#pgals

pGALS is a screening tool designed to detect problems with the musculoskeletal system of school-aged children. 

NB - this tool is not appropriate for children younger than school age

There are two sections to the tool:

A specific and focussed history

A brief examination

As with any musculoskeletal examination, the key principles are detecting asymmetry and deformity, through a process of look, feel, move.

Key Questions:

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 by yourself without any help?

Can you walk up and down stairs without any problems?

Examinaiton

Inspection - only takes a few seconds but is very important

Child should stand upright in only shorts, with a short sleeve top if a girl.

Look from:

The front, the side, behind of the whole body

The front and side of the face

Look for:

Asymmetry in muscle bulk, bone structure, joint swelling, shoulder/hip level

Deformity - Flexion, knock knee, scoliosis

Rashes

Gait

Ask child to walk to corner of room and back. Observe for:

Limping, gait rhythm, difficulty in turning around

Heel strike, stance phase, toeing off

Ask child about discomfort

Then ask child to walk on their heels and on their toes, ask about discomfort.

Arms

Sit child on couch - watch face for discomfort through exam

Inspect for: asymmetry, deformity, rashes

Manouvres

Supinate hands as much as possible

Make fists

Oppose thumb and each finger, repeat for other hand

Prayer sign, inverse prayer sign

Raise arms above head

Look up

Put hands behind head

Flex neck to each side

Ask child to put three of their own fingers into their mouth

Legs

Lie child flat on couch

Inspect for asymmetry of leg length and bulk, deformity rashes. Also check the bottom of feed for verucas or foreign bodies

Feel - see if knees are warm, and check for an effusion

Move

Check for full extension of the knee

Ask child to bring knee all the way to buttock 

Flex knee and hip to 90 degrees, then check internal and external rotation

Spine

Ask child to stand.

Ask child to bend forward and check that there is a consistent inline curvature of the spine from behind, and from the side.