Musculoskeletal issues



In an Australian study in 2011 amongst 223 young people with Down syndrome, , aged 15-30 years, 61% complained of bone or muscle related problems.

Identification of musculoskeletal problems can be a challenge and is often delayed due to diagnostic overshadowing and difficulties in vocalization of pain.

A musculoskeletal assessment should be included as a part of yearly health examination to enable early identification and treatment.

Musculoskeletal problems difficulties arise from the underlying hypotonia, hypermobility, ligamentous laxity, auto immune dysfunction and premature ageing process, associated with Down syndrome.

The orthopaedic problems seen in Down syndrome include:

  • Spine:
  • Hip:
    • Hip instability including subluxation and dislocation
    • Slipped upper femoral epiphysis
    • Perthes Disease
    • Osteoarthritis of the hip
  • Patellofemoral Instability
  • Foot Abnormalities
    • Congenital talipes equino varus (CTEV-clubfoot )
    • Metatarsus Primus varus and associated hallux valgus and varus
    • Flat feet
  • Non-orthopaedic problems include:
    • Inflammatory arthritis
    • Early onset osteoporosis

Last updated: March 2015.







DSMIG Guidance

Cervical spine disorders:Craniovertebral instability

Basic Medical Surveillance Essentials for people with Down syndrome

Last updated: March 2012


Inflammatory Arthropathy Keypoints

based on a presentation by Dr. Janet Gardner-Medwin. DSMIG Glasgow. May 2007

Presentations at DSMIG Meetings

Presentations still to be uploaded


Cervical Spine Disorders in children with Down syndrome

Dominic Thompson

14th November 2014 and 2008 London


Orthopaedic Problems

Miss Sally Tennant

15th May 2013, London


Inflammatory Arthropathy

Dr. Janet Gardner-Medwin

May 2007, Glasgow

Additional Resources

Atlanto axial information pack 2012

Information and advice form British Gymnastics


Arthritis in Down’s syndrome is still being missed.

Cruikshank M, Tunc A, Walsh J, Galea P, Davidson J, Gardner-Medwin J.

Pediatric Rheumatology 2008; 6 (Suppl 1): 54.


Book Chapter – Musculoskeletal manifestations

Down Syndrome – Current Perspectives Mackeith 2015

ds-current-perspectives-book-coverEdited by Richard Newton , Shiela Puri and Liz Marder