Because of the weight-bearing demands placed by tetraplegic patients on their upper limbs, questions about the durability of operative procedures (tenodeses and transfers) performed to enhance upper limb function has been mentioned as a reason not to refer these patients for surgery. To address this perception, we analyzed 45 patients operated at least 10 years prior according to preoperative goals. Goal 1 - Active elbow extension - Transfer of posterior deltoid to triceps was performed exclusively until 1985, when, for patients presenting with elbow flexion contracture greater than 45 degrees, contracture release was combined with biceps to triceps transfer. We examined 21 patients. Fifteen had deltoid to triceps transfer, 10 bilaterally. Preoperatively, all required a motorized wheelchair. Ten years following surgery, nine use a push chair exclusively; four others use a push chair at least some of the time. Three patients who gained ability to self-transfer continue to be able to perform this formidable task. In the six patients with biceps to triceps transfer (all needing contracture release) three could use a push-chair, although not exclusively. Importantly, none had developed a recurrence of elbow contracture. Goal 2 - Restoration of key pinch for the weaker patients and key pinch and digital grasp for the stronger patients - Weaker IC Group 2 patients had key grip by FPL tenodesis. Seven were evaluated. Five had maintained pinch strength essentially equivalent to that demonstrated 12 months following surgery; two were weaker (average, 25 Newtons.) Slightly stronger IC Group 3 patients had brachioradialis to FPL transfer. Six were evaluated and all had maintained useful power (average 20 Newtons.) In three, thumb IP hyperflexion (Froment’sign) diminished pinch power. Eighteen stronger IC Group 4 and 5 patients had undergone two stage grasp/release procedures; half had bilateral reconstruction. Flexor power was by variable, multiple transfers of ECRL, brachioradialis, PT, or accessory ECRB. Typically 2 muscles were devoted to thumb grasp power. Grip power had not deteriorated in these patients compared to values measured at 12 months postoperatively. Pinch force averaged 34 Newtons. Those patients having intrinsic stabilization, (e.g., Zancolli "lasso") had more powerful grasp. We conclude that carefully chosen upper limb reconstructive procedures in properly educated patients are both effective and durable. Aside from their brain, the upper limbs remain the most important residual resource for tetraplegic patients. Systematic postoperative re-evaluation of their operated upper limbs should become a standard part of their interval examinations.