Attached
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.
