A total of 155 adults suffering from severe BP traction lesions was treated neurosurgically. Shoulder function recovery was analysed in 54 patients. Inclusion criteria for the present study are: (1) the axonal outflow to both axillary nerve (AXN) and suprascapular nerve (SSN) is completely interrupted at the C5, C6 or superior trunk level, (2) proximal stumps in nerve grafting are spinal nerves, (3) distal stumps are AXN and/or SSN, (4) each distal stump was connected to one proximal donor stump, (5) a postoperative follow-up of at least two years. The mean age of the patients at surgery was 22 years. The mean interval between trauma and operation was 116 days. 25 patients were shown to have neurotmesis or avulsion C5, C6 (C7) or neurotmesis of the superior trunk. 29 patients sustained avulsion C8-T1 as well. If only one spinal nerve emerged from the intervertebral foramen (most often C5), it was used to reinnervate the biceps preferentially if 1) CT-myelography demonstrated intact roots, 2) the fascicular pattern of the nerve crosssection on frozen examination appeared normal, 3) the frozen section showed more than 50% myelin and only slight fibrosis, and 4) the size of the crosssectional area was equal to or larger than that of the fascicles to the biceps in the distal stump. Otherwise, the proximal stump was used for restoration of glenohumeral abduction and exorotation. In 29 patients grafting to regain biceps muscle function could be performed and in 21 patients nerve transfer was carried out. 67% of the patients attained biceps muscle force of MRC grade ³ 3. For the restoration of shoulder function grafts were led from C5 to the SSN in 12 patients and from C5 to both the SSN and AXN in 13 patients. The accessory to suprascapular nerve transfer was applied 21 times and in 8 patients combined with an hypoglossal nerve transfer. 18 % of the patients attained functional abduction of ³ 30 degrees and 7% of these patients had functional exorotation of ³ 30 degrees as well. Given the priority scheme according to which the reconstructions were performed in these patients it is not surprising that elbow flexion recovery was superior to shoulder function recovery. The reanimation of shoulder function, however, is disappointingly low. One could argue that, in selected cases, the applied priority scheme of BP repair should be changed to improve overall outcome.