Spasticity, a hallmark of upper motor neuron syndrome, often results in joint deformities and contractures due to muscle imbalance. In the upper extremity, the typical pattern includes shoulder internal rotation, elbow flexion, forearm pronation, wrist flexion and ulnar deviation, thumb-in-palm deformity, and finger swan neck or clenched fist deformities. These spastic deformities arise from hyperactive flexor, adductor, and pronator muscles, coupled with paralyzed extensor and supinator muscles. Current surgical interventions such as tendon lengthening and transfers address the musculoskeletal consequences but fail to target the underlying spasticity.

Selective neurectomy, a surgical nerve procedure, offers a promising approach by partially resecting motor nerves of spastic muscles, directly reducing spastic tone without compromising muscle strength. Recent anatomical studies highlight the feasibility of combining selective neurectomies with nerve transfers to address both spasticity and muscle weakness. Notably, procedures such as brachioradialis-to-extensor carpi radialis longus (ECRL) transfers and hyperselective neurectomies in the forearm have shown potential in cadaveric models.

This study aims to expand the scope of these findings by identifying novel nerve transfers and verifying their anatomical feasibility for addressing spasticity in the upper limb. Furthermore, we aim to evaluate the clinical outcomes of these combined procedures in spasticity management, a domain yet to be explored. This research could pioneer a transformative approach in the surgical treatment of spasticity, integrating nerve transfer and selective neurectomy techniques to restore balanced motor function.