Twenty-two patients who had paralysis of the trapezius muscle secondary to injury of the spinal accessory nerve had transfer of the levator scapulae and rhomboid major and minor muscles. In each patient, function of the trapezius had failed to improve with either physical therapy or an operative attempt at neurolysis or reconstruction of the spinal accessory nerve. The etiology of the injury was biopsy of a cervical node in thirteen patients, trauma in seven, and radical dissection in the neck in two. All patients had pain, visible deformity, and dysfunction of the shoulder girdle. Physical examination revealed asymmetry of the neckline, drooping of the shoulder girdle with lateral displacement of the scapula, and weakness of active elevation. Fourteen patients had had an incorrect clinical diagnosis, and twelve patients had had an inaccurate or incomplete electromyographic examination. A long thoracic nerve palsy developed in three patients. At an average of seven and a half years (range, two to fourteen years), the result of the operative procedure, as determined with the American Shoulder and Elbow Surgeons Shoulder Evaluation Form, was excellent for thirteen patients, satisfactory for six, and unsatisfactory for three. All but three patients had adequate relief of pain and demonstrable functional improvement.