Paediatric-History taking & Physical examination of Pediatric gait, arms, legs, spine (pGALS)Created OnApril 30, 2020Last Updated OnApril 30, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Pediatric gait, arms, legs, spine (pGALS) < All Topics Table of Contents Introduction: pGALS is a modification of GALS used for school-aged children It is essentially similar to adult GALS with additional maneuvers Screen foot and ankle (walk on heel and tiptoes) Wrist (palm together an hand back to back) Temporomandibular joints (open mouth and insert three fingers) Elbow (touch the sky) Neck (look at ceiling) When to perform pGALS Child with muscle, joint or bone pain Unwell child with fever Limping hild Delay motor milestones ‘Clumsy’ child with no underlying neurological disease Child with chronic disease and known MSK presentation When pGALS screening is abnormal, carry out more detailed examination of the relevant area by look, feel, move approach Joint abnormalities may be subtle in children – compare both sides of the limbs Screening questions: Is there any pain or stiffness in your joints, muscle or back? Is there any problem going up and down stairs? Is there any difficulty in getting dressed (e.g put on button) without any help? Inspection: Similar to GALS Gait: Ask patient to walk normally to the end of the room, turn around and walk back Normal variant of gaits in children Toe walking – below 3 years old In toeing Bow legs – resolve by 18 months Knock knees – resolve by 7 years Flat feet – most have flexible flat feet with normal arch on tip toeing, resolve by 6 years Crooked toes – resolve with weight bearing Walk on your heel Walk on your tiptoes Examine shoes Arms: Hold your hands out straight in front Assess forward flexion of shoulder, elbow extension, wrist extension, extension of small joints of fingers Turn hands Assess wrist supination and elbow supination Make a fist Assess flexion of small joint of fingers Pinch index finger and thumb together Assess coordination of small joints and functional grip Touch tips of each finger with thumb Assess manual dexterity and coordination of small joints Squeeze MCP joint Look for inflammatory joint disorder Put hands together palm to palm and back to back Assess extension of small joints of fingers, wrist extension and flexion, elbow flexion Reach up and touch the sky Assess elbow extension, wrist extension, shoulder abduction, neck extension Put hand behind neck Assess shoulder abduction, external rotation of shoulders, elbow flexion Legs (examine with patient lying down on the couch): Feel for effusion of knee (patellar tap) Bring your heel to your buttock and straighten your leg Assess active movement of knee – flexion and extension Feel for crepitus Passive movement of hip with knee flexed to 90’ – hip flexion and internal rotation Point toes up and down Spine: Look at the ceiling Assess neck extension Touch shoulder with ear Assess lateral flexion of spine Open mouth wide and put three own’s finger in mouth Assess TMJ, check for deviation of jaw movement Bend forward to touch the toes Assess forward flexion of thoracolumbar spine, check for scoliosis Record finding in each component (similar to GALS) Taken from Doctrina Perpetua guides on Paediatric
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