paediatric Gait, Arms, Legs, Spine (pGALS): Introduction
Musculoskeletal complaints in children are very common and a frequent reason for consultation with healthcare professionals. Taking a history and performing an examination of the musculoskeletal system is a very important part of the process of making a diagnosis. The purpose of this short video is to demonstrate a simple, quick and effective way to screen the musculoskeletal system in school-aged children that can be done in a few minutes. Examination of a younger child is likely to require a quite different approach and is not covered in this demonstration.
We have called this screen pGALS, which stands for Paediatric Gait, Arms, Legs and Spine. This screening examination has been developed from the adult GALS and this is now routinely taught to medical students. The amendments to GALS are all simple manoeuvres that are commonly used in clinical practice by doctors and therapists who are experienced in the assessment of children.
Taking the history from the child and the parent is very important in the assessment process and gives you the opportunity to establish a rapport with the child. As part of your general systematic enquiry you should include the following key questions relating to the musculoskeletal system. These are:
Do you have any pain or difficulty in moving your arms, legs, neck or back?
When you get dressed, are you able to do this yourself without any help?
Can you walk up and down the stairs without any problems?
A positive response to any of these questions will alert you to the possibility of significant problems in the musculoskeletal system.
When examining a girl, we would suggest that she wears a sleeveless top and shorts.
Before going through the components of pGALS in detail it is worthwile taking a few moments to observe the child standing upright and ask them to be as straight as possible. It is helpful to scan the child from head to toe looking from the front, the side and behind the child. This takes a few seconds but can give very important clues. For example, does the child look generally well?
Check for rashes such as psoriasis, check for asymmetry such as muscle bulk including muscle wasting and the presence of joint swelling. Check for a knock-knee or a bow-leg deformity and, from the side, check for a flexion deformity perhaps at the knee or the hip. Check the child’s face from the front and the side. For example, a small jaw or facial asymmetry may suggest temporomandibular joint disease.
Remember that you may see more from the back of the child than from the front, for example, swelling of the ankles is often more obvious from behind the child. Check the back of the child, looking for asymmetry of skin creases or shoulder level which may suggest a scoliosis.