GALS and SPINE MSK examination Flashcards
When examining the patient what position do you want them to be standing in?
Anatomical position
What are the three questions you need to ask at the start of a GALS examination
Are they in any pain in your joints or in the back?
Do they find it difficult to get dressed or washed?
Do they find it difficult to go up or down a flight of stairs
What planes do you look at when inspecting the patient?
Front
Side
Behind
What are you looking for on inspection?
In what plane for each?
Muscle bulk ( front and back)
Alignment of the spine ( side and behind)
Any hyper flexion and extension of the knees and elbows (side and back)
Bakers cyst ( side and back)
Foot abnormalities (side and back)
What are you inspecting in spine?
Kyphoisis ( thoracic and sacral)
Lordosis ( cervical and lumbar)
Scoliosis
Iliac crest alignment
What are the foot abnormalities you are looking for?
High arch palate (pes cavus)
Low arch palate ( pes planus)
Hallux Valgus (bunnion)
Toe clawing
What is a possible sign of Charcot Marie tooth disease/
Pes cavus ( high arch palate)
What are you looking for in GAIT?
Smoothness Stride length Arm swing Turning quickly Symmetry
How do you want the hands to be on inspection?
Stretch their hands out and outstretch their fingers
What are you looking for on the palmar side?
Any muscle wasting in the hyperthenar and thenar eminence
What two movements do you ask the patient to do when assessing abduction and extension?
Hand behind their back and head
How do you test for power grip and precision grip?
Power grip from them to make a fist and then grip your two fingers
Precision grip–> pincer movement of their fingers
How do you test for inflammatory disease in their hands?
Squeeze their MCP joints and look at their face
What are you testing for in the leg?
Do active flexion and extension of the leg
Then passive looking for crepitus
Also do flexion and internal rotation of the hip
What extra test do you do of the knee for patellar effusion
Patellar tap
what are you testing in the spine?
Lateral flexion of the C spine
Then bending forward for the L spine
How do you test the temperomandibular joint in the spine section?
You ask the patient to open their mouth and side to side
What further examination would you do after GALS?
Specific area examination and also imaging
What do you ask the patient to do firstly in a spinal exam?
Ask them to sit and stand to look at their spine posture
On feel section of spinal examination what are you feeling?
Palpate cervical to lumbar spinal process and sacral iliac joints
Looking for tenderness and symmetry
Also palpate the para-spinal muscles for tenderness
What planes do you look at when assessing the spine?
Sideways
Back
What are you assessing from sideways view of spine?
Lordosis and Kyphosis
What are you assessing from looking from behind of the spine?
Sciolosis
Muscle wasting
Asymmetry
What movements are you doing in the cervical section of the spine?
Cervical flexion: Chin to chest
Cervical Extension: Tilt head backwards
Cervical lateral flexion: ear to shoulder
Rotation of head
What movements are you doing in lumbar section of the spine? While your finger is placed on lumbar area?
Lumbar flexion
Lumbar extension
Lumbar lateral flexion
What does straight leg raise indicate?
If you have nerve pain in the leg
What does Dorsiflexion of the big toe indicate?
L5 nerve root problem
What upper reflexes are you suppose to do?
o check biceps, triceps and supinator reflexes in each arm.
What lower reflexes are you suppose to do?
Patella and ankle jerk.
Common presenting complaints in GALS?
Back pain Pain in joints Stiffness in joints Swelling Reduced mobility Fatigue
What are the different types of onsent and what do they indicate?
Acute–> RA/gout
Sub acute –> septic
Chronic –> OA
What do you ask in radiation?
How many joints affected and has the number increased
What associated symptoms should you ask in MSK history?
Fever, malaise Stiffness or swelling Being depressed Reduced mobility GI problems, psiorasis, weight loss Any Vascular or neuropathic symptoms
In terms of mechanical injury does these actions relieve or exacerbate the pain?
a) exercise
b) rest
c) NSAIDS
a) exacerbates
b) relieves
c) relieves midley
In terms of infection injury does these actions relieve or exacerbate the pain?
a) exercise
b) rest
c) NSAIDS
a) relieves
b) exacerbates
c) greatly relieves
What PMH would you ask?
TB DM Trauma Vascular/neuro Psoarsis
What should you ask in social history?
What job they do and if this has stopped them from doing it?
Hobbies and has it had a affect
The effect on their daily living
Affect on their mood and if they are depressed
Home circumstances getting around
