Muscle-based procedures have been the mainstay of surgical treatment of spastic upper limb deformities, in particular when muscle contractures are a main contributor to the deformity. The type of muscle-based procedures that are utilized to correct a spastic deformity is dependent upon the presence of volitional motor activation and the magnitude of muscle contracture. These procedures can markedly improve patient’s quality of life and enhance upper limb function. However, comprehensive multidisciplinary care and establishment of shared patient–physician or caretaker–physician decision-making is integral to successful surgical outcomes.