8: GALS screen (+ bits of everything) Flashcards
What does GALS stand for
- Gait
- Arms
- Legs
- Spine
What is the reason behind performing a GALS test?
It is a screening test –> designed to be quick screening to pick up early musculoscletal abnormalities
How would you initiate a GALS screening?
Ask key questions
- Have you any pain or stiffness in your muscles, joints or back?
- Can you dress yourself completely without any difficulty?
- Can you walk up and down stairs without any difficulty?
When performint the Examination of the GALS screen, which order do you examine GALS?
- Gait
- Spine
- Arms
- Legs
How do you examine the GAIT in a GALS screen?
observe patient walking, turning and walking back
look for:
- smoothness and symmetry of leg, pelvis and arm movements
- normal stride length
- ability to turn quickly
How do you examine the spine in a GALS screen?
Look at the spine from top to bottom and look for symmetry
- Is paraspinal and shoulder girdle muscle bulk symmetrical?
- Is the spine straight?
- Are the iliac crests level?
- Is the gluteal muscle bulk normal?
- Are the popliteal swellings?
- Are the Achilles tendons normal?
- Are there signs of fibromyalgia?
- condition, characterised by certain trigger points of pain
- Test the trigger points: does mild pressure over either mid-point of each supraspinatus or gentle squeezing of skinfold over trapezius muscles elicit tenderness?
Ask the patinet to turn to the side and examine:
- Are spinal curvatures normal?
- e.g. lumbar lordosis might indicate ankylosing spondolytis
- Is lumbar spine and hip flexion normal?
- ask patient to touch their toes
- Is cervical spine normal?
- ask patient to perform lateral cervical spine movement
What do you test in the Arms of the GALS screen?
- Look for normal girdle muscle bulk and symmetry
- Look to see if there is full extension at the elbows
- Are shoulder joints normal?
- ask patient to position hand behing head with elbows as far back as possible
- Examine hands palms down with fingers straight
- Observe supination, pronation, grip and finger movements
- Test for synovitis at the metacarpo-phalangeal joints (MCP joints)
- is the sqeeze painful?
What do you test in the Examination of the Legs in the GALS screen?
- Look for knee or foot deformity
- Assess flexion of hip and knee
- assess flexion of hip and knee, whilst supporting the knee. passively internally rotate each hip, in flexion
- Look for knee swellings
- examine each knee for presence of fluid using ‘bulge’ sign and ‘patella tap’ sign
- Test for synovitis at the metatarso-phalangeal joints (MTP joints)
- sqeeze, discomfort suggests synovitis
- Inspect soles of the feet
- for rashes and Callocitis
If you detect a joint abnormaliy in a GALS screen, what is the next step?
Further investigate joint: Locomotor examination
- Inspection: swelling, redness, deformity
- Palpation: warmth, crepitus, tenderness
- Movement: active, passive, against resistance
-
Function: loss of function
- Is it inflammatory?
- Swelling + Tendernis (most clinically useful but also all other signs of infammation )
If there is an abnormal joint detected in the GALS screen, which qestions do you try to address with the Locomotor examination?
What is the nature of the joint abnormality?
- Is there inflammation?
- Is there irreversible joint damage?
- Is there a mechanical defect?
What is the extend of the joint abnormatlity?
Are any other features of diagnostic importance present?
When detecting joint inflammation in the GALS screen, name some exaples what you could find and which conditions these findings are associated with
Is it arthritis?
- Gout?
- osteoarthritis?
What is the swelling like?
Enthesopathy?
What is enthesopathy?
pathology at the enthesis i.e. the site where ligament or tendon inserts into bone, if inflammation: enthesitis
•examples include:
- plantar fasciitis
- Achilles tendinitis
Name signs of irreversible joint damage
- Deformities
- Crepitations
- Loss of normal range of movement
Which factors do you look for when assesing the extend of the joint abnormality involved?
- The Number of joints involved
- polyarthritis >4
- olioarthritis 2-4
- Monoarthritis
- Is involvement symmetrical?
- Note the size of involved joints
- Is there axiall involvement?
What would be a typical pattern of arthritis in rheumatoid arthritis?
•bilateral and symmetrical involvement of large and small joints is typical of rheumatoidarthritis (normally no involvement of axial joints, except C1+2)
What would be a typical pattern of arthritis in reavtive arthritis?
•lower limb asymmetrical oligoarthritis and axial involvement would be typical of reactive arthritis
What would be a typical pattern of arthritis in gout?
•exclusive inflammation of the first metatarsophalangeal joints is highly suggestive of gout
–> Also often knee affected aswell
What are commonly spared joints in osteoarthrits?
Name a main extraarticular feature of Rheumatoid arthritis
SUBCUTANEOUS NODULES
- often around olecranon
What is Gout?
A disease in which tissue deposition of monosodium urate (MSU) crystals occurs as a result of hyperuricaemia and leads to one or more of the following:
- •Gouty arthritis
- •Tophi (aggregated deposits of MSU in tissue)
Often leading to
- extremely painful
- abrupt onset
- red, warm swollen joint (often 1st MTP joint, knee)
What is arthritis?
refers to definite inflammation of a joint(s) i.e. swelling, tenderness and warmth of affected joints
What is arthralgia?
refers to pain within a joint(s) without demonstrable inflammation by physical examination
What is a dislocation?
articulating surfaces are displaced and no longer in contact
What is a Subluxation?
Partial dislocation
What is a Varus deformity?
Lower limb deformity whereby
distal part is directed towards the midline e.g. varus knee with medial compartment osteoarthritis
What is a Valgus Deformity?
lower limb deformity whereby whereby distal part is directed away from the midline e.g. hallux valgus
When would you perform a synovial fluid examination?
To confirm or exclude an infectious cause for an inflammed joint
What is meant by the term synovial effusion?
An abnormal increase in synovial fluid
- often presnet in joint disease
Which molecule determines the viscosity of the synovial fluid?
What kind of molecule is it?
the hyaluronic acid which results in the increased viscosity of synovial fluid
- Is a GAG protein (glycosaminoglycan)
What is Raynaud’s phenomenon?
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
–> it is very common in normal population but can be an indicator for Rheumatoid Arthritis, SLE
What are the different components of a synovial joint?
(i) articular capsule,
(ii) articular cartilage,
(iiI) synovial fluid
What is the structure and function of the articular capsule in synovial joints?
he articular capsule surrounds the joint and is continuous with the periosteum of articulating bones
- Outer Fibrous layer
- Inner Synovial Layer (Synovium)
- highly vascularised and involved in nutrient exchange of everything
- 1-3 cells deep
- Type I collagen
What is the structure and function of articular cartilage?
Hyaline cartilage covers articulating surfaces:
(i) minimises friction upon joint movement, and
(iii) absorbs shock.
Mainly composed of Aggrecan (Proteoglycan)
Type II collagen
What is a proteoglycan?
glycoproteins containing sulphated glycosaminoglycan chains e.g.
- Core proein and
- many GAG chains attached
- E.g. Aggrecan
What is a glycosaminoglycan?
(i) repeating polymers of disaccharides e.g.
* •Hyaluronic acid (= hyaluronate)
