GALS

Question 1

How exposed should the patient be?

Answer 1

chest, upper and lower body

Question 2

What should you do before you begin?

Answer 2

Ask if the patient is in any pain

Question 3

What are the three important questions to ask at the start?

Answer 3

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

Question 4

Summary of things to consider when examining gait?

Answer 4

• Is the patient demonstrating a normal heel strike/toe off gait?
• Arm swing?
• Is each step of normal height? - increased stepping height noted in foot drop
• Is gait smooth and symmetrical?
• Abnormalities - antalgia/waddling/festinant/broad based/high stepping?

Question 5

From where do you inspect the spine?

Answer 5

Front, side and back

Question 6

Summary of spine inspection?

Answer 6

• Stand behind patient and assess straightness of spine, muscle bulk and symmetry in legs and trunk.
• Look for asymmetry at level of iliac crests (unilateral leg shortening) and swelling or other abnormality of gluteal, hamstring, popliteal and calf muscles.
• Look at the Achilles tendons and hindfoot regions for swelling or deformity.

Question 7

Assessment of physiological spine tings?

Answer 7

• Cervical lordosis - assess for hyperlordosis - spondylolisthesis/ osteoporosis/ discitis
• Thoracic kyphosis - normal is 20-45 degrees - hyperkyphosis = >45 degrees. Indicative of vertebral #/ Scheuermann’s kyphosis.
• Lumbar lordosis - assess for hyperlordosis - common causes include obesity and tight lower back muscles.

Question 8

Summarise assessment of spine movement?

Answer 8

• Stand beside patient. Ask him to bend down and touch his toes. Highlights any abnormal spinal curvature or limited hip extension.
• Stand behind patient, hold pelvis, ask him to turn from side to side without moving feet. Tests THORACOLUMBAR ROTATION.
• Ask patient to slide the hand down the lateral aspect of the leg towards the knee. Tests LATERAL LUMBAR FLEXION.
• Stand in front of patient, ask to put ear on shoulder. Tests LATERAL CERVICAL FLEXION.
• Ask patient to look up at ceiling and down at the floor to test CERVICAL FLEXION and EXTENSION.
• Ask patient to let jaw drop pen and move it from side to side. Tests both TEMPOROMANDIBULAR JOINTS.

Question 9

Where you do inspect arms?

Answer 9

Front

Question 10

Summarise inspection of arms?

Answer 10

• Swelling/deformity of wrists and hands - may suggest RA.
• Inspect palms - assess muscle bulk of thenar and hypothenar eminences.
• Inspect dorsum of the hand and check for full finger extension at the MCP, PIP and DIP joints.
• Gently squeeze metacarpal heads - tenderness indicates inflammation (RA)

Question 11

Summary of movement of Arms?

Answer 11

• Ask patient to clench fists then open palms flat.
• Ask patient to squeeze middle and index fingers - tests strength of power grip.
• Ask patient to touch each fingertip with thumb - assesses precision grip and problems with co-ordination or concentration.
• Show the patient how to make the ‘prayer sign’ - bending the wrists back as far as possible. Put the backs of the hands together in a similar fashion. This assesses wrist flexion and extension.
• Ask patient to extend hands straight in front of body. Assesses elbow extension.
• Ask patient to bend the arms up to touch the shoulders. Assesses elbow flexion.
• With elbow bent 90 degrees, ask patient to turn palms up and down. Assesses supination and pronation at wrist and elbow.
• Ask patient to place hands behind head with elbows going back. This tests abduction and external rotation of the GH joint.
• Firmly press the midpoint of each supraspinatus to test for hyperalgesia.

Question 12

How should the patient be positioned for leg examination?

Answer 12

Supine on couch

Question 13

Summary of leg movement?

Answer 13

• If no contraindication, perform Thomas’ test for fixed flexion on both hips.
• Palpate each knee for warmth and swelling. Check for patellar tap.
• Flex each hip and knee with your hand on the patient’s knee. Feel for crepitus in the patellofemoral joint and knee.
• Flex the patient’s knee and hip to 90 degrees and passively rotate each hip internally and externally, noting pain or limited movement.
• Look at feet for any abnormality. Examine the soles, looking for calluses and ulcers indicative of abnormal load bearing.
• Gently sequeeze metatarsal heads for tenderness.

Question 14

End piece?

Answer 14

Say you would perform a focused exam on joints with suspected pathology.