Abstract INTRODUCTION: Previously, the authors presented the coaptation of C3 and C4 primary rami to one of brachial plexus trunks to regain function from cervical root avulsion-caused paralysis. The purpose of this presentation is 2-fold: (1) discuss specific surgical techniques and (2) discuss control or prevention of intractable pain associated with root avulsion. METHODS: (1) The surgical procedure consists of exposure of C3 and C4 anterior rami coaptation to the upper trunk (Erb-Duchenne) or lower trunk (Klumpke), with sural nerve bridge graft, and additionally intercostal nerve coaptation to median and ulnar nerves for flail arm. (2) Of 30 total patients, 23 patients presented with Erb-Duchenne palsy due to C5 and C6 root avulsion, 3 presented with Klumpke palsy due to C8 and T1 avulsion, and 4 presented with C5 through T1 avulsion (a flail arm). These patients are divided into 2 groups according to pain control: Group 1 patients were operated on within 3 months after avulsion, group 2 was treated surgically later than 3 months postinjury. RESULTS: (1) The surgical procedure consists of exposure of C3 and C4 anterior rami coaptation to the upper trunk (Erb-Duchenne) or lower trunk (Klumpke), with sural nerve bridge graft, and additionally intercostal nerve coaptation to median and ulnar nerves for flail arm. (2) Of 30 patients, 23 patients presented with Erb-Duchenne palsy due to C5 and C6 root avulsion, 3 presented with Klumpke palsy due to C8 and T1 avulsion, and 4 presented with C5 through T1 avulsion (a flail arm). These patients are divided into 2 groups according to pain control: Group 1 patients were operated on within 3 months after avulsion; group 2 was treated surgically later than 3 months post injury. CONCLUSION: Coaptation procedures are effective to control arm and hand pain associated with nerve root avulsion.