GALS

Question 1

Intial Questions

Answer 1

• Do you have any joint pain or stiffness in your muscles, joint or back?
• Can you dress without difficulty? - upper limb function
• Can you walk up and down the stairs without difficulty? - lower limb function

Question 2

Gait Observation

Answer 2

• Symmetry, smoothness and the ability to turn quickly
• Observe from standing the bulk and symmetry of shoulder, gluteal, quads and calf muscles
• Limb alignment
• Alignment of the spine
• Equal level of iliac crests
• Ability to fully extend elbows and knees
• Popliteal swelling
• Abnormalities in feet
• Comment on arm swing, pelvic tilt, stride length, ability to turn quickly and any antalgic (painful) gait on walking. Ask whether walking is painful/painless.

Question 3

Spinal Abnormalities

Answer 3

lordosis, kyphosis or asymmetry in shoulders, pelvis or knees

Question 4

Feel of spine

Answer 4

• Ask patient to tilt their head to get ear to shoulder - lateral flexion of the neck
• Bend to touch toes, Palpate to feel normal version of vertebrae by placing two fingers on lumbar vertebrae. Should move apart in flexion and back together on extension

Question 5

Arms observation

Answer 5

• Put hands behind their head - shoulder abduction and external rotation and elbow flexion
• Straighten arms completely - elbow extension
• Patients hand outstretched and arms in front of them check for deformities
• Turn hands over - supination assesses wrists and elbows
• Ask patient to make a fist - assess power grip hand and wrist function and range of movement in fingers
• Patient to put each finger in turn to meet thumb
• Gently squeeze MCP to check for tenderness

Question 6

Legs assessment

Answer 6

• Full flexion and extension of both knees as well as internal rotation
• Patellar Tap for effusion
• Check feet for deformities or callouses
• Squeeze MTP to check for tenderness suggesting inflammatory joint disease

Question 7

Further investigation

Answer 7

• A focused examination of joints with suspected pathology.
• Further imaging if indicated (e.g. X-ray and MRI).

Question 8

Possibel diagnosis

Answer 8

• RA
• OA
• Ankylosis Spondylitis