Abstract: Objective To explore the rehabilitation effect of extracorporeal shock wave combined with mirror image therapy in the treatment of patients with upper limb spasm after stroke and to expound its possible mechanism. Methods A selection of 132 cases of upper limb spasm after cerebral apoplexy, out of 12 cases which were lost to follow-up of patients during January 2015 to June 2018 from the Second affiliated hospital of Wenzhou medical university nerve rehabilitation, who were randomly divided into treatment group and control group. The control group used extracorporeal shock wave treatment on the basis of comprehensive rehabilitation treatment, and the treatment group added the joint mirror extracorporeal shock wave therapy. Two groups of patients were treated by modified Ashworth scale assessment of contracture, patients' upper limb motor function was assessed by the simplified Fugl-Meyer motor function rating scale (FMA), the curative effect was assessed by BI (Barthel Index), and the curative effect was assessed by Brunnstrom stages. Results Ashworth score, FMA score and Barthel index of hemiplegic patients in both groups were significantly improved (all P<0.01). Meanwhile, Ashworth score, FMA score and Barthel index were significantly higher in the treatment group than in the control group (all P<0.01). The upper limb and hand Brunnstrom stages of the patients before and after treatment indicated significant difference before and after treatment (all P<0.05), and the upper limb function recovery of the treatment group was significantly better than that of the control group. Conclusion Extracorporeal shockwave combined with mirror image therapy can partially improve the contracture state of the upper limb after stroke, improve the function of the upper limb, promote the recovery of the upper limb function, improve the ability of the patients' daily life activities, and contribute to the recovery of stroke.