Abstract: Background: Most paraplegic patients report shoulder pain due to considerable stress placed on the shoulder by wheelchair propulsion and other activities of daily living. Wheelchair-based circuit resistance training (CRT) should promote favourable shoulder kinematics to protect the shoulder from mechanical impingement following paraplegia. The purpose of the study was to investigate the effect of circuit resistance training with modified hand position on shoulder kinematics in paraplegic patients. Methods: Thirty patients from both gender, aged from 40 to 60 years, with shoulder pain due to paraplegia participated in this study. They were assigned randomly into two equal groups: (Study Group) performed CRT with modified hand position and (Control Group) performed CRT with traditional hand position. Both groups received conventional physiotherapy program (2 sessions per week for 2 months). The patients were evaluated by numeric rating scale (NRS) for assessment of pain intensity, electrical goniometer for assessment of shoulder joint range of motion (ROM) and 3- D ultrasonography for assessment of subacromial space. Results: There was a significant decrease in pain intensity and a significant increase in the shoulder ROM in both groups after treatment with the best results for study group. The study group showed significant improvement in subacromial joint space, whereas the control group showed no improvement. Conclusion: Hand position alters kinematics during CRT and should be selected to emphasize healthy shoulder mechanics.