Uppper Limb Tetraplegia Surgery was one of the topics at the 20-year anniversary of the famous Hand Surgery Clinic in Bad Neustadt, Germany. Professor Jan Fridén was invited to report the state-of-the-art of this rapidly developing field. The presentation and ensuing discussions highlighted the importance of immediate active training and relearning after surgical reconstruction of hand function. Multiple new surgical techniques were detailed and patient perceived outcome of surgery and rehabilitation was reported. It was made clear the a new era of surgeries and rehabilitation methods has made the results better from the functional and patient perspectives. Outcome measurements must be an integrated part of this type of treatment.