Shoulder pain is a common secondary condition in stroke patients, occurring in seven out of ten cases. In addition to the pain it causes, shoulder pain also affects the patient’s upper extremity activities every time. These patients often go to orthopedic clinics if they can walk, but in reality this is not a general orthopedic condition. Since the upper limbs are paralyzed to varying degrees after a stroke, the shoulder, the joint with the largest range of motion in the human body, is correspondingly less stable, and excessive strain and pressure can cause abnormal misalignment of the shoulder, resulting in injury. Furthermore, the lack of sensory loss in the early stages of the stroke makes the shoulder lack protective mechanisms when it suffers injury. As the condition changes, the limb becomes spastic, the shoulder movement does not resemble the pattern in normal conditions, and is mostly accompanied by internal retraction and internal rotation, with a corresponding reduction in the slip between the scapula and the thorax. This characteristic spasticity allows the shoulder to repeatedly strike the subacromial tissues of the humeral tuberosity during supination, causing injury. This injury, has been confirmed by visible magnetic resonance images. The paralysis of the limb weakens the circulation and causes tissue edema, which in turn makes it difficult for the injury to heal itself. The prolonged lack of movement causes tissue contracture, which increases the difficulty of shoulder movement. Paralysis of the shoulder girdle muscle allows the humeral head to be subluxated towards the bottom, increasing the discomfort of the patient’s shoulder. All of the above contributes to the shoulder pain that is unique to stroke patients. Rational and effective treatment must address each of these causes. This is summarized as follows: do a good job of protecting the shoulder when it is soft, for example, when doing passive activities on the paralyzed limb, overcome the eagerness to do so and avoid excessive pulling on the paralyzed shoulder. Although lying on the affected side can increase the sensory stimulation, the time should not be too long, so as not to crush the shoulder when it is unconscious. In case of spasticity (stiffness, increased muscle tone), it is advisable to do shoulder abduction and supination with the palm facing upward so that the shoulder is externally rotated and the large humeral tuberosity avoids the squeezing of the shoulder peak. At the same time, it is necessary to cooperate with the passive activities of the scapula to increase the range of motion of the scapula. It is important to add some exercises that do not hurt the shoulder and serve to restore shoulder strength and control, such as frosting board/straight arm lateral and forward thrusts; when there is edema, elevate the arm and fingers so that they are above the heart level. If possible, a pressure pump can be applied to apply intermittent compression to the limb to promote blood circulation; the pulling of the contracted shoulder must be gradual and never exceed the patient’s tolerance; no special treatment is needed for general subluxation, only active exercise of the paralyzed shoulder girdle muscle is required to make the subluxation recover on its own. Normally, when sitting, you can put your arm on the table to avoid dropping of the shoulder. For more serious cases, use the appropriate shoulder support; for those who have already suffered shoulder injury, use low power laser, electrotherapy and ultrasound and other physical therapy measures as appropriate to relieve inflammation and pain. Anti-inflammatory and pain-relieving drugs can also be applied appropriately. We often do local closure for some intractable shoulder pain, injecting a small amount of corticosteroids and anesthetics into the injury site, with mild side effects and good results. Recently, we have also carried out botulinum toxin injection treatment for spastic stroke shoulder pain. Since botulinum toxin has the effect of both muscle relaxation and analgesia, it is quite effective in the corresponding patients who meet the conditions.