A three-year-old boy allegedly murdered by a Black Country couple may have suffered a serious head injury when either violently shaken or thrown against a sofa or mattress, a jury heard.

Dr Stephen Chapman, head of radiology  at Birmingham Children’s Hospital, where Ryan Lovell-Hancox died about 40 hours after being found unconscious at a bedsit, was giving evidence. Kayley Boleyn and Christopher Taylor looked after Ryan for about three weeks before his death.

Dr Chapman told Wolverhampton Crown Court: “The haemorrhage was of the type caused by a sudden rotation of the head in keeping with shaking or impact with a firm object such as a sofa or mattress.

“If it had been a hard surface it is more likely that there would have been a skull fracture and there was no evidence of that.”

Dr Michael Collins is consultant radiologist at New Cross Hospital, Wolverhampton, where Ryan was taken and had a CT scan before being transferred to Birmingham.

He said the haemorrhage happened in the previous seven or 10 days but could not more exact. Ryan had 54 visible injuries on December 22, 2008, when taken to hospital by ambulance from the flat in Slim Avenue, Bradley, Wolverhampton.

Dr Cathy Higgins, a consultant paediatrician at the hospital, gave details of bruises, scratches and grazes on the face, torso, arms and legs of Ryan. Four bruises could have been caused by his face being squeezed with considerable force, she said yesterday.

Three marks near the jaw were likely to have been the imprint of three fingers and may have resulted from a slap, but another bruise on the opposite side of the face was probably made by a thumb, suggesting the face had been held by a hand, she said.

Bruises to the ears indicated possible blows to sides of the head, while an injury to the nose may have been a friction burn caused by his face being rubbed on a carpet or through deliberate application of heat, she added. She said: “The dating of bruising from appearance is an inexact science. It is possible that all these injuries could have been days old but the extent and pattern of them was not normal for a child of this age.”

John Cooper QC, defending Taylor, said the flat was in such a “cluttered state” there would have been a greater chance of Ryan picking up bruises while moving about.

He said a “significant number” of injuries were “very small” and some may have been caused by two dogs but: “It is not our case that all the injuries were accidental.”

Ryan was unconscious and needed help breathing but had no broken bones and no sign of heart damage. He died on Christmas Eve 2008 after a cardiac arrest.

Taylor, 25, and Boleyn, 19, initially claimed Ryan was hurt falling in the bath but blamed each other after doctors rejected the explanation. Both deny murder and child cruelty. Taylor denies causing or allowing the death of Ryan while Boleyn admits allowing the death. The trial continues.