Most stroke patients with hemiplegia have decreased muscle strength or even floppy upper limbs at the onset of stroke, and most of them have sensory impairment of the affected limb. At this time, the patient, family members and health care workers mainly focus on the severity of the disease, the progress of the disease and the prognosis of the patient, and may neglect the protection of the affected upper limb and shoulder joint during improper handling, resulting in damage to soft tissues such as rotator cuff, joint capsule and tendons. After the disease stabilizes (usually in about 2 weeks), the affected limb enters the spastic phase from the flaccid phase with increased muscle tone. The appearance of flexion spasticity pattern will further aggravate the damage of shoulder joint alignment abnormalities, periapical soft tissues, etc. It is easy to have pain, and severe cases will refuse, active movement and touch with others, which not only leads to stagnation of upper limb rehabilitation training, but also often aggravates patients’ anxiety, depression and other emotional disorders, which seriously affects patients’ quality of life. Shoulder joint subluxation Early in stroke, the scapular girdle muscles are flaccid, muscle tone decreases, and the upper limb’s own gravity makes the glenohumeral joint capsule and surrounding ligaments overstretched, causing shoulder joint subluxation. Shoulder joint adhesions due to lack of active movement of the muscles around the joint, which makes the blood circulation slow and lymphatic fluid stagnant, resulting in tissue edema, increased plasma fibrous exudation, and adhesions between the joint capsule and tendons and muscles. This is one of the direct causes of shoulder pain. Shoulder-hand syndrome, also known as reflex sympathetic dystrophy, is also one of the common complications of stroke. Due to increased sympathetic excitability and vasospastic response in the hemiplegic side of the limb, there is dystrophy in the local tissues. Patients present with marked swelling around the shoulder, wrist, hand and fingers, elevated skin temperature, flushed skin and limited finger flexion without evidence of trauma or infection. Early management of shoulder pain Emphasis on early prevention and measures to reduce shoulder injury and subluxation is the basis for preventing the occurrence of shoulder pain. It is important to start focusing on the protection of the affected shoulder joint early in the stroke, avoiding rough and excessive movement of the upper limb, and should emphasize good limb position placement, which not only inhibits the development of abnormal movement patterns, but also facilitates the protection of the shoulder joint and reduces the occurrence of shoulder pain. The main measures are as follows: 1. When the patient is lying in the supine position, a pillow can be placed on the back of the shoulder to keep the shoulder joint in an anterior protrusion position and prevent the shoulder joint from retracting; more often, the affected side is lying and the upper limb on the affected side is extended forward; while in the healthy side lying, a soft pillow can be placed under the upper limb on the affected side and the affected limb is extended forward at the same time; 2. In the state of low muscle tone during the flaccid phase, in order to prevent the upper limb from sagging due to gravity when sitting, the shoulder joint should be placed in a semi 3. In the process of position change, the upper limb of the affected side should be held by the elbow joint to prevent the upper limb of the affected side from dropping. There is a controversy about whether to use the suspension aid of the affected upper limb. Some scholars believe that excessive use of suspension bandage will disturb the body image, make the upper limb brake and increase the flexion spasticity pattern until it affects the normal gait. Therefore, it is now generally accepted that only during the flaccid phase and in the prolonged walking state, assisted immobilization of the affected shoulder joint is required, and the scapular girdle is usually fixed with a shoulder strap rather than suspending the entire upper extremity. Treatment of shoulder pain Exercise therapy The disappearance of shoulder pain and the improvement of shoulder subluxation essentially require the improvement of upper limb motor function, so active upper limb functional training and improvement of spasticity pattern are the main means of treating shoulder pain after stroke. Active motor therapy isotonic or isometric contraction of the affected upper limb, or movement of the affected limb driven by the healthy hand in a Bobath hand manner in the pain-free range, can stimulate muscle contraction to varying degrees, promote venous and lymphatic reflux, and reduce edema. Passive exercise therapy of shoulder joint, elbow joint and wrist-metacarpal-phalangeal joint in the pain-free range can promote reflux and prevent tissue edema. Alternating cold and warm methods of applying oral medications to treat impaired reflux in the affected upper extremity due to abnormally high sympathetic nervous system tone are often less effective. Patients may be advised to use cold water (4°C to 10°C) and warm water (about 40°C) to soak the upper extremity alternately, with the temperature and time as tolerated by the patient. For patients with sensory impairment, the therapist and the patient need to soak simultaneously to prevent frostbite. The centripetal finger wrapping method uses wool or cotton string (2mm diameter or more) to wrap the fingers from distal to proximal, then from the metacarpophalangeal joint to the wrist in the same order, then loosens them one by one, and repeats the process. It can instantly reduce edema and improve circulation, and has obvious efficacy in long-term adherence, and is simple, economical and feasible. Physiotherapy Transcutaneous neuromuscular electrical stimulation is a low-frequency electrical stimulation, through the skin electrodes to specific low-frequency pulse current into the body, can selectively excite the sensory thick fiber nerve, excite the spinal cord glial cells, block the pain impulse afferent, and activate the endogenous analgesic effect; also can maintain muscle volume, improve muscle strength. Other physical therapy methods include functional electrical stimulation, ultrasound, ultrasound, and electro-wax therapy. Post-stroke shoulder pain is a common complication that severely hinders the rehabilitation process and has a serious impact on the patient’s mood, confidence and quality of life.