Watch the child play, walk into the room and interact with parents / siblings. This often yields valuable information prior to the actual examination. Take time to build rapport with a nervous child – examination will be easier if the child is relaxed.
Expose as much of the relevant body area as possible. Comparison of limbs can be useful, and joint effusions, rashes and other clues can easily be missed.
Always look at the child’s face during the examination – many children and young people will deny pain but facial expression, withdrawal or crying may suggest discomfort.
pGALS is a validated simple assessment of the musculoskeletal system - it is easier and quicker to perform than you think! Practice as much as you can and you are then more likely to pick up abnormalities.
Abnormal findings in pGALS should be followed by detailed examination of the relevant region using a ‘look, feel, move, function, measure’ approach (pREMS).
Never forget to examine the joint above and below the problem site. Referred pain is common.
Asymmetry of joint range of movement is usually significant but remember symmetrical loss of joint range can be easily missed.
For children with chronic conditions it is important to assess growth - plot height and weight on growth charts. Also look for evidence of leg length discrepancy or muscle wasting.
Remember examination of other systems is often indicated e.g. abdominal, neurological, development. The findings of pGALS and pREMS need to be interpreted in the clinical context.
Remind yourself of the normal major motor milestones and normal development – it’s a lot easier to identify abnormal when you’re happy with normal!
Please note: a pdf document of these Top Tips is also available here.
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