Shoulder deformation without neurological injuries: A rare visible sequela after positional torture

Abstract

Introduction: Positional torture - commonly involving forced immobilisation in extreme or contorted postures - is known to produce musculoskeletal and neurological harm while often leaving minimal visible evidence. Although chronic pain and functional impairments are well documented, overt structural deformities of the shoulder region in the absence of neurological symptoms are exceptionally rare. Case presentation: We describe a 23-year-old male survivor of torture who developed bilateral acromioclavicular deformities following prolonged immobilisation with his arms bound in forced hyperextension for 10–12 hours per day over a 15-day period. Two years after the events, physical examination revealed symmetrical swelling over the acromioclavicular joints, preserved range of motion, full muscle strength, and intact sensory function. Magnetic resonance imaging demonstrated marked thickening of the fibrous subcutaneous tissues without involvement of deeper musculoskeletal structures or the brachial plexus. Discussion: This presentation differs from the shoulder sequelae most frequently reported in torture survivors - such as impingement syndrome, tendinopathy, and adhesive capsulitis - which typically manifest with pain rather than visible deformity. Current anatomical studies of suspension-related torture mechanisms suggest that sustained hyperextension may precipitate soft-tissue remodelling and fibrofatty proliferation in the absence of persistent neuropathy, which is consistent with our findings. This case broadens the recognised spectrum of physical outcomes associated with positional torture by demonstrating that visible, bilateral shoulder deformities can occur without neurological deficit or pain. The findings highlight the critical importance of meticulous inspection and targeted palpation in the medico-legal examination of torture survivors, even when symptoms appear minimal or absent.