GALS Exam Flashcards
How would you describe what a GALS exam contained to a patient and gain consent?
“I’d like to examine your muscles and joints today, It’s going to involve you walking a bit and moving your arms, legs and back, is that okay?”
What are the 3 screen questions done before starting a GALS exam?
- “Do you have any pain or stiffness in your muscles, joints or back?”
- “Do you have any difficulty getting yourself dressed without any help?”
- “Do you have any problem going up and down the stairs?”
What is the general outline of a GALS exam?
- introduction
- screening questions
- inspection
- Gait
- Arms
- Legs
- Spine
- other tests
- completion
How do you inspect the patient in a GALS exam?
- Perform a brief general inspection of the patient, looking for clinical signs suggesting underlying pathology
- Inspect from front
- Inspect from side
- Inspect from behind
What things might you see when assessing someones gait?
- cycle
- range of movement
- limping
- leg length
- turning
- trendelenburg’s or waddling gait
- footwear choice
What is Trendelenburg’s gait?
Abnormal gait caused by unilateral weakness of hip abductor muscles secondary to superior gluteal nerve lesion
What is a waddling gait?
Abnormal gait caused by bilateral weakness of hip abductor muscles, typically associated with myopathies
How do you assess the patients arms in the GALS exam?
- ask to put their hands behind their head and point their elbows out to the side
- ask to hold their hands out in front of them with their palms facing down and fingers outstretched
- ask to turn their hands over to assess palmar aspect
- ask to make a fist
- ask to squeeze your fingers and assess grip strength
- ask the patient to touch each finger in tern to their thumb
- metacarpophalangeal joint squeeze
How do you assess the legs in a GALS exam?
- ask the patient to lie on the bed with their legs out in front of them
- ask them to fully flex and extend their knee, place hand to feel for crepitus as they do so
- bend the knee and hip to both 90, hold the knee and use the ankle to move leg, assessing internal and external rotation of the hip
- perform a patellar tap
How do you assess the feet in a GALS exam?
- inspect soles of feet for swelling, deformities or callosites
- metatarsophalangeal joint squeeze (watch patients face)
How do you assess spine in the GALS exam?
- ask patient to stand upright
- ask patient to try and touch your shoulder to your ear on each side (cervical lateral flexion)
- assess range of lumbar flexion
What further investigations might you do if an anomaly is found on a GALS exam?
- XR, MRI
- focused examination of affected joint
How do you perform a TMJ function test?
- ask patient to open their mouth wide and put 3 of their fingers into their mouth
State an example summary for a normal GALS exam
“Today I examined X, a X year old M/F. On general inspection he appeared comfortable at rest with no indication of MSK disease. There were no objects or medical equipment around the bed of relevance.
Assessment if the patients Gait, Arms, Legs and Spine were unremarkable.
In summary, these findings are consistent with a normal GALS examination.
If anomalies were seen, further investigations may include a more focussed exam of affected joints/areas, XR or MRI.”
