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Whether you are looking to learn more about paediatric musculoskeletal problems, or are involved in the care of children, then PMM and PMM-Nursing will help you change your clinical practice for the better. PMM is free and open to all !

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 overt 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.
  • Remember that pGALS includes manoeuvres that may assess several joints at once as well as balance and coordination. 
  • Consider clinical patterns for example:
    • hypermobility with a Marfanoid habitus or abnormal skin elasticity.
    • association of leg length discrepancy and scoliosis.
    • widespread joint contractures and trigger fingers.


The image below shows pGALS being performed using a 'copy me' approach 

The image below shows the movements of tip toe and heel walking - examples of pGALS manoeuvres which assess several joints as well as balance and coordination.