Objective To explore the effects of extracorporeal shock wave therapy (ESWT) at acupoints combined with kinesiology taping (KT) on the upper limb motor function and spasticity degree of elderly stroke patients with hemiplegic shoulder pain (HSP). Methods A total of 102 elderly stroke patients with HSP who were admitted to Xiaoshan Traditional Chinese Medicine Hospital of Hangzhou from January 2023 to December 2025 were selected. They were divided into the control group, the ESWT group, and the combined group according to the random number table method, with 34 cases in each group. The control group received conventional rehabilitation＋KT, the ESWT group received ESWT treatment, and the combined group received conventional rehabilitation＋ESWT＋ KT. All groups underwent 4 weeks of treatment. The visual analogue scale (VAS), Fugl-Meyer assessment for upper extremity (FMAUE) score, modified Barthel index (MBI) score, and modified Ashworth scale (MAS) grading were assessed before and after treatment. Results After treatment, the VAS scores of all three groups were lower than those before treatment (all P＜0.05), and the FMA-UE and MBI scores and the MAS ratings were higher than those before treatment (all P＜0.05). The VAS score of the combined group after treatment was lower than that of the control group and the ESWT group (all P＜0.05), and the FMA-UE and MBI scores were higher than those of the control group and the ESWT group (all P＜0.05). The improvement in MAS grading of the combined group was better than that of the control group and the ESWT group (all P＜0.05). Conclusion ESWT at acupoints combined with KT can effectively alleviate the pain symptoms of elderly patients with HSP, and has a positive effect on improving upper limb motor function and daily living activity ability.