Most stroke patients with hemiplegia have decreased muscle strength or even weakness of the affected upper limb 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 emergence of flexion spasticity pattern will further aggravate the shoulder joint alignment abnormalities, periapical soft tissue and other injuries, which are prone to pain and severe cases will refuse, active movement and touching 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 band muscles become soft and hypotonic, and the gravitational effect of the upper limb itself makes the glenohumeral capsule and surrounding ligaments overstretched, causing shoulder joint subluxation. Shoulder joint adhesions The lack of active movement of the muscles around the joint causes slow blood circulation and lymphatic fluid stagnation, 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. The patient presents 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, pillows 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 stretched forward; while in the healthy side lying, soft pillows can be placed under the upper limb on the affected side and the affected limb is stretched 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 semi 3. In the process of position change, the affected elbow joint should be supported by the upper limb on the healthy side to prevent the upper limb on 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 extremity, or movement of the affected extremity 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 The shoulder joint, elbow joint and wrist-metacarpal-phalangeal joint can be moved in a painless range in a moderate amount to promote reflux and prevent tissue edema. Alternating cold and warm methods Application of oral medications to treat impaired reflux in the affected upper extremity due to abnormally high sympathetic nervous system tone is 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 at the same time to prevent frostbite. Centripetal finger wrapping Wool or cotton string (2 mm or more in diameter) is wrapped around the fingers from distal to proximal, then from the metacarpophalangeal joint to the wrist in the same sequence, then unwound one by one and repeated. It can reduce edema and improve circulation instantly, and is effective in the long term, 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 stimulate 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 and improve muscle strength. Other physical therapy methods include functional electrical stimulation, ultrasound, ultrasound, and electro-waxing. Summary: 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. Shoulder pain can be prevented and reduced by paying attention to shoulder joint protection and good limb placement in the early stage; during the recovery period, attention should be paid to shoulder joint subluxation and shoulder pain, and shoulder pain will eventually improve gradually with the improvement of upper limb function, supplemented by physical therapy and medication.