Prior to considering surgery, a detailed and careful assessment must be completed. Coulet et al. (2002) recommended assessing the following;
The extent of LMN injury at the injured metamere must be assessed and each key muscle group evaluated to determine:
After a careful and complete evaluation, Coulet et al. (2002) recommended mapping the muscles to identify three the following:
The next assessment to be made is to decide what primary function to be restored. Kozin (2002) recommended the following priority: 1) restoration of elbow extension; 2) pinch restoration for hand function; and 3) grasp and release function.
Nerve transfers should be performed after a re-innervation window, to allow adequate waiting time to ensure optimal spontaneous recovery has been achieved for lesional level myotomes. Bertelli et al. (2011) recommended waiting at least 6 months. Re-innervation of muscle innervated by infralesional segment is not time-dependent and can performed years after injury (Bertelli et al. 2011).