GALS

Question 1

What is the purpose of performing a GALS examination?

Answer 1

It is a rapid screening tool used to assess the first movements effected in rheumatic disease

Question 2

What should you ask as a patient performs each movement?

Answer 2

Is there any pain?

Question 3

What are the three initial questions to ask?

Answer 3

Do you have any pain of stiffness?
Are you able to dress and undress without difficulty?
Are you able to go up and down stairs without difficulty?

Question 4

What do you inspect from the front?

Answer 4

Abnormalities in all major joints

Question 5

What do you inspect from the side?

Answer 5

Normal spine curvatures
Hip and knee flexion deformity
Knee hyperextension

Question 6

What are the normal spine curvatures?

Answer 6

Cervical lordosis
Thoracic Kyphosis
Lumbar lordosis

Question 7

What should you assess during gait

Answer 7

Arm swing
Pelvic tilt
Stride length
Turning
Pain

Question 8

What do you assess for “spine”?

Answer 8

Flexion of lumbar spine

Lateral flexion of the neck

Question 9

How do you assess flexion of the lumbar spine?

Answer 9

Place fingers on two adjacent lumbar vertebrae
Ask patient to bend forward to touch their toes
Fingers should move apart then come back together

Question 10

How do you assess lateral flexion of the neck?

Answer 10

Ask patient to tilt their head sideways to touch ear to shoulder

Question 11

How do you assess shoulders?

Answer 11

Hands behind head

Push elbows back

Question 12

What do you look for on observation of the hands wrists and elbows?

Answer 12

Hands palm up and palm down out in front
Joint swelling/deformities
Loss of contours
Wasting
Skin/nail changes
Nodules

Question 13

What else do you observe when patient has arms straight out in front?

Answer 13

Ability to fully straighten elbow

Ability to supinate and pronate

Question 14

What do you feel for in the hands?

Answer 14

Tenderness

Laterally squeeze MCPs of hand and look for pain

Question 15

How do you assess movement in the hands?

Answer 15

Make a full fist
Squeeze your finger
Fingers to thumb individually

Question 16

How do you position patient to assess their legs?

Answer 16

Lie on table

Question 17

What do you do on assessment of the legs

Answer 17

Patient to fully flex and extend knee (crepitus)
Bend knee and hip to 90, assess internal and external rotation
Perform patellar tap

Question 18

How do you perform a patellar tap?

Answer 18

Slide hand down from mid thigh to upper pole of patellar
Push down firmly on patellar with 3 fingers
Positive result is a bounce and tap sound

Question 19

How do you assess the feet?

Answer 19

Inspect soles for swelling, deformity and callosities

MTP squeeze

Question 20

How do you complete the examination?

Answer 20

Thank patient
Ask to redress
Wash hands
Present findings