The anterior interosseous nerve (AIN) is a branch of the median nerve arising at the radiohumeral joint and coursing deep in the forearm, providing motor innervation to the deep forearm muscles including the flexor pollicis longus (FPL), flexor digitorum profundus (FDP, lateral half), and pronator quadratus (PQ). Injuries to the median nerve proximal to the radiohumeral joint can result in persistent weakness in the muscles supplied by the AIN, most notably in finger pinch, resulting in inability to make the OK sign. The radial nerve branch to the extensor carpi radialis brevis (ECRB) is an expendable donor nerve which can provide simultaneous restoration of the FPL and strong independent flexion of the radial FDP. This has the added benefit of preserving some tendon transfer options in the future. The nerve to the ECRB enters the muscle 5 cm distal to the lateral epicondyle, allowing it to easily reach the recipient median nerve branches in the forearm.