Abstract Clinical examination and decision-making in the spastic upper limb is a complicated process. This article discusses key principles and strategies for assessment and management of these patients. The main aims of treatment are to improve function, appearance and facilitate caring. Key decision-making factors are the patient's age (with anti-spasticity procedures being preferred in the younger and rebalancing and stabilizations in older patients), degree of spasticity (pure spasticity being treated with neurectomies and contractures with surgical releases) and degree of voluntary control (high voluntary control doing better with rebalancing procedures and stabilizations doing better in those with little voluntary control). With careful planning, good patient selection and appropriate choice of treatment, patients typically experience improved quality of life and benefit from surgical intervention.
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