PART B – The musculo-skeletal system 6. LIGAMENTS INJURIES Exceeding the normal range of movement in a joint or loading the joint by traction, as in suspension and other types of positional torture, the ligaments may be sprained. An inflammatory response with swelling, pain and joint dysfunction will be present in the acute phase. 3. In a first-degree distortion, the ligaments are sprained without macroscopic rupture, and there will be no mechanical instability in the joint. 4. In a second-degree distortion, there will be a partial macroscopic rupture of the ligaments, leading to a slight mechanical instability in the joint. 5. In a third-degree distortion, the ligaments will be completely ruptured and the joint clearly mechanically unstable. The healing process in ligaments and tendons is considerably slower than that of muscles. A full recovery with normalisation of strength and function takes months. Pain and joint dysfunction are very frequent complaints in the chronic phase. At clinical examination, reduced range of movement in peripheral joints, as well as in the spine, is the most typical finding, but various degrees of joint laxity/instability may also be found (Rasmussen, 1990; Skylv, 1992; Forrest, 2002). Specific clinical tests may be applied for diagnosing the instability and direction of instability in joints. 7. BONE INJURIES Fractures produce a loss of bone integrity due to the effect of a blunt mechanical force on various vector planes. A direct fracture occurs at the site of impact or at the place at which the force was applied. The location, contour and other characteristics of a fracture reflect the nature and direction of the applied force. 17 In the acute phase, local swelling, bony deformity, tenderness and loss of function will be typical findings at the clinical examination. In the chronic phase, various degrees of bony deformity, pain at activity and loss of function may be found. Fractures related to alleged physical torture are reported with a frequency of 13% in a study by Rasmussen (1990), of 27% in a study by Allodi (1985) and of 4% in a study by Randall, Lutz and Quiroga (1985); limb and rib fractures being predominant. Various types of spinal fractures and other lesions, including lesions in intervertebral discs and disc herniation, are likewise reported, but systematic radiodiagnostic studies are lacking (Aytaçlar & Lök, 2002). (See also § 184 and §§ 206-211 in the Istanbul Protocol.)