Examinations Flashcards
What is GALS?
Gait, Arms, Legs, Spine assessment.
A quick screening assessment for MSK disorders.
Explain GALS assessment in osce.
Explanation and consent
Adequate exposure
General inspection
General examination
Gait exam
Arms exam
Legs exam
Spine exam
Additional examinations
Professionalism
Explain arms assessment in GALS.
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
Explain legs assessment in GALS.
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
Explain spine assessment in GALS.
Inspect spine from behind and from the sides.
Palpate over supraspinatus
Test cervical spine lateral flexion
Test hip and lumbar spine flexion
Explain antalgic gait.
Pain causes the patient to reduce the time spent on the affected side.
Explain trendelenburg gait.
Poor hip abduction.
Pelvis drops down on the opposite side when standing on the affected leg.
Explain sensory ataxia.
Wide-based stamping.
Sight helps to compensate making it worse when eyes are shut.
Explain cerebellar ataxia.
Wide-based staggering.
Arms often flung out to try to improve balance.
Explain hemiplegic gait.
Narrow-based where the leg is swung forwards and the toes scrap the ground.
Explain festinant or projectile gait.
Difficulty in inatiating walking and then there is a shuffling run.
Reduced arm swing.
Explain waddling gait.
Duck-like due to bilateral hip muscle weakness.
Explain psychogenic gait.
Variable but worse when under observation.
Explain bow legs.
Due to medial compartment arthritis usually OA as the medial compartment takes most load.
Explain knock knees.
Much less common and are indicative of both compartments being involved in inflammatory arthritis.
What might flat feet be a feature of?
Joint hypermobility syndromes and of inflammatory arthritis.
Explain examination sequence of hand examination.
Explanation and consent
Adequate exposure
General inspection
General examination
Look
Feel
Move
Function
Additional examination
Professionalism
Explain what to look for in hand examination.
Dorsal and palmar aspects
Deformities, scars, swelling and wasting.
Skin - Calcinosis, telangiectasia, psoriasis.
Nails - psoriasis
Rheumatoid nodules or tophi on extensor aspects of elbows.
What to feel for on hand examination.
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
Movement examination in hand examination.
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
What functions will you ask the patient to do on hand examination?
Ask patient to undo a button, pick up something.
Write with a pen.
Additional examinations to carry out in hand exam.
Thumb abduction - median nerve
Little finger abduction - ulnar nerve
Phalen’s and Tinel’s tests
Light touch and pin prick sensation
What are Tinel’s and Phalen’s tests done for?
To diagnose carpal tunnel syndrome.
Explain Tinel’s test.
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.
Explain Phalen’s test.
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.
Hand weaknesses in CTS.
Thumb opposition and abduction.
Patient is asked to abduct their thumb and to touch the little finger with their thumb as opposition.
