Examinations

Question 1

What is GALS?

Answer 1

Gait, Arms, Legs, Spine assessment.

A quick screening assessment for MSK disorders.

Question 2

Explain GALS assessment in osce.

Answer 2

Explanation and consent

Adequate exposure

General inspection

General examination

Gait exam

Arms exam

Legs exam

Spine exam

Additional examinations

Professionalism

Question 3

Explain arms assessment in GALS.

Answer 3

Inspection of hands, both palmar and dorsal - comment on deformities.

Assess pincergrip and powergrip.

Squeeze across 2nd-5th MCPJs for tenderness.

Elbow flexion and extension

Pronation and supination

Shoulder external rotation

Question 4

Explain legs assessment in GALS.

Answer 4

Deformities, leg length inequality, swellings or muscle wasting.

Knee joint effusion

Passive knee flexion and extension

Hip flexion and internal rotation

Feet for deformities and callosities

MTPJ squeeze test for tenderness

Question 5

Explain spine assessment in GALS.

Answer 5

Inspect spine from behind and from the sides.

Palpate over supraspinatus

Test cervical spine lateral flexion

Test hip and lumbar spine flexion

Question 6

Explain antalgic gait.

Answer 6

Pain causes the patient to reduce the time spent on the affected side.

Question 7

Explain trendelenburg gait.

Answer 7

Poor hip abduction.

Pelvis drops down on the opposite side when standing on the affected leg.

Question 8

Explain sensory ataxia.

Answer 8

Wide-based stamping.

Sight helps to compensate making it worse when eyes are shut.

Question 9

Explain cerebellar ataxia.

Answer 9

Wide-based staggering.

Arms often flung out to try to improve balance.

Question 10

Explain hemiplegic gait.

Answer 10

Narrow-based where the leg is swung forwards and the toes scrap the ground.

Question 11

Explain festinant or projectile gait.

Answer 11

Difficulty in inatiating walking and then there is a shuffling run.

Reduced arm swing.

Question 12

Explain waddling gait.

Answer 12

Duck-like due to bilateral hip muscle weakness.

Question 13

Explain psychogenic gait.

Answer 13

Variable but worse when under observation.

Question 14

Explain bow legs.

Answer 14

Due to medial compartment arthritis usually OA as the medial compartment takes most load.

Question 15

Explain knock knees.

Answer 15

Much less common and are indicative of both compartments being involved in inflammatory arthritis.

Question 16

What might flat feet be a feature of?

Answer 16

Joint hypermobility syndromes and of inflammatory arthritis.

Question 17

Explain examination sequence of hand examination.

Answer 17

Explanation and consent

Adequate exposure

General inspection

General examination

Look

Feel

Move

Function

Additional examination

Professionalism

Question 18

Explain what to look for in hand examination.

Answer 18

Dorsal and palmar aspects

Deformities, scars, swelling and wasting.

Skin - Calcinosis, telangiectasia, psoriasis.

Nails - psoriasis

Rheumatoid nodules or tophi on extensor aspects of elbows.

Question 19

What to feel for on hand examination.

Answer 19

Joint tenderness

MCPJ and wrists - RA

Thumb bases and DIPJs - OA

Warm swellings - RA

Bony swelling - OA

Soft swellings - RA

Tendon swelling with tendon crepitus - RA

Dupuytren’s

Question 20

Movement examination in hand examination.

Answer 20

Ask to make a fist - watch flexion and MCPJ, PIPJs and DIPJs.

Fully extend fingers

Check wrist flexion and extension

Radial and ulnar deviation

Check supination and pronation

Question 21

What functions will you ask the patient to do on hand examination?

Answer 21

Ask patient to undo a button, pick up something.

Write with a pen.

Question 22

Additional examinations to carry out in hand exam.

Answer 22

Thumb abduction - median nerve

Little finger abduction - ulnar nerve

Phalen’s and Tinel’s tests

Light touch and pin prick sensation

Question 23

What are Tinel’s and Phalen’s tests done for?

Answer 23

To diagnose carpal tunnel syndrome.

Question 24

Explain Tinel’s test.

Answer 24

Tap over the carpal tunnel with your index and middle fingers for 30-60 seconds.

If the patient develops tingling in the thumb and radial two and a half fingers this suggests median nerve irritation.

Question 25

Explain Phalen’s test.

Answer 25

Ask the patient to hold their wrist in complete and forced flexion for 60 seconds.

If the patient’s symptom develop then the test is positive.

Question 26

Hand weaknesses in CTS.

Answer 26

Thumb opposition and abduction.

Patient is asked to abduct their thumb and to touch the little finger with their thumb as opposition.