Clinical - GALS

Question 1

What is the order of each category used in GALS?

Answer 1

Introduction
Inspection

Following can be mixed order;
Gait
Arms
Legs
Spine

Conclusion

Question 2

What should you do in the Introduction?

Answer 2

1) . Ensure hand hygiene
2) . Introduce self to patient
3) . Identify patient - Name + DOB
4) . Ask what patient would like to be addressed as
5) . Explain what you are going to do
6) . Obtain verbal consent
7) . Ensure adequate exposure - shorts only

Ask 3 screening questions;

1) . Do you have any pain or stiffness in your muscles, joints or back?
2) . Can you dress yourself completely without any difficulty ?
3) . Can you walk up and down the stairs without any difficulty ?

Demonstrate and ask patient to stand in anatomical position

Question 3

What should you do in the Inspection?

Answer 3

Inspection (in the anatomical position);

General inspection — on general inspection 100k for any abnormal positioning / posture Of limbs.

Look for any swelling, deformity, scars, erythema over individual joints.

Inspect from the front — specifically look for head position in relation to trunk, shoulder contour, quadriceps
muscle bulk symmetry, mid or forefoot abnormalities.

Inspect from the side — specifically for normal cervical lordosis, thoracic kyphosis, lumbar lordosis. Can also
look at degree Of elbow and knee extension.

Inspect from the back — looking for normal shoulder muscle bulk, abnormal spinal alignment (scoliosis), level
iliac crests, gluteal muscle bulk and symmetry, popliteal swellings, calf rmscle bulk and hind foot
abnormalities.

Question 4

What should you do when assessing the Gait?

Answer 4

Gait;
- Ask the patient to walk forwards for a short distance, turn and walk back

• Look specifically for smoothness of movement, symmetry and turning ability.

Describe the gait. e.g. normal, antalgic, ataxic etc

Question 5

What should you do when assessing the Arms?

Answer 5

Arms;

Much of this can be done by simple demonstration

Shoulder;
- Ask patient to put hands behind his back and get thumbs as high up back as possible — this will assess for
internal rotation.
- Ask patient to put hands behind head — this Will reveal problems With shoulder abduction and external rotation.

Elbow;
- Ask patient to touch fingers to the shoulders of the same arm (flexion)
- Ask to straighten elbows (extension)
- Ask patient to bring elbows into sides and bend elbows to 90 degrees. Keeping elbows tucked into the sides -
instruct patient to turn palms towards floor (pronation) then towards the ceiling (supination).

Wrist;

• Perform the prayer sign — palm to palm, with fingers pointing upwards and then attempt to raise elbows. (wrist
  extension)
• Reverse this so the hands are dorsum to dorsum With fingers pointing down and then lower elbows. (wrist
  flexion)

Hands;
- Visually assess wrist and hand function by asking patient to make a fist with each hand.

• Assessment of strength of grip can be assessed by asking the patient to squeeze your fingers. (Offer 2 fingers)
• Pinch grip can be assessed by asking the patient to touch index, middle, ring and little fingers in tum to their
  thumb.
• Squeeze across the metacarpophalangeal (MCPJs) joints to check for tenderness suggesting inflammatory joint
  disease.

Question 6

What should you do when assessing the Spine?

Answer 6

Spine;

Cervical;

• Touch chin to chest (flexion)
• Look up towards the ceiling (extension)
• Look over shoulder — both sides (rotation)
• Move each ear down towards either shoulder (lateral flexion)

Thoracic;
-Crouch behind the patient and fix their pelvic position by holding the iliac crests — this will eliminate
contribution from the hip joints to this movement. The altemative way to fix the pelvis is to ask the patient to sit
on the couch — this will prevent pelvic rotation.

-Ask the patient to turn to each side as though looking behind him (rotation).

Lumbar;
- Ask the patient to keep levs straight and try to touch toes to assess for flexion of the lumbar spine. At the same
time, by placing fingers on the spinous processes Of two adjacent vertebrae, you can assess for normal vertebral
movement. The gap between fingers increasing on flexion and retuming to the original distance, on retum to a
standing position.

• Ask the patient to stand upright With hands at sides. Ask then to slide hands down the lateral aspect Of thighs in
  tum to assess lateral flexion.

Question 7

What should you do when assessing the Legs?

Answer 7

Legs

To adequately assess, the patient will need to be in a semi-recumbent position on an exam couch.

Hips; — test individually - start with active movement

• Ask the patient to bring knee towards his chest (hip flexion)
• Then assess internal and external rotation passively - holding the knee and ankle, flex the hip and knee to 90
  degrees and assess rotation.

Knees; — test individually

• Ask the patient to bring his heel towards his buttocks — (flexion)
• Place a hand behind the knee and ask him to to’ to press hand into the examination couch with the back of his
  knee (extension)
• Check for an effusion by performing a patellar tap (or cross fluctuation test for small effusion).

Ankles:

• Ask the patient to keep his knees straight and try to point his toes towards his head (dorsi-flexion).
• Now ask the patient to point his toes down “as though going into a tip-toe position” (plantar flexion)

Feet;

• Inspect the soles ofthe feet for any obvious callus formation — may indicate abnormal weight distribution while walking.
• Squeeze across the metatarsophalangeal joints (MTPJs) which might indicate an inflammatory process.

Question 8

What should you do to conclude the examination?

Answer 8

Conclusion;

• Thank the patient
• Wash hands
• Prepare to summarise findings.