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Herein we present the case of a 78-year-old female who suffered a radial nerve injury following her third left shoulder arthroplasty. At first follow-up twoandahalfweeks following shoulder surgery, she presented with left arm weakness and profound, persistent hand weakness. This was diagnosed as complete radial nerve palsy.After threemonths, the patient still had no return of function. At that point, she became a candidate for tendon transfer surgery to remediate her complete radial nerve palsy. At six months post-arthroplasty, it was noted on exam that she unexpectedly regained weak wrist extension two weeks before her scheduled three tendon transfer surgery. The decision was made to proceed with a modified two tendon transfer procedure. Surgery is the most reliable treatment to restore function, but it must be tailored for each patient’s specific needs. A current assessment of the patient’s reconstructive needs must be performed to prevent overtreatment. We suggest referral for surgical evaluation,with emphasis on up-to-date clinical exam and functionality, as the typical course of action for patients with non-resolution of radial nerve palsy.

Modification of Tendon Transfer Surgery for Radial Nerve Palsy due to Pre-operatively Observed, Unexpected Partial Return of Wrist Extension