Practical tips and pGALS

When to perform pGALS:

• Unwell child with pyrexia.
• Child with limp.
• Delay or regression of motor milestones.
• The ‘clumsy’ child in the absence of neurological Disease.
• Child with chronic disease and known association with musculoskeletal presentations (such as with inflammatory bowel disease).

Practical tips in performing pGALS:

• Use a 'copy me' approach.
• Look for verbal and non-verbal clues of discomfort (e.g., facial expression, withdrawal).
• Do the full assessment as the extent of joint involvement may not be obvious from the history.
• Look for asymmetry (e.g., muscle bulk, joint swelling, range of joint movement).
• Remember to interpret the findings in the context of the general examination and the clinical presentation (see the example below).
• Consider clinical patterns for example:
• non-benign hypermobility with a Marfanoid habitus or abnormal skin elasticity.
• association of leg length discrepancy and scoliosis.
• widespread joint contractures and trigger fingers (see below).

The slide below demonstrates multiple joint abnormalities on pGALS assessment with joint contracture at the wrists, fingers, shoulders, elbows, knees. He also had features of carpal tunnel syndrome and trigger fingers; (i.e., fingers 'sticking' when making a fist and then attempting to release again). He has a chronic multisystem condition called Mucopolysaccharidosis (MPS) type 1 resulting in widespread joint contractures. He has a hearing aid as another feature of his condition.  A video is available to demonstrate pGALS and pREMS in this child.