56% of spinal cord injuries result in quadriplegia, with C5 being the most common injury level. they will lose simple daily activities.Increased arm and hand function is an important rehabilitation goal for most individuals with quadriplegia. Most of patients with cervical level SCI felt that gaining arm and hand function would significantly improve their quality of life and prioritized it over regaining sexual function, trunk stability, bowel and bladder control, and walking. Surgical techniques have been established to increase upper extremities function for these individuals. The use of traditional tendon transfers to improve upper extremity function in cervical spinal cord injury (SCI) patients is limited. So the use of peripheral nerve transfers in this setting is feasible and has a low perioperative complication profile.Surgical techniques have been established to increase upper extremity function for tetraplegics, focusing on restoring elbow extension, wrist movement, and hand opening and closing. Additionally, more innovative treatments that have been developed (nerve transfers) provide more options for improving the function and quality of life.The International Classification for Surgery of the Hand in Tetraplegia (ICSHT) was specifically developed to identify candidates for upper extremity restoration. This classification provides information about the number of voluntary muscles available for surgical transfer to provide another function lost due to paralysis. The strength of the key muscle for each level of the classification must be rate d as grade 4 in order to receive that designation.