Traumatic tetraplegia is an overwhelming injury often requiring permanent adaptations by patients and families. The greatest potential for improving the quality of life lies with rehabilitation and restoration of upper extremity function. Functional surgery of upper limb following tetraplegia is individualized based on functional level and can signi ficantly improve hand functional quality of life. We have observed a 46-year old man with a C5 complete spinal cord injury and the patient had achieved functional improvement of upper extremity by functional surgery of upper limb for tendon transfer of posterior deltoid to triceps muscle and biceps tendon release. (J Korean Acad Rehab Med 2003; 27: 1000-1003)