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In children, upper extremity spasticity is a complex clinical finding with functional deficits and social implications that can be substantial. It can create significant challenges and cause distress in both the patients and their caregivers. Unfortunately, spasticity is incurable, and available treatment options are imperfect. Historically, surgical treatments for this condition were predominantly bone and soft tissue-based procedures. More recently, there is a growing body of evidence to support nerve-based procedures to decrease the degree of spasticity within select muscle groups, while maintaining volitional control. The term “hyperselective neurectomy” (HSN) has been used to describe a procedure where a specific, partial neurectomy is performed on peripheral nerve branches in close proximity to the level of the motor endplates. The result is less dysfunctional spasticity while maintaining selective native innervation to allow for continued volitional function. In this review, we discuss the role of HSN in the treatment of the spastic pediatric upper extremity. Additionally, we describe our groups’ early clinical experience with this procedure and how we have implemented it into our established practice of single-event multilevel surgery (SEMLS). HSN techniques may be applicable to the lower extremity cerebral palsy surgeons doing similar SEMLS.