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The objective of this tutorial is to present a patient with hemiplegic cerebral palsy affecting the upper extremity. This patient will serve as an example of the importance of serial examinations, discussion with the patient and family about the desired functional goals, and treatment options available to the orthopaedic surgeon. It may also serve as an illustration of the benefits that surgical intervention may provide and the difficulty achieving balance. It is important to appreciate the role of the occupational therapy team, both before and after surgery, both in terms of understanding functional deficits, but also in terms of maximizing function.