Abstract: Objective To analyze the abnormal structural changes of shoulder joint in patients with hemiplegic shoulder pain (HSP)by MRI and find out the causes of shoulder pain in these patients. Methods Thirty-five patients with HSP who underwent MRI in our hospital from October 2013 to July 2017 were selected. The clinical characteristics and the MRI findings were assessed. Results HSP occurred mainly in the patients of Brunnstrom Ⅱ and Ⅲ. Of the 35 cases, MRI findngs showed 34 cases had muscle damage, 32 cases with bursa effusion, 29 cases with shoulder cavity effusion, 21 cases with degenerative damage, 16 cases with glenoid labial injury, 12 cases with long bicipital tendon-glenoid labrum injury, 9 cases with ligament injury, 6 cases with bone marrow edema, 6 cases with synovitis, 3 cases with articular cartilage injury and 1 case with avulsion fracture of large tubercle of humerus. Ubacromial-subdeltoid bursa effusion was found in 22 cases, coracoid bursa effusion in 30 cases and infra-scapular bursa effusion in 8 cases. And subscapular bursitis commonly occurred in HSP patients with better upper limb function. Twenty-nine patients had supraspinatus tendon injury and 20 patients had subscapalaris tendon injury. Conclusion Bursa effusion, supraspinatus tendon injury and subscapalaris tendon injury may be the causes of HSP, and subscapular bursitis may be one of the causes HSP patients with better upper limb function.