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Yr 3 - Clinical Examinations > GALS Examination > Flashcards

GALS Examination Flashcards

1
Q

What does GALS stand for?

A

Gait Arms Legs Spine

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2
Q

Ideally, how should patient be exposed for a GALS exam?

A

Only wearing shorts and undergarments

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3
Q

What is the purpose of a GALS exam?

A

Screen for functional disability

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4
Q

Before beginning the examination, what 3 screening questions are asked?

A

1) Any pain or stiffness in your muscles, joints or back?
2) Any difficulty getting yourself dressed without any help?
3) Any problem going up and down the stairs?

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5
Q

What is the first question (pain/stiffness in muscles/joints/back) screening for?

A

Screens for common symptoms present in most forms of joint pathology

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6
Q

What are some examples of joint pathologies?

A

Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis

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7
Q

What is the second question (difficulty getting dressed) screening for?

A

Screens for fine motor impairment and significant restriction joint range of movement

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8
Q

What is the third question (problem going up and down stairs) screening for?

A

Screens for impaired gross motor function and general mobility issues (e.g. restricted range of movement in the joints of the lower limb)

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9
Q

What is the difference between fine and gross motor function?

A

Gross: skills involving large muscle movements, such as independent sitting, crawling, walking, or running.

Fine: use of smaller muscles, such as grasping, object manipulation, or drawing

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10
Q

Define gait

A

A person’s manner of walking

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11
Q

How do you assess the patient’s gait?

A

Ask the patient to walk to the end of the examination room and then turn and walk back whilst you observe their gait.

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12
Q

What 8 signs are you looking for when assessing the patient’s gait?

A
  1. Gait cycle
  2. Range of movement
  3. Limping
  4. Leg length
  5. Turning
  6. Trendelenburg’s gait
  7. Waddling gait
  8. Footwear
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13
Q

In what pathologies is range of gait movement often reduced?

A

Chronic joint pathology e.g. osteoarthritis, inflammatory arthritis

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14
Q

What is an antalgic gait?

A

An abnormal pattern of walking 2ary to pain that ultimately causes a limp (stance phase is shortened relative to the swing phase).

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15
Q

What would limping suggest?

A

Joint pain (antalgic gait) or weakness

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16
Q

How may a patient with joint disease ‘turn’?

A

Patients with joint disease may turn slowly due to restrictions in joint range of movement or instability

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17
Q

What is Trendelenburg’s gait?

What is it caused by?

A

Abnormal gait caused by unilateral weakness of hip abductor muscles → ‘pelvic drop’ on side of swinging leg

Caused by superior gluteal nerve lesion or L5 radiculopathy

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18
Q

What is a waddling gait?

A

Abnormal gait caused by bilateral weakness of hip abductor muscles.

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19
Q

What is a waddling gait typically associated with?

A

Myopathies e.g. muscular dystrophy

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20
Q

What are the 6 phases of the gait cycle?

A
  1. Heel strike
  2. Foot flat
  3. Mid-stance
  4. Heel-off
  5. Toe-off
  6. Swing
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21
Q

What 4 clinical signs are you looking for during the general inspection of a GALS exam?

A
  1. Body habitus
  2. Scars
  3. Muscle wasting
  4. Psoriasis
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22
Q

Why are you assessing a person’s body habitus?

A

Obesity is significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis)

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23
Q

What could muscle wasting indicate?

A

Disuse atrophy secondary to:

  • joint pathology
  • lower motor neuron injury
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24
Q

How does psoriasis typically present?

A

Salmon coloured plaques on extensor surfaces

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25
Q

What type of MSK pathology is psorasis associated wtih?

A

Psoriatic arthritis

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26
Q

During a closer inspection of the patient in a GALS exam, which position is the patient in? Which angles are you looking from?

A

Ask the patient to stand in the anatomical position and turn in 90-degree increments as you inspect from each angle for evidence of pathology (anterior/lateral/posterior/lateral).

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27
Q

During closer inspection of the anterior view, what 11 signs are you assessing for?

A
  1. Posture
  2. Scars
  3. Joint swelling
  4. Muscle bulk
  5. Joint erythema
  6. Elbow extension
  7. Valgus joint deformity
  8. Varus joint deformity
  9. Pelvic tilt
  10. Fixed flexion deformity of the toes
  11. Big toe deformities
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28
Q

What can asymmetry in posture indicate?

A

Scoliosis or joint pathology

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29
Q

What can unilateral joint swelling indicate?

A

Effusion, inflammatory arthropathy, septic arthritis

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30
Q

What is joint erythema suggestive of? What conditions is this seen in?

A

Active inflammation e.g. inflammatory arthropathy, septic arthritis

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31
Q

What can asymmetry in muscle bulk be due to?

A

Disuse atrophy, lower motor neuron injury

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32
Q

What is the normal carrying angle of the elbow?

A

5-15 degrees

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33
Q

What is an increased elbow carrying angle referred to as?

A

Cubitus valgus

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34
Q

What is cubitus valgus typically associated with?

A
  • Previous elbow joint trauma
    • Congenital deformity (e.g. Turner’s syndrome)
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35
Q

Which congenital abnormality is associated with cubitus valgus?

A

Turner’s syndrome

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36
Q

What is Turner’s syndrome?

A
  • Chromosomal disorder; one of the X chromosomes is missing (or partially missing)
  • Only affects females
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37
Q

What is a decreased elbow carrying angle referred to as?

