A jury heard that injuries suffered by Amber Gibson were consistent with manual strangulation.
A pathologist told the High Court in Glasgow that Amber's cause of death was determined to be compression of the neck.
Dr Gemma Kemp, 42, stated that Amber also sustained significant blunt-force injuries to her neck and head, which could have rendered her unconscious.
Amber's brother Connor Gibson, 20, is charged with the sexual assault and murder of 16-year-old Amber Gibson at Cadzow Glen, Hamilton, Lanarkshire, on Friday, November 26, 2021.
Co-accused Stephen Corrigan, 45, is accused of breach of the peace and attempting to defeat the ends of justice. He had lodged a special defence of alibi.
It is claimed Corrigan found Amber's body, but rather than alert police, he inappropriately touched her and then hid her remains under bushes and branches.
Dr Kemp told jurors that she initially saw Amber’s body at the scene covered by bushes and branches “caked in mud.”
She later examined her body at a hospital and co-wrote a report which was reviewed in court.
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The witness stated that Amber suffered bruising to the whites in both of her eyes.
She also sustained signs of burst blood vessels in her ear, mouth and face.
Prosecutor Richard Goddard asked if the injuries are typical of strangulation.
Dr Kemp replied: “Yes.”
The court heard there were eight further bruises and grazes to Amber’s neck.
She said: “In combination (with the other injuries) these bruises and abrasions can feature in fingernail compression, nails and pressure of the fingernails around the neck."
Dr Kemp stated that: "This is consistent with manual gripping and strangulation."
Amber suffered internal injuries which included a bruise on her throat and a muscle in her neck.
Dr Kemp said: "There was evidence of blunt force trauma to her head.
"There were bruises to the right side of her forehead, nose and cheek as well as to the front of her right ear.
"There were abrasions to the right side of her forehead and she suffered a fractured nose."
There was also a large area of bruising from the front to the back of her head.
The source of the blunt force trauma injuries is unknown.
Dr Kemp accepted that there would have been multiple blows and would have been enough to knock Amber unconscious.
Amber also suffered a bruised middle finger which is believed to be a "defensive injury."
The witness further stated Amber's body did not contain alcohol and she did not have a disease.
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Forensic scientist Lisa Gray, 41, earlier told the court that she examined damaged clothing found at the scene.
This included a bra jurors have heard belonged to Amber which was buried in the undergrowth near her body.
Miss Gray stated there was extensive damage to the right strap, the hook fastening and a tear in the panel.
She claimed that the strap damage was a result of pulling.
Mr Goddard asked the witness if the bra was "ripped apart."
Miss Gray replied: "Yes."
A grey top recovered at the scene was also damaged around the neck and said to have been pulled.
A pair of jogging bottoms were covered in mud and there were signs that the wearer was "dragged."
The trial continues before Judge Lord Mulholland.
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