Patients (23) with total complete brachial plexus injuries were reviewed an average of 5.5 yr from the time of injury. Different treatment approaches (3) were used as follows: no surgery (4), above-elbow amputation alone (14), and sboulder arthrodesis combined with above-elbow amputation (5). Return to gainful employment and prosthetic wearing habits were best achieved with early (within the 1st yr) above-elbow amputation alone. There seemed little to recommend shoulder arthrodesis combined with above-elbow amputation.