Surgical rehabilitation for the weaker patients (groups 1 and 2 of the International Classification).

We have benefited from having had an initial large experience with the straightforward and predictable FPL tenodesis procedure and, after gaining experience, have continually modified it with the goal of customizing procedures to particular patients. We have moved toward reconstructing a dynamic pinch by tendon transfer when the brachioradialis is not needed to augment wrist extension. In any case, any patient and any hand are different. There is no such thing as a "standard procedure" when dealing with tetraplegic patients, and available procedures must be discussed in view of each patient's needs, desires, and specific circumstances.