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Orthopedic Abnormalities

About 14% of the individuals with Down syndrome have increased mobility of the cervical spine at the level of the first and second vertebrae, a condition known as atlantoaxial instability (AAI). Most are asymptomatic, but about 10% of those with AAI have symptoms of spinal cord compression (neck pain, torticollis, change in gait, loss of upper body strength, or changes in bowel/bladder functioning). It’s important for nurses familiar with the individual to report any of these changes to the primary health care provider as soon as they occur, in order to prevent further complications. Nurses can also guide the adult into exercise and sports options that are safer for persons with AAI. For example, Special Olympics, Inc. bars athletes with AAI from competing in equestrian sports, diving, alpine skiing, snowboarding, and other sports that increase the risk for spinal cord compression.

INSTANT FEEDBACK:

Adults with Down syndrome and AAI should not participate in organized sports or other forms of therapeutic recreation.

Degenerative arthritis is often seen in adults with Down syndrome. The most commonly affected joints are the foot (18%), knee (12%), hip (10%) and ankle (5%). Foot disorders are also common, including hallux valgus, metatarsus primus varus, and severe pes planus.

Other orthopedic abnormalities associated with Down syndrome in adults include:

subluxation and dislocation of the patella
scoliosis and degenerative changes in the thoracolumbar spine
femoral head epiphysiolysis
dislocation or subluxation of the hips

It’s important for degenerative arthritis to be diagnosed promptly and treated immediately, to limit joint deterioration and preserve function. Because regular physical activity is so important in weight management for adults with Down syndrome, joint pain that limits the individual’s mobility can have serious health implications.

INSTANT FEEDBACK:

When discussing recreational options with an adult with Down syndrome, it’s important for the nurse to be aware of significant orthopedic abnormalities that may make physical activities painful or dangerous.