The recent use of nerve transfers presents a paradigm shift in the management of nerve injury. Surgical reconstruction of proximal level nerve injures or repairs with long nerve grafts often result in less than optimal outcomes, thus presenting the opportunity for other reconstructive techniques. Nerve transfers provide a closer source of axons to the motor end plates from an uninjured nerve to a recipient nerve and in many cases these transfers eliminate the need for a nerve graft by allowing a direct end to end nerve repair without tension. Basic research on cortical plasticity, peripheral nerve regeneration and muscle recovery support the concept that transfer is by far the best method of nerve reconstruction when ever possible. This edition of Clinics will review the surgical options and experiences of experts in the field using nerve transfers for patients with upper extremity nerve injuries.