Sport participation by children and adolescents is an integral aspect of contemporary American society and physically challenged adolescents can derive the same physical and psychosocial benefits from sport participation as those without disability. It is estimated that 12 percent of school aged children, in the United States are physically challenged. Sports participation by physically challenged athletes has steadily increased over the past several years. Physically challenged athletes manifest a wide range of neuromotor impairments and disabilities that impact their sport participation. Some of the major medical concerns include increased risks for hyperthermia, hypothermia, autonomic dysreflexia, neurogenic bladder, neurogenic bowel, latex allergy, high risk for pressure sores, and osteopenia. The epidemiology of musculoskeletal injuries in physically challenged athletes is generally similar to those without physical disabilities. Management considerations for the physician include classification of athletes, pre-participation evaluation and determination of eligibility for participation. In order too illustrate some of these issues we have briefly reviewed cerebral palsy, spinal cord injury, and myelomeningocele.