5 GAL Flashcards
describe and perform the GALS examination
Gait
- observe patient walking / turning/ walking back
Arms
- look for asymmetry
- see if elbows are straight
- ask patient to put both hands behind the head and push elbows back
- observe supination/pronation
- examine hands
- observe grip
- assess dexterity of hands
Legs
- look for deformity / asymmetry
- assess hip + knee flexion
- assess rotation of hip
- look for rashes/ callus on sole
Spine
- look fo asymmetry / scoliosis / swelling/ tendon/ spinal curvature observation
==> squeeze skin over trapezius - tenderness = fibromyalgia
- ask to bend forward + touch toes
Compare btw arthritis + Arthralgia
arthritis = to definite inflammation of a
joint
arthralgia = pain within joint without demonstrable inflammation by physical examination
what are the 5 signs of active inflammation?
- swelling (tumor)
- warmth (calor)
- erythema (rubor)
- tenderness (dolor)
- loss of function (functio laesa)
gout = acute joint inflammation
define gout
A disease in which tissue deposition of monosodium urate (MSU) crystals occurs due to hyperuricaemia –> and leads to one or more of:
a) Gouty arthritis
b) Tophi (aggregated deposits of MSU in tissue)
–> commonly affects MTP joint of the big toe
defne joint deformity
malalignment of two articulating bones
define crepitus
audible and palpable sensation resulting from movement of one roughened surface on another
–> classic feature of osteoarthritis
define dislocation
articulating surfaces are displaced and no longer incontact
define subluxation
partial dislocation
define valgus
lower limb deformity whereby distal part is directed away from the midline
e.g. hallux valgus
define varus
lower limb deformity whereby distal part is directed towards the midline
e.g. varus knee with medial compartment OA
Mechanical joint defects are identified by:
- painful restriction of motion in absence of features of inflammation
- instability
-
The distribution of the polyarthritis is helpful in the differential diagnosis:
- bilateral and symmetrical involvement of large and small joints is typical of =
lower limb asymmetrical oligoarthritis and axial involvement would be typical of =
exclusive inflammation of the distal interphalangeal joints of the fingers is highly suggestive of =
bilateral and symmetrical involvement of large and small joints is typical of RHEUMATOID ARTHRITIS
lower limb asymmetrical oligoarthritis and axial involvement would be typical of REACTIVE ARTHRITIS
exclusive inflammation of the distal interphalangeal joints of the fingers is highly suggestive of PSORIATIC ARTHRITIS
POLY arthritis =
Oligoarthritis =
MONO arthritis =
POLY arthritis = > 4 joints
OLIGO arthritis = 2- 4 joints
MONO arthritis = single joint
The distribution of the polyarthritis is helpful in the differential diagnosis:
- bilateral and symmetrical involvement of large and small joints is typical of =
lower limb asymmetrical oligoarthritis and axial involvement would be typical of =
exclusive inflammation of the distal interphalangeal joints of the fingers is highly suggestive of =
inflammation of 1sts CMC , DIP, PIP MYP –> suggestive of =
gout usually affects =
bilateral and symmetrical involvement of large and small joints is typical of RHEUMATOID ARTHRITIS
lower limb asymmetrical oligoarthritis and axial involvement of PIP + MCP would be typical of REACTIVE ARTHRITIS
exclusive inflammation of the DIP joints of the fingers is highly suggestive of PSORIATIC ARTHRITIS
inflammation of 1sts CMC , DIP, PIP MYP –> suggestive of = osteoarthritis
gout usually affects = 1st MTP / ankle / knees
What synthesises synovial fluid?
- synthesized by synovial lining cells
synovial fluid =
viscous fluid in joint space of synovial joints
synovial fluid =
viscous fluid in joint space of synovial joints
- -> rich in hyaluronic acid
- -> accumulates in joint disease
- ->
abnormal increase in synovial fluid volume =
synovial effusion - normal composition
unlike in synovitis (which has inflammatory exudate)
What can cause synovial effusion?
a) Increased production of hyaluronic acid by synovial fibroblasts–> due to mechanical forces
b) Excess hyaluronic acid –> increases oncotic pressure + increases synovial volume
When is it useful or important to examine synovial fluid?
how is it performed ?
- when joint infection is suspected
- to confirm diagnosis in suspected crystal arthritis
performed by:
- needle aspiration under aseptic conditions (termed arthrocentesis)
–> contraindication if they have abnormal bleeding conditions / skin infection
why might raynaud’s phenomenon common in connective tissue disorders such as SLE?
- Intermittent vasospasm of digits on exposure to cold
- Typical colour changes – white to blue to red
–> Vasospasm leads to blanching of digit
–> Cyanosis as static venous blood deoxygenates
Reactive hyperaemia
What is SJÖGREN’S SYNDROME
connective tissue disease
Autoimmune exocrinopathy
occurs –> there is lymphocytic infiltration of especially exocrine glands
What is inflammatory muscle diseases
connective tissue disease
- Proximal muscle weakness due to autoimmune-mediated inflammation either with (dermatomyositis) or without (polymyositis) a rash
- -> skin changes visible
- -> associated with autoantibodies (antinuclear antibody)
Systemic Sclerosis
connective tissue disease
- Thickened skin with Raynaud’s phenomenon
- ->
Systemic Sclerosis
connective tissue disease
- Thickened skin with Raynaud’s phenomenon
- -> caused by accumulation of collagen, and by injuries to small arteries.
