Nerve Transfers to Restore Hand Function in Spinal Cord Injury

Inclusion Criteria: * Patients with a spinal cord injury AIS level C5 to C7. Those with motor complete injuries (AIS A or B) will be considered for surgical intervention if they are ≥ 5 months post injury. Motor incomplete patients (AIS C or D) will be considered if they are ≥ 1.5 years post injury. * Patients will require ≥ MRC 4 strength of the muscle supplied by the donor nerve (e.g. brachialis, supinator). * Finger flexor and extensor strength should be ≤ MRC 1 strength. * Muscles supplied by the donor nerve, will need to have no or minimal of evidence of lower motor neuron injury as dictated by evidence of fibrillations, positive sharp waves, or moderate or severely decreased recruitment on needle electromyography. * Those being evaluated for surgery outside nine-months post injury recipient muscles will be required to be free of lower motor neuron pathology. * Ability to comply and participate in rigorous post-surgical therapy regimen. Exclusion Criteria: * Comorbidities precluding safe surgery including autonomic/hemodynamic instability, pulmonary instability, active infection, chronic pressure sores or untreated urinary tract infections as determined by physician. * Simultaneous tendon transfer or tenodesis surgery (which would preclude separation of the effect of nerve transfer alone).