GALS

Question 1

What are the screening questions you should ask?

Answer 1

Any pain in your muscles, joints or back?
Are you able to dress yourself completely without any difficulty?
Are you able to walk up and down stairs without difficulty?

Question 2

What do you look for on inspection from the front?

Answer 2

Shoulder symmetry
Shoulder muscle bulk
Elbow extension
Quadriceps bulk
Knee swelling / deformity
Foot deformity

Question 3

What do you look for on inspection from the side?

Answer 3

Cervical / thoracic / lumbar spine shape
Knee flexion
Foot arches
Toe deformity

Question 4

What do you look for on inspection from behind?

Answer 4

Shoulder symmetry
Spinal alignment
Iliac crest alignment
Gluteal muscle bulk
Popliteal swellings
Hindfoot abnormalities

Question 5

What movements do you assess in the arms?

Answer 5

1. Arms behind head (shoulder abduction and external rotation)
2. Turn hands over (supination)
3. Make a fist (assessing function)
4. Squeeze doctor’s fingers (strength)
5. Touch each finger with thumb
6. Squeeze MCPs

Question 6

What do you look for on inspection of the hands?

Answer 6

Asymmetry
Joint swelling
Deformity
Thenar wasting / hypothenar wasting (palms)

Question 7

What movements do you assess in the legs?

Answer 7

1. Knee flexion and extension (feel for crepitus)

2. Passive internal rotation of the hip joints with knee + hip flexion (turn ankle outwards)

Question 8

What do you look for on inspection of the feet?

Answer 8

Swelling
Callosities
Deformity

Question 9

What do you feel in the feet?

Answer 9

Squeeze MTP joints (observe for pain)

Question 10

What do you feel in the hands?

Answer 10

Squeeze MCP joints (observe for pain)

Question 11

What movements do you assess in the spine?

Answer 11

1. Cervical spine lateral flexion (45 degrees = normal)
2. Spine flexion with fingers on back - observe for change in distance between fingers
3. Jaw opening and closing with hands on TMJ

Question 12

What do you look for when assessing gait?

Answer 12

1. Gait cycle
2. Range of movement
3. Limping
4. Leg length
5. Turning (speed)
   Trendelenburg’s gait = abnormal gait caused by unilateral weakness of hip abductors (superior gluteal nerve pathology)
   Waddling gait = abnormal gait caused by bilateral weakness of hip abductors (myopathies eg muscular dystrophy)

Question 13

What do you feel on knee examination?

Answer 13

1. Temperature
2. Palpate quadriceps tendon, patella tendon and patella
3. Patellar tap (push down and feel for fluid)
4. Swipe test
5. Palpate knee when flexed (head of fibula, tibial tuberosity, popliteal fossa etc)

Question 14

What movements do you do only for a knee exam?

Answer 14

1. Active knee flexion and extension
2. Passive knee hyper-extension (should not be more than 10 degrees, lift leg whilst extended)
3. Anterior and posterior drawer test (cruciate ligaments)
4. Lachman’s test (same but at 30 degrees flexion)
5. Assess medial and lateral collateral ligaments