Since the initial description of Moberg's technique for posterior deltoid transfer in the spinal cord injured patient, ever-increasing attention has been paid to the functional importance of elbow extension. Many different centers have reported consistently good results with the procedure and have repeatedly confirmed that relatively little donor site morbidity occurs from loss of the posterior fibers of the deltoid muscle. With expanding experience, the only consistent difficulties have been those related to the length of time required for postoperative immobilization and the slow rate of rehabilitation that must be enforced to avoid elongation of the interposed toe extensor tendon grafts. Modifications of the initial technique have been mentioned that attempt to address these postoperative factors.