Recovery after an upper extremity peripheral nerve injury varies depending on multiple factors. In patients with poor functional recovery, tendon transfers may be indicated. The decision to perform an early tendon transfer at the time of nerve repair or before expected reinnervation is considered on a case-by-case basis. There are a multitude of potential tendon transfer options, the choices of which depend on remaining function, specific deficits, and surgeon experience and preferences. A thoughtful approach to reconstruction can lead to a substantial functional improvement with minimal donor site morbidity.