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pREMS

Following pGALS, the observer is directed to a more detailed examination of the relevant area(s). 

pREMS (paediatric Regional Examination of the Musculoskeletal System) is based on the ‘look, feel, move, function’ principle similar to that of adult REMS for each joint or anatomical region, with active movements performed first and then passively by the examiner; the addition of ‘measure’ for some joints is relevant as are additional options pending the clinical scenario (e.g. checking for pulses or more detailed muscle or neurological assessment). 

pREMS is relevant to paediatric rheumatology although clearly many components are relevant to paediatric orthopaedics and can be used by doctors and allied health professionals.

The following links access video demonstrations of pREMS:

pREMS - Hand and wrist           pREMS - Elbow           pREMS - Shoulder
pREMS - Foot and ankle           pREMS - Knee           pREMS - Hip
pREMS - Spine           pREMS - Gait           pREMS - Hypermobility
pREMS - Enthesitis           pREMS - Complete demonstration  

 

The Table below summarises tests and signs demonstrated in the respective pREMS videos

pREMS video

Tests additional to 'look feel move' are listed below

pREMS Hand and wrist

 

  • Tinel's test (carpal tunnel syndrome) 
  • Nail fold capillaroscopy
  • Peripheral nerves
  • Peripheral pulses
  • Hypermobility

pREMS Elbow

  • Muscle power
  • Peripheral nerves
  • Peripheral pulses
  • Hypermobility
  • Entheses

pREMS Shoulder

 

  • Muscle power
  • Peripheral nerves
  • Peripheral pulses
  • Hypermobility

pREMS Spine

  • Straight leg raise
  • Schober's test
  • Leg length measurement
  • 1 leg standing spine extension test

pREMS Hip

  • Leg length measurement 
  • Leg alignment
  • Sacroiliac joints
  • Thomas' test
  • Trendelenberg's test
  • Gower's test
  • Entheses
  • Muscle power
  • Hypermobility

pREMS Knee

  • Cruciate and collateral ligament stability
  • Clarke's test
  • Patellar maltracking
  • Thigh foot angle
  • Hamstring tightness
  • Iliotibial band tightness
  • Knock knee/ bow leg assessment
  • Thigh girth measurement
  • Muscle power
  • Hypermobility
  • Normal development of leg alignment

pREMS Foot and ankle

  • Peripheral pulses
  • Thigh foot angle
  • Hypermobility
  • Entheses
  • Muscle power
  • Nail fold capillaroscopy 

pREMS Gait

  • Footwear
  • Limb and trunk proportions
  • Jaw profile  

pREMS Hypermobility

  • Collagen disorders 
 

pREMS Entheses

  • Knee 
  •  Foot and ankle 

The diagrams used in the pREMS videos to demonstrate surface anatomy and ranges of movement are available.

The details of pREMS for each joint are available in resources.

 

Why register?

Some parts of pmm which involve pictures or videos of children, can only be viewed by registered users. Registering also allows you to bookmark favourite pages and track your viewing.

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