To observe therapeutic effect of extracorporeal shock wave therapy (ESWT) combined with acupuncture on patients with upper limb flexor spasm after stroke. Methods: Total 80 patients with hemiplegia of the upper limbs and increased upper limb flexor tension after stroke were recruited and randomly divided into groups control, acupuncture, ESWT, and combined treatment, with 20 patients in each. All groups were treated with standard rehabilitation, and the acupuncture group was additionally given acupuncture therapy, the ESWT group given ESWT, and the combined treatment group given acupuncture and ESWT. Treatment was continued for 4 weeks. The modified Ashworth Scale (MAS), simplified Fugl-Meyer assessment for upper extremity (U-FMA), and modified Barthel Index (BI) were used to evaluate muscle spasm, motor function, and daily living ability before and after treatment. Results: There was no significant difference in the MAS, U-FMA, and BI scores between the groups before treatment (P>0.05). After 4 weeks of treatment, all groups showed a decrease in MAS scores and increase in U-FMA and BI scores compared to before treatment (P<0.05). The combined treatment group showed a lower MAS score and higher U-FMA and BI scores than the control, ESWT, and acupuncture groups. Conclusion: ESWT combined with acupuncture has a significant curative effect on patients with upper limb flexor spasm after stroke; additionally, this treatment is safe and has no side effects.