A rare late complication of physical torture. A case report

Abstract

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Introduction The public interest and the allegations levelled against custodians regarding ill treatments have been increased in Sri Lanka. Their attention is grabbed by the immediate complications of torture, but do not pay much attention to the late or delayed complications. The present victim was subjected mainly to physical pain and was suffering from a rare and late complication of torture. Case report A 35 year old male was arrested for alleged house breaking. He was kept under police custody and subjected to physical and mental torturing repeatedly. Alleged to have been hanged with his hands for a number of hours for several days. He presented to a tertiary care hospital six weeks after the incident with right shoulder weakness. Examination revealed hyper-pigmented scars over the left wrist joint and back of the left forearm, and right sided winged scapula with resistance. He complained that he could not perform most movements of his right shoulder and alleged that it has affected his day to day life. Fig. 1. Scar over wrist Fig 2. Winged scapula Discussion In winged scapula, the shoulder blade, protrudes from a person’s back with a wing-like resemblance. Though the most common cause of winged scapula is serratus anterior palsy, there are still other circumstances that present the same ailment less commonly [1] such as trapezius and rhomboid palsy, and dislocation of scapula. [2]The dislocation of scapula was excluded by the X-ray studies. The serratus anteriorparalysis is typically caused by damage to the long thoracic nerve [3] due to several reasons; non-traumatic, iatrogenic or traumatic injury. [4] Non-traumatic injury to the long thoracic nerve includes, causes such as viral illness, allergic-drug reactions, drug overdose, toxic exposure, C7 radiculopathy, and co-arctation of the aorta. [4] Such non-traumatic injuries were not found. Iatrogenic causes of winged scapula due to damage to the long thoracic nerve such as forceful manipulation, mastectomies with axillary node dissectionfl] were not found. The trauma-induced injury to long thoracic nerve includes causes such as repetitive movements, excessive compression of the shoulder area by straps, various household activities and blunt trauma [5],The Istanbul protocol has identified the winged scapula as a recognized complication of hanging with the wrists. • [2] Therefore, the presence of hyper pigmented scars over left wrist and the winged scapula of the right shoulder were corroborated with the history of torture by suspension from wrist by the custodians. In serious cases, the ability to perform activities of daily living such as changing one’s clothes and washing one’s hair may be hindered. [4] Therefore, the complications observed in the present case should also be considered as serious consequences of winged scapula. Conclusion: The presence of hyper pigmented scars over the left wrist joint and the late complication such as winged scapula of the right shoulder were corroborated with the alleged history of torture by suspension from wrist by the custodians.