Shoulder pain is one of the most common complications after stroke, with different reported incidence ranging from 20% to 80%. The typical clinical manifestation is shoulder pain on the hemiplegic side, accompanied by limited shoulder joint movement. The pain mostly occurs during upper limb activities such as dressing and shoulder lifting, which can interfere with rehabilitation, daily life and nursing care. The pain sometimes occurs at rest and even interferes with sleep. Sometimes the pain is not limited to the shoulder, but can affect the wrist and fingers, causing more pain. The shoulder joint is the most mobile three-dimensional kinematic joint in the human body, and it is also the most unstable and injury-prone structure. Current research suggests that hemiplegic shoulder pain is caused by a variety of factors. Subacromial impingement syndrome, rotator cuff injuries, complex regional pain syndrome, myasthenia gravis, adhesive capsulitis, shoulder subluxation, and pulling brachial plexus injuries have all been associated with shoulder pain. Each of these factors may cause shoulder pain alone, or they may combine to cause shoulder pain due to a mixture of factors. Hemiplegic shoulder pain not only affects the recovery of upper extremity care and function, but also leads to decreased quality of life, depression, and prolonged hospitalization. Therefore, active rehabilitation and management of hemiplegic shoulder pain is needed. Correct body position placement and shoulder sling Stroke patients have low muscle tone in the early period after the onset of stroke, and correct body position placement is clinically important for preventing shoulder injury, preventing spasm and contracture, and preventing shoulder pain. In general, when lying on the back, a cushion can be placed behind the shoulder, and the shoulder can be placed in a proper abduction and external rotation position. Prolonged lying on the affected side is to be avoided as it tends to cause compression injuries. Some doctors prefer to use a shoulder sling to protect the floppy shoulder, but this is not ideal because it puts the shoulder in a deformity-prone position of internal retraction and internal rotation and restricts the movement of the upper limb. The use of various soft shoulder rests to correct the inferior subluxation of the shoulder is currently popular, but it is questionable whether they actually provide correction. Early shoulder mobilization and correct exercises The shoulder is a joint prone to adhesions. After stroke, the range of motion of the shoulder joint in hemiplegic patients is often reduced and shows deformities of internal rotation and internal retraction. Therefore, preventive treatment should be started as early as possible. Early moderate movement of the shoulder joint, especially shoulder abduction, external rotation and supination, can prevent adhesive lesions caused by braking and maintain the range of motion of the joint. However, too much range of motion may inadvertently cause injury, which is especially likely to occur in patients with sensory deficits. Studies have found that the most popular shoulder activity, practiced with a high pulley, has resulted in the highest incidence of hemiplegic shoulder pain. Localized Physical Therapy Physical therapy commonly used to treat hemiplegic shoulder pain includes cold therapy, heat therapy, and electrotherapy. Studies have concluded that ice water immersion, alternating hot and cold water immersion and compressive centripetal wrapping have the effect of improving vasodilatation function, promoting venous return, reducing swelling and relieving pain, and are very effective in complex regional pain syndrome. Medium and high-frequency electrotherapy, low-power laser and ultrasonic wave, etc., which have certain efficacy on injury, can be used in the treatment of hemiplegic shoulder pain. Drug therapy Oral non-steroidal anti-inflammatory drugs can provide some analgesic effect and are analgesic methods that can be prioritized. However, such drugs have certain side effects on circulation, digestion and other systems, and must be used by selected individuals. Local and systemic use of corticosteroids is a reliable treatment for impingement syndrome and complex regional pain syndrome. However, patients are often unable to receive hormone therapy due to medical problems and ideological concerns. Antispasmodic medications relax spastic muscles and also help the physical therapist to perform manipulation to relieve pain. The star of antispasmodic medications is botulinum toxin, which has been shown in multiple small-sample studies to result in decreased hemiplegic shoulder pain and increased range of motion in shoulder abduction and external rotation. Because of its dual action of reducing muscle tone and analgesia, Botox would have a promising future in the treatment of hemiplegic shoulder pain. The problem with the use of botulinum toxin is that it is expensive and requires good injection technique. Neuromuscular Electrical Stimulation Neuromuscular electrical stimulation, by stimulating specific muscles, usually the superior trapezius, supraspinatus, and middle and posterior deltoid fascicles, increases the tone of the stimulated muscles, pulls the humeral head back to its normal anatomical position, and improves motor control of the upper extremity in stroke patients, and the reduction of shoulder pain may be related to this. Neuromuscular electrical stimulation has been shown to be effective in preventing subluxation, relieving pain, and improving joint range of motion and upper extremity function. The Royal Medical Guidelines have included it as a priority treatment for hemiplegic shoulder pain. Surgery With improved rehabilitation techniques, surgery is rarely performed for hemiplegic shoulder pain. However, in cases of subacromial impingement syndrome or very severe rotator cuff tears, this is still one of the options to consider. The problem with surgery is that the patient no longer has a common orthopedic problem, but a dual CNS and orthopedic problem. Even successful surgery can still result in poor outcomes. Recognition of hemiplegic shoulder pain by the patient and his or her family can facilitate communication between doctor and patient so that the patient receives the best possible treatment. Disregarding hemiplegic shoulder pain and emphasizing pain tolerance training will seriously affect the prognosis of the affected limb.