To observe the efficacy and safety of extracorporeal shock wave therapy (ESWT) combined with acupuncture in the treatment of upper limb muscle spasm after stroke. Methods: A total of 70 patients with upper limb spastic hemiplegia post-stroke were randomly divided into control group and ESWT group with 35 patients in each. Both groups accepted routine rehabilitation training and acupuncture, and ESWT group additionally received extracorporeal shock wave therapy 1 time a week for 4 weeks. The 2 groups were assessed before and after 4 weeks of treatment with the modified Ashworth Scale (MAS), upper extremity Fugl-Meyer Assessment (U-FMA), modified Barthel Index (MBI), and Patient Reported Outcome (PRO) scores. Three months after treatment, the long-term clinical outcome were evaluated through PRO scores. Results: After 4 weeks of treatment, MAS, U-FMA, MBI, and PRO scores in the 2 groups were significantly improved compared to those before treatment (P<0.05), and the scores in the ESWT group were significantly better than those in the control group (P<0.05). At the 3-month follow-up, the PRO score of both groups had significantly improved compared to before treatment (P<0.05), and the PRO score of the ESWT group was significantly higher than that of the control group (P<0.05). Conclusion: ESWT combined with acupuncture can effectively improve motor function and activities of daily living and decrease upper limb spasm after stroke, and it can improve long-term clinical efficacy