Musculoskeletal ImagingPain, congenital indifference to
an insensitivity to pain, occurring as a component of several hereditary sensory neuropathies. Among the symptoms that may be recognized in infancy or childhood are a decreased or absent reaction to pain, scars on the tongue or finger due to burns or infections, corneal opacities resulting from unnoticed foreign bodies, and self-mutilation with amputation of fingers and toes. On radiographs patients may have fractures of the metaphysis and diaphysis of long bones, epiphyseal separations,
neuropathic osteoarthropathy and soft tissue ulcerations (
Fig.1). The presence of unusual fractures and physeal abnormalities on radiographs should stimulate a search for subtle neurologic deficit. All of the syndromes of
congenital insensitivity to pain, such as familial dysautonomia (
Riley Day syndrome), show virtually identical skeletal abnormalities.
DR/RB
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Lateral radiograph of the ankle demonstrates extensive destruction of the hindfoot due to neuropathic osteoarthropathy.
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Pain, congenital indifference to, Fig.1 | |