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An integrated pharmaceutical, surgical, and therapeutic approach is described for the management of patients with spasticity and paralysis of the elbow due to central nervous system injury. The patient populations considered in this article include those with cerebral palsy, traumatic brain injury, and spinal cord injuries. Therapy evaluations and techniques and pharmacologic interventions to prevent loss of elbow motion are presented. Surgical techniques such as tendon lengthening, joint releases, and/or tendon transfer and postoperative therapy guidelines to restore loss of elbow motion are reviewed. Outcomes of this team approach in one clinical setting are presented.