Cerebral Palsy (CP) is a static disorder of movement and posture secondary to an insult to the developing central nervous system. The peripheral manifestations and functional impairments of this condition vary in severity from mild-to-profound. In hemiplegic CP, 1 side of the body is affected more than the other. Spastic hemiplegia is the most common type and that for which upper extremity surgery is most indicated. Treatment options range from physical therapy and splinting to botulinum toxin A injections (Botox) to tendon transfers to arthrodeses. This article will discuss the indications, preoperative evaluation, our preferred surgical technique, and postoperative protocol for the most commonly used tendon transfers in the upper extremity in spastic hemiplegia.