconstructiong opening and closing phases at the same time. Especially Jan Friden, from Gothenburg, with major experience in this area championed this thought, partially driven by the transport problems in Sweden during winter, it saved the patients an operation and minimized hospital stay. The development of hand surgery for tetraplegia has received important contributions through published reports and by the international conferences initiated with the influence of Erik Moberg from Goteborg, Sweden. Conferences have been of great interest because of the convergences of hand surgeons interested in the field, promoting discussion and comparison of different surgical methods and experiences. Goals for surgery A common goal of surgical reconstruction of the arms in patients with tetraplegia is to restore elbow extension, key pinch and palmar grip. Restoration of these functions, results in increasing a patient's independence. Elbow extension is an important part of upper limb surgical reconstruction in patients with tetraplegia. Although