The goal of this instructional course is to provide the community of academic hand surgeon with a roadmap, both logistically and clinically, to be able to care for this underserved and deserving patient population. This is an area of hand surgery which requires no special skills, reimburses handsomely, serves a true need in our communities, and is personally rewarding. The participant will learn 1) strategies for patient recruitment, 2) health concerns in this unique population, 3) physical examination, 4) surgical planning and techniques, and 5) post-operative rehabilitation. Detailed surgical techniques will be presented for biceps-to-triceps tendon transfers, brachioradialis to either ECRB and FPL, ECRL to FDP, and ECU opponensplasty.