What condition should be evaluated for in a 16-year-old with Down syndrome prior to a sports participation physical?

In a 16-year-old with Down syndrome, evaluating for atlantoaxial instability prior to sports participation is crucial because individuals with Down syndrome are at an increased risk for this condition. Atlantoaxial instability is a form of cervical spine instability, where there is excessive movement between the first cervical vertebra (the atlas) and the second cervical vertebra (the axis). This instability can lead to neurological complications, particularly during activities that involve hyperextension of the neck or trauma.

Many individuals with Down syndrome have anatomical differences, such as lax ligaments and a hypoplastic odontoid process, that contribute to the likelihood of developing this instability. If present, atlantoaxial instability can pose a significant risk of spinal cord injury, especially in the context of sports that may involve excessive head or neck movement.

Other conditions such as congenital heart disease, while important and common in Down syndrome, are typically evaluated in a different context regarding overall physical capability and exercise tolerance rather than specific risks in sports. Osteogenesis imperfecta and scoliosis are also considerations in patients with Down syndrome but do not carry the same immediate and serious risk associated with sports participation as atlantoaxial instability does. Therefore, the emphasis on inspecting for atlantoaxial instability prior to