Principles of Assessment in Adolescent and Young Adult Rheumatology Practice

  • Helen Foster
  • Sharmila JandialEmail author
Part of the In Clinical Practice book series (ICP)


Musculoskeletal (MSK) presentations are common, ranking highly in the self-reported health problems amongst adolescents, and result from a spectrum of causes. The evidence-based approach to paediatric and adolescent MSK clinical examination includes a basic examination (pGALS) and a more detailed regional MSK examination (pREMS). These tools were developed in recognition that ‘children are not little adults’. The MSK assessment must be interpreted in the context of general assessment, suspected ‘red flags’ and systemic enquiry. The importance of early diagnosis and prompt referral of suspected MSK disease to specialist teams is increasingly relevant in the era of potent treatments for AYA with rheumatic disease but also applies to other MSK conditions.


Clinical assessment Clinical skills 


  1. 1.
    Baker KF, Jandial S, Thompson B, Walker D, Taylor K, Foster HE. Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice – a UK survey. BMC Med Educ. 2016;16(1):277.CrossRefGoogle Scholar
  2. 2.
    Chan MO, Sen E, Heasman P, Rapley T, Wraith E, Clayton E, Foster HE. Detecting joint abnormalities in children with mucopolysaccharidoses using pGALS. Pediatr Rheumatol Online J. 2014;12:32.CrossRefGoogle Scholar
  3. 3.
    Foster HE, Kay LJ, May CR, Rapley TR. pREMS – pediatric regional musculoskeletal examination for school aged children. Arthritis Care Res. 2011;63(11):1503–7.CrossRefGoogle Scholar
  4. 4.
    Foster HE, Jandial S. pGALS – a simple examination of the musculoskeletal system. Pediatr Rheumatol Online. 2013;11:44.CrossRefGoogle Scholar
  5. 5.
    Goff I, Rowan A, Bateman BJ, Foster HE. Poor sensitivity of musculoskeletal history in children. Arch Dis Child. 2012;97(7):644–6.CrossRefGoogle Scholar
  6. 6.
    Goff I, Wise E, Boyd D, Jandial S, Foster HE. Paediatric musculoskeletal medicine for primary care. Educ Prim Care. 2014;25:249–56.CrossRefGoogle Scholar
  7. 7.
    Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents—a review. Pain. 1991;46(3):247–64.CrossRefGoogle Scholar
  8. 8.
    Jandial S, Rapley T, Foster H. Current teaching paediatric musculoskeletal medicine within UK medical schools. Rheumatology. 2009;48(5):587–90.CrossRefGoogle Scholar
  9. 9.
    Jandial S, Myers A, Wise E, Foster HE. Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. J Pediatr. 2009;154(2):267–71.CrossRefGoogle Scholar
  10. 10.
    Jandial S, Stewart J, Foster HE. What do medical students need to know about musculoskeletal medicine? BMC Med Educ. 2015;15:171.CrossRefGoogle Scholar
  11. 11.
    Morishita K, Petty RE. Musculoskeletal Manifestations of mucopolysaccharidoses. Rheumatology (Oxford). 2011;50(Suppl 5):v19–25. Review.CrossRefGoogle Scholar
  12. 12.
    Smith N, Rapley T, Jandial S, English C, Davies B, Wyllie R, Foster HE. Paediatric musculoskeletal matters (pmm)—collaborative development of an online evidence based interactive learning tool and information resource for education in paediatric musculoskeletal medicine. Pediatr Rheumatol Online J. 2016:5;14(1):1.Google Scholar

Further Reading and Resources

  1. BSR eLearning modules – – modules on adult JIA targeting educational needs of adult Rheumatology healthcare professionals.
  2. E-Learning for Healthcare. – modules on limp, normal Development and adolescent health issues.
  3. EULAR/PReS Online course in Paediatric rheumatology
  4. EUTEACH – – European Training in Effective Adolescent care and health.
  5. Newcastle University short online courses – paediatric musculoskeletal modules –
  6. Paediatric musculoskeletal matters12 –
  7. pGALS app – a free resource. Available through app stores and in multiple languages.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Newcastle University Medicine Malaysia (NUMed)Johor BahruMalaysia
  2. 2.Paediatric RheumatologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK

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