Understand | diagnose | change

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 !


pGALSplus is a ‘toolkit’ based on pGALS, and includes questions and assessments to help identify children with more serious pathology. 

pGALSplus aims to help clinicians determine if a child with a musculoskeletal problem will need specialist referral or not and if so whether to rheumatology,  orthopaedics or neurology/neurodisability. A Model of Care involving triage is called RightPath and further information is available: 


  • Children with musculoskeletal problems access healthcare in many different ways. For many children, particularly young children, presentations can be vague;  an example is the clumsy child where it is often not clear if the problem is related to musculoskeletal, neurological or developmental difficulties.
  • pGALS as a musculoskeletal assessment is useful to identify areas that may be abnormal (such as a restricted wrist, or a swollen ankle). However as a 'stand alone' assessment it does not give information as to the likely cause of the abnormality and which may be needed to guide ongoing referrals.
  • pGALSplus was developed as a tool for clinicians who may be asked to assess children with problems such as limp, clumsiness and or joint pain.
  • The addition of specific manoeuvres to pGALS support the clinician to differentiate between certain conditions and is focussed on exemplar presentations; 
    • Common conditions (such as hypermobility and developmental co-ordination disorder),
    • Less common but eminently treatable conditions (such as juvenile idiopathic arthritis) and,
    • Very rare but life-changing conditions (such as muscular dystrophy and the mucopolysaccharidoses).

Resources to demonstrate pGALSplus can be found below: