Orthopedic surgery for upper extremity spasticity is based on a precise clinical evaluation with motor and sensitive and cognitive factors. Use of electromyography and lidocain or toxin is necessary. Surgical aims are classified as hygienic or functional. Surgical procedures are divided into neurectomies, muscle, tendon and joint procedures. Results, in spite of heterogeneous populations and nonstandardized assessments, are described about shoulder, elbow and hand.