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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 !

Virtual or Video-pGALS (V-pGALS)

V-pGALS aims to facilitate assessment in the context of remote / telehealth clinics. 

V-pGALS includes amended / additional manoeuvres to pGALS derived from components of pREMS Hip and Spine.

The Table below lists V-pGALS components: * denotes the amends / additions to pGALS. 'TP' refers to a Telepresenter who may be a parent, carer or a health care professional. 

The V-pGALS Table is available as a pdf download (checklist).

There is a pdf download V-pGALS to demonstrate the manoeuvres (graphic).

Further information about telehealth in paediatric rheumatology is provided and includes a link to a webinar and live demonstration of V-pGALS.



Any pain (joint/muscle/back) scale 0-10*

Any morning stiffness / Gelling [in minutes]*

Difficulty with dressing or undressing?

Difficulty walking or going up or downstairs?


Standing postureswelling, alignment, rash, deformity, wasting, posture, feet

Walk & turn, walk on heels, walk on tiptoeability, foot posture, limp


Observation: nails, skin, muscles, deformity

Hold hands out straight: elbow, wrist, finger extension

Make a fist (*‘cat claw’/‘monkey paw’): supination, full flexion fingers

Pinch index finger & thumb: small finger joints, key grip strength

Touch individual fingers to thumbsmall finger joints, dexterity,

TP to squeeze MCP joints*: tenderness grade (0-10)

Hands palm to palm / back to backwrist flexion/extension

Reach arms up, head backelbow, wrist, neck extension

Hands behind neckshoulder abduction, external rotation


Observation: nails, skin / soles, muscles, posture, alignment, leg length, flat feet

TP feels knee: at rest & on moving. Check for warmth, swelling, crepitus. If swollen ask TP if swelling feels soft (grape like) or hard (stone)?

TP assess movement of hips: leg roll* or prone lying*(‘X’/‘W’ leg position*)

TP assess range of movement knees: full extend and heel to buttock

Squat*: active knee flexion, restriction at ankle

Balance on tip toes*

1-leg stand*balance, Trendelenberg

Sit cross legged & stand up*: fluency, balance, power


Observation: skin, muscles, posture, normal lordosis, deformity

Touch ear to shouldercervical spine lateral flexion

Open mouth (1-3 fingers& move jaw side-to-side*

Bend forward and touch toes

TP to assess sacroiliac joint tenderness [grade 0-10]*