Twenty-three patients with total complete brachial plexus injuries were reviewed an average of 5.5 years from the time of injury. Three different treatment approaches were used; no surgery (four), above-elbow amputation alone (14), and shoulder arthrodesis combined with above-elbow amputation (five). Return to gainful employment and prosthetic wearing habits were best achieved with early (within the first year) above-elbow amputation alone. There seemed little to recommend arthrodesis of the shoulder combined with above elbow amputation.