The management of the upper limb in children with cerebral palsy (CP) is complex and challenging, requiring a co-ordinated, multidisciplinary approach. The management team may include developmental paediatricians, occupational therapists, physiotherapists, orthotists and upper extremity surgeons from an orthopaedic, hand or plastic surgery background. Alleviating pain and preventing/treating pressure sores, particularly in hands and elbows, must always be a prioritized goal. Interventions are generally aimed at improving function, joint mobility and cosmesis by various combinations of motor training, muscle strengthening, spasticity, movement disorder management and prevention of contractures and other fixed deformities. Movement disorders may respond to oral medications but, when severe, may require neurosurgical approaches, such as intrathecal baclofen or deep brain stimulation. The correction of fixed musculoskeletal deformities requires various combinations of muscle-tendon releases and lengthenings, tenotomies, tendon transfers, osteotomies, arthrodeses and joint-stabilizing procedures. Surgery management varies according to the needs and goals of each child and family.