Going off what you said in that one ask, where a character being strung up by their wrists can cause nerve damage and pain throughout their arms, can it also cause damage to the shoulders?
Yes and after talking to a remedial massage therapist (they described it as ‘slightly below a physiotherapist in terms of qualifications) a few months back I realised that I’ve actually been underestimating the damage to shoulders in my answers.
I think there’s a lot of focus on nerve damage in my sources because it’s irreparable. Whereas theoretically most of the muscular and tendon damage suspension causes can be treated and people can see significant improvement.
However once you factor in the poverty of most torture survivors and the length of time it can take to see a doctor- Well the fact an injury is theoretically treatable becomes less relevant.
There are also several different methods of suspension by the wrists, some of which cause more injuries.
I’m guessing you’re referring to a scenario where the character’s hands are tied in front of them and they’re hoisted off the floor. That’s the scenario I write about most of the time.
However historically it was also pretty common to tie the victim’s hands behind the back (which dislocates the shoulders). This was also sometimes modified by repeatedly raising and dropping the victim. Which did further damage to the shoulders and could also cause broken bones in the legs.
There’s also a method that I’ve only seen referenced in historical Japan so far (which may be due to the fact I can’t read Chinese) which involved tying victims by their fingers. This resulted in the slow dislocation of every joint in the fingers.
Going with the scenario where the hands are tied in front of the character this can lead to really reduced mobility in the shoulder. Partly due to chronic pain and partly due to damage to the soft tissues around the joint.
The nerve damage can cause some interesting effects. Numbness and tingling sensations are common in people with ‘normal’ shoulder injuries, I haven’t seen reports of torture survivors discussing this but that might represent a lack of reporting rather then a lack of symptoms. It can also cause pain but interestingly the pain isn’t always at the site of the injury. It can be felt further down the nerve pathway. So a character might have a shoulder related nerve injury but feel pain further down their arm.
Posture and mobility responses to this chronic pain can actually make the damage worse if an injury is untreated in the long term. A character that’s hunching over a lot to try and relieve pain in their shoulders might actually be putting more pressure on the site of the injury, increasing their pain in the long term (ie months to years). Or they might be creating a situation where some of their muscles become relatively overdeveloped and other underdeveloped, which would then feed into decreased mobility in the shoulder.
My impression is that reduced shoulder mobility may not be as noticeable as reduced mobility in the hands. People seem to automatically adjust how they perform basic tasks in order to compensate for reduced mobility in the shoulders. This can cause the same kind of unusual muscle use I described above and that can lead to pain in different areas, like the neck.
Taking a step back I think the best way to think about shoulder injuries is to consider the character’s general health, how long and often they were suspended in the story and their access to medical care afterwards.
The impression I got from my conversation with the (extremely helpful, thank you) remedial massage therapist was that most of the shoulder injuries a suspension victim would get are treatable and there can be significant improvement. Both in terms of pain and mobility.
But the extent of that improvement depends on early access to medical care after the injury.
A character who is regularly suspended while they’re held, or suspended for a prolonged period (ie over 15 minutes) is going to have a more severe initial injury. An older character (50s onward) is also likely to have a more severe initial injury.
And the longer a character goes without having that initial shoulder injury assessed and treated, the worse the damage is likely to get. The way the character compensates for their shoulder injury over a long period of time will also cause problems, ranging from pain to further reduction in movement.
So a character who is suspended and also imprisoned for a year without treatment will be in a worse position then a character who is rescued after a week and taken straight to a doctor.
Now I don’t think I’m qualified to describe the kind of care a character would need for these shoulder injuries in detail. I know that they often involve extensive physiotherapy, lifestyle adjustments and sometimes surgery.
If you want a more detailed breakdown of treatments I’d suggest looking up muscular tears. These come in three grades with 1 being the least severe and 3 the most.
