Rationale: The use of musculoskeletal ultrasound (MU) method in the diagnosis of shoulder pain and injury and guidance of injection and pain blocking has been established. However, the treatment of posthemiplegic shoulder pain (HSP) with MU-guided precise physical therapy has not been reported. Patient concerns: Here, we present the first case report of a 64-year-old man with a right basal ganglia hemorrhage. Left side shoulder pain remained unbearable, which seriously affected sleep and shoulder-related activities. Interventions: The patient received MU-guided precise drug administration, laser, and other physical therapy in addition to exercise training for 2 months. Outcomes: The pain was significantly relieved and shoulder function was improved. Effusion extent and tendon thickness were reduced. Lessons: MU-guided precise physical therapy can effectively reduce symptoms of HSP and improve inflammation and effusion absorption of lesioned tissue.