GALs

Question 1

What is GALS?

Answer 1

Gait
Arms
Legs
Spine

Question 2

What is the adequate exposure?

Answer 2

Exposed chest, upper and lower body

Ideally in shorts +/- vest

Question 3

What are the screening questions?

Answer 3

Any joint stiffness and/or pain?

Can you dress yourself?

Can you walk up and down stairs?

Question 4

What are you looking for in gait?

Answer 4

Gait cycle
Able to turn
Evidence of pain

Question 5

What are abnormal gaits?

Answer 5

Antalgic
Myopathic
Ataxic
Parkinsonian

Question 6

What is an antalgic gait?

Answer 6

Decreased stance phase due to pain

‘limping’

Question 7

What is a myopathic gait?

Answer 7

Hip abductors fail and hip drops on affected side

Question 8

What is an ataxic gait?

Answer 8

Prolonged stance
Reduced swing

Wide base position

Question 9

What is a parkinsonian gait?

Answer 9

Small shuffling gait

Often with leaning forward to build up speed

Question 10

What can you inspect from the front?

Answer 10

Scioliosis/asymmetry 
Obesity / cachexia 
Rashes
Shoulder bulk 
Nromal elbow extension (5-15 degrees)
Varus/valgus deformity 
Knee deformity

Question 11

What can you inspect from the side?

Answer 11

Hyperlordosis in neck 
Thoracic kyphosis 
Lumbar lordosis 
Knee flextion 
Foot arches

Question 12

What can you inspect from behind?

Answer 12

Shoulder bulk 
Scoliosis 
Pelivic tilt 
Gluteal wasting 
Popliteal swellings 
Achilles tendon

Question 13

What do you assess in the hands?

Answer 13

Feel all hand joints

Assess temperature

Question 14

What deformities can be seen in the hand?

Answer 14

Bouchard nodes 
Heberden nodes
Z-thumb 
Swan neck deformity 
Boutonnieres 

Thenar/hypothenar wasting

Question 15

What are Bouchard nodes?

Answer 15

Nodes at PIPJs

Question 16

What are Heberden nodes?

Answer 16

Nodes at DIPJs

Question 17

What is a z-thumb?

Answer 17

Seen in RA

Z shaped thumb

Question 18

What is swan neck deformity?

Answer 18

Flexed DIPJ

Hyperextended PIPJ

Question 19

What is Boutonnieres?

Answer 19

Extended DIPJ

Flexed PIPJ

Question 20

What movements do you ask in the arms?

Answer 20

Hands behind head

• shoulder abduction
• elbow flexion

Hands out with fingers outstretched

• pronation
• shoulder flexion
• finger extension

Turn hands over
- supination

Make fist
- finger flexion

Squeeze finger
- grip strength

Touch each finger to thumb

Question 21

What movements do you do in legs?

Answer 21

Passive

• knee flexion
• knee extension
• hip internal rotation

Question 22

What else do you look for in the legs?

Answer 22

Patellar effusion

• tap
• sweep

Question 23

What do you look for in the spine?

Answer 23

Scoliosis
Lordosis
Kyphosis

Question 24

What is scoliosis?

Answer 24

Sideways curvature of spine

Question 25

What is kyphosis?

Answer 25

Excessive outward curvature of the spine

Question 26

What is lordosis?

Answer 26

Excessive inward curvature of the spine

Question 27

What movements do you ask for in spine?

Answer 27

Lateral flexion of cervical spine

Question 28

What else do you assess?

Answer 28

TMJ

- ask patient to put 3 of own fingers in their mouth