Study design: A retrospective follow-up study. Objectives: To assess the value of surgery on the tetraplegic hand to improve its function. Setting: Spinal unit. Hospital La Fe. Valencia (Spain). Method: We reviewed the functional results obtained in 15 patients (10 males and 5 females) operated on at our hospital between 1988 and 1997. We performed 66 surgical procedures on 20 upper limbs. After a year or more the patients were evaluated by two independent examiners not related with the surgeons, using the questionnaire of Lamb and Chan modi®ed by Mohammed, taking into account the change in the performance of activities of daily living (ADL), the patient's satisfaction, and the ful®lment of their expectations. Results: A good or excellent result was obtained in 71.4% of our patients, 85.7% were satis®ed with the operation and 57.2% said that the surgery did not meet their expectations. The bad results occurred in patients with previous joint rigidity, ocular sensibility, pain, and lack of motivation. Conclusion: Hand surgery improved the function of tetraplegics and should be performed more frequently. The hands should be cared for from the very beginning to keep them supple. The information given to the patients should be realistic. Spinal Cord (2003) 41, 90 ± 96.