Due to late presentation, transection of the spinal accessory nerve (SAN) regularly necessitates a nerve graft, which is a difficult procedure. Identification of both nerve stumps in scar tissue is difficult and sometimes not feasible. Alternatively, we proposed a direct nerve transfer using a fascicle from the posterior division of the upper trunk, leading to the deltoid or the triceps muscle (Cambon-Binder et al., Hand Surg Eur 43:589–595, 2018). This technique is easier and avoids donor nerve site complications. In an 11-patient series, we observed active shoulder abduction improvement of 57° in average, at a mean follow-up of 25 months. Trapezius muscle strength reached M4 or M5 grade in ten cases and M3 in one case, and no deltoid or triceps impairment was noted. Moreover, scapula kinematics got normal in 2/3 of patients.