Vienna, 4.6.2024 Laura suffers from the sequaele of an obstetric brachial plexus lesion on the right side with partial regeneration. The first step operation was performed on June 4, 2019. An anterior shoulder release at multiple levels, an elongation pf the pectoralis major tendon, a tenolysis of the long head of bicps muscle and a teres major transfer via a dorsal approach were carried out. The procedure and the postoperative care were uneventful. Due to the COVID situation we had a long intervall without clinical examination. On the clinical examination on February 13, 2022 Laura could move her right arm very effective in the threedimensional space, indicating a satisfactory external shoulder joint rotation. Internal to external shoulder joint rotation was measured with S 70-0-40°. Global shoulder joint abduction was around 100° actively, passively free. At this moment, Laura showed lack of thumb opposition, impeding her to use her full hand usage potential. However, finger extension can be carried out to some extent. Since her condition cannot be improved by physicl treatment during the last 2 years surgery was indicated. On March 22, 2022 we performed a EPL rerouted transfer to the palmaris longus and the FDS3 for improvement of active thumb positioning and key grip.  Laura was examined again on 13.3.2023. There was very good opposition with tip to tip movement, even key grip was possible nicely. The thumb could be moved for abduction and extension. However, the extension of the ring and small finger deteriorated and a swan neck deformity developed at the index finger and middle finger. On 16.5.2023 we performed a tenolysis of all EDC tendons, the retinaculum extensorum 4 and 5 were enlarged, and the tractor lateralis af all fingers were transposed palmar to the PIP joint axis. Laura was examined last on May 27, 2024. Now global abduction was measured with 100°. She is able to open a door including the use of active external rotation. The wrist is still stable and all fine grip movement are possible. The psotioning of the hand is very good. However, a elbow flexion contracture of 50° has developed. At the moment this is not an indication for surgery. Unfortunately, we found a mild relapse of swan neck deformity on D3, 4. The EPL transfer to the palmaris longus and FDS3 should be shortened in order to improve thumb IP extension. Since these pathologies should not deteriorate we have scheduled this surgery for 18.7.2024. Two days hospital care ina double room are necessary. The costs are estimated with Euro 12.000.- Kind regards