A posterior interosseous nerve (PIN) deficit limits one’s ability to extend the fingers and thumb. The goal of the anterior interosseous nerve (AIN) to the pronator quadratus (PQ) to the PIN nerve transfer is to restore the ability to open the hand for functional grasp and dexterity. The AIN to the PQ may be transferred to the proximal portion of the PIN in an attempt to recover all PIN muscle function. More often, however, it is used to augment a second nerve transfer by transferring AIN to PQ to the distal branch of the PIN (DBPIN), which innervates EPL, EPB, APL, and EIP to recover better thumb function. Postoperative therapy includes three phases based on the donor activation focused rehabilitation approach. Therapy progresses based on manual muscle strength testing of the recipient muscles. Trace muscle contraction may be observed beginning at the APL following a distal transfer approximately 4–8 months following surgery.