We present the results of 137 nerve transfers in 56 limbs (35 participants, 21 bilateral) with special reference to the International Classification for Surgery of the Hand in Tetraplegia, as outcomes for Groups 0 and 1 are rarely reported. These participants were assessed for a minimum of 20 (median 36) months after operation. Medical Research Council grades and strength measurements showed that for Group 0, reconstruction of useful wrist extension was achieved in six out of eight limbs. Reanimation of finger and thumb flexion in this group remains difficult and in only one out of four limbs was prehensile function achieved. Limbs in Group 1 had functional results for finger extension and grip. Outcomes of nerve transfers for the other groups and for triceps reanimation were comparable with previous reports. We believe that nerve transfers in patients with high level tetraplegia are underused but could bring valuable improvement.
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