An impairment of the posterior interosseous nerve (PIN) limits one’s ability to extend the fingers and thumb. The flexor carpi radialis (FCR) branch of the median nerve is transferred to the PIN with the intent to reanimate finger MCP extension (EDC) and thumb MCP and IP extension (EPL). The goal of this transfer is to restore the ability to open the hand for functional grasp, release of objects, and fine motor dexterity. Postoperative therapy includes three phases based on the donor activation focused rehabilitation approach. Therapy progresses based on manual muscle strength testing of the recipient EDC and EPL muscles using manual muscle testing (MMT). Trace muscle contractions may not be observed for up to 9 months following surgery, and it generally takes 12–18 months to achieve functional movement. Compared to tendon transfers, FCR-to-PIN transfer has the potential benefit of allowing individual finger extension.