paediatric Gait, Arms, Legs, Spine (or, 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.
Here is a link to the pGALS website. It has some great videos, so check it out!