Hanging Injuries and Strangulation Clinical Presentation

Updated: Dec 03, 2020
  • Author: Scott I Goldstein, DO, FACEP, EMT-T/PHP; Chief Editor: Trevor John Mills, MD, MPH  more...
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A patient may present with a first episode of hanging or strangulation with no history of interpartner violence or hanging. Most patients who are asymptomatic may not present for medical evaluation because of a feeling of embarrassment or because there are no immediate symptoms.

A history of interpartner violence is a predictor of future interpartner violence, and strangulation is one of the many methods assailants use as a weapon of control and power. A history of such violence is important because there may be no initial signs or symptoms of strangulation. 

When a patient presents with a hanging injury, there should always be an evaluation made for a history of depression or suicide attempt. [34]


Physical Examination

A strangulation injury may be asymptomatic. Delayed injury is a real risk, and awareness is important after any type of assault. The initial examination findings can range from mild and vague neck pain to respiratory arrest.

The physical examination findings are the result of obstruction of venous return (eg,  bruising, edema, petechiae), obstruction of airflow (hypoxia,anoxia), and direct trauma (laryngeal fracture, hematoma). 

Signs and symptoms of strangulation include finger marks around the neck, bruising, coughing, stridor, change in voice, facial/subconjuctival petechiae, and laryngeal tenderness. [9]

Signs and symptoms of hanging include ligature markings around the neck; tools utilized on the scene (found by EMS), such as belts, ropes, and cords; facial/subconjunctival petechiae; retinal/scleral hemorrhage; and stridor.



Complications include the following:

  • Respiratory complications: These are the major cause of delayed mortality in near-hanging victims. Both aspiration pneumonia and ARDS may develop, complicating the clinical course.

  • Tracheal stenosis

  • Neurologic sequelae: A wide array of complications may occur in survivors of strangulations and near-hangings, including muscle spasms, transient hemiplegia, central cord syndrome, and seizures. [35]  Spinal cord injury can also cause long-term paraplegia or quadriplegia and short-term autonomic dysfunction. Other injuries include transient ischemic attack, anoxic encephalopathy, 

  • Scarring of neck tissue

  • Psychiatric disturbances: Psychosis, Korsakoff syndrome, amnesia, and progressive dementia all have been reported after surviving a hanging or strangulation. Nearly all patients who have undergone strangulation or near-hanging demonstrate restlessness and a propensity for violence.

  • Vascular: Carotid artery dissection

  • Musculoskeletal: Hematoma, muscle strain or tears