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Paediatric GALS

From Mediwikis

Basic examination for general musculoskeletal problems in children[1][2]. Try to make it into a game, 'copy me', to keep their attention

Questions

  • "Do you have any pain or difficulty moving your arms, legs, neck or back?"
  • "Are you able to dress yourself without help?"
  • "Can you walk up and down stairs without any problems?"

Observation

  • Head to toe
  • Front, side and back
  • Check for flat feet

Gait

  • Walk to wall and back
  • Walk on heels
  • Walk on tiptoes (is there a normal arch on tip toe?)

Arms

  • Inspect hands and arms - look for swelling, psoriasis
    • Ask: any pain?
  • Squeeze MCP joints

Movements

  • Turns hands over / hands out in front
  • Make fist
  • Oppose each finger and thumb
  • Prayer sign
  • Reverse prayer sign
  • Raise arms straight above head
  • Hands behind head, point elbows back
  • Ear to each shoulder
  • Insert child's 3 fingers into their own mouth

Legs

Lying back on couch

  • Inspect closer, check leg alignment and leg length, soles of feet,
  • look for joint swelling, muscle wasting, scars, psoriasis (nails, skin)
  • Palpate joints for heat
  • Fluid sweep at knee / patella tap
  • Flex leg- heel to bottom, and then extend (check each side and compare)
  • Passively:
    • Full Flexionhips
    • Internal rotation of hips

Spine

Look for scoliosis and normal S shape of spine

While standing, touch their toes, while you keep two fingers on the lumbar vertebrae

References and video demonstration of pGALS

  1. Paediatric Musculoskeletal Matters- pGALS- http://www.pmmonline.org/page.aspx?id=342
  2. pGALS – paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system. Helen E Foster and Sharmila Jandial. Pediatric Rheumatology 201311:44 DOI: 10.1186/1546-0096-11-44