A

Cubitus varus / ‘gunstock deformity’

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38
Q

Which trauma is cubitus varus typically associated with?

A

Typically develops after supracondylar fracture of the humerus

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39
Q

Describe ‘valgus deformity of the knee’

A

Tibia is turned outward in relation to femur, resulting in knees ‘knocking’ together

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40
Q

Describe ‘varus deformity of the knee’

A

Tibia is turned inward in relation to femur, resulting in bowlegged appearance

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41
Q

What pathologies can cause a lateral pelvic tilt?

A
  • Scoliosis
  • Leg length discrepancy
    • Hip abductor weakness
42
Q

Name 2 subtypes of ‘fixed flexion’ deformities of the toe

A
  1. Hammer toe
  2. Mallet toe
43
Q

What are ‘fixed flexion’ deformities of the toes?

A

These are foot deformities that occur due to an imbalance in the muscles, tendons or ligaments that normally hold the toe straight.

44
Q

What is hammer toe?

A

An abnormal bend in middle joint of toe causing toe to bend down towards the floor

45
Q

What is mallet toe?

A

Affects joints nearest toenail (distal joints)

46
Q

What is the medical term for a bunion?

A

Hallux valgus

47
Q

During closer inspection of the lateral side of the patient, what 5 things are you assessing for?

A
  1. Cervical lordosis
  2. Thoracic kyphosis
  3. Lumbar lordosis
  4. Knee joint hyperextension
  5. Foot arch
48
Q

What is cervical lordosis associated with?

A

Chronic degenerative joint disease (e.g. osteoarthritis)

49
Q

What is the normal amount of thoracic kyphosis?

A

20-45 degrees

50
Q

What congenital disease is hyperkyphosis associated with?

A

Scheuermann’s disease (congenital wedging of the vertebrae)

51
Q

What is the loss of normal lumbar lordosis suggestive of?

A

Sacroiliac joint disease (e.g. ankylosing spondylitis)

52
Q

What is ankylosing spondylitis?

A

Ankylosing spondylitis is a type of arthritis in which there is a long-term inflammation of the joints of the spine. Can cause fusion of vertebrae.

53
Q

What is knee joint hyperextension seen in?

A

Ligamentous damage, hypermobility syndrome

54
Q

Describe ‘pes planus’

55
Q

Describe ‘pes cavus’

A

Abnormally raised foot arch

56
Q

During closer inspection of the posterior angle of the patient, what 7 things are you assessing for?

A
  1. Muscle bulk
  2. Spinal alignment
  3. Iliac crest alignment
  4. Popliteal swellings
  5. Achilles’ tendon thickening
  6. Valgus joint deformity
  7. Varus deformity
57
Q

What would lateral curvature of the spine suggest?

58
Q

What can iliac crest misalignment indicate?

A
  • Leg length discrepancy
  • Hip abductor weakness
59
Q

What are 2 examples of causes of popliteal swellings?

A
  1. Baker’s cyst
  2. Popliteal aneurysm (typically pulsatile)
60
Q

What is Achilles’ tendon thickening associated with?

A

Achilles’ tendonitis

61
Q

What 6 compound movements of the arms are you assessing?

A
  1. Hands behind head
  2. Hands held out in front with palms facing down
  3. Hands held out in front with palms facing up
  4. Making a fist
  5. Grip strength
  6. Precision grip
62
Q

What 3 movements are you assessing in ‘hands behind head’?

A
  1. Shoulder abduction
  2. External rotation
  3. Elbow flexion
63
Q

What would a restricted/excessive range of movement during ‘hands behind the head’ indicate?

A

Restricted → shoulder or elbow pathology (e.g. osteoarthritis)

Excessive → hypermobility

64
Q

What 4 movements are you assessing during ‘hands held out in front with palms facing down’?

A
  1. Forward flexion of shoulders
  2. Elbow extension
  3. Wrist extension
  4. Extension of small joints of fingers
65
Q

What clinical signs you assessing the hands for in ‘hands held out in front with palms facing down’?

A

Inspect dorsum of hands for asymmetry, joint swelling and defomity; rheumatoid arthritis, Heberden’s nodes, Bouchard’s nodes, swan neck defomity

Inspect nails for signs associated with psoriasis e.g. nail pitting

66
Q

What joints do Heberden’s nodes affect?

67
Q

What joints do Bouchard’s nodes affect?

68
Q

What movement are you assessing in ‘hands held out in front with palms facing up’?

A

Wrist and elbow supination

69
Q

What does restriction of wrist/elbow supination indicate?

A

Wrist/elbow pathology e.g. osteoarthritis

70
Q

What clinical signs are you looking for in ‘hands held out in front with palms facing up’?

A

Inspect thenar and hypothenar eminences for evidence of muscle wasting

71
Q

What movements are you assessing in ‘making a fist’?

A

Flexion of small joints of fingers and overall hand function

72
Q

What pathologies may be indicated if the patient is unable to make a fist?

A
  • Joint swelling (e.g. inflammatory arthritis, infection)
  • Deformities of small joints of hands
73
Q

What is reduced grip strength indicative of?

A
  • Pain e.g. swelling of small joints of hands
  • Motor neuron lesions (e.g. median nerve damage 2ary to carpal tunnel syndrome)
74
Q

How will carpal tunnel syndrome affect grip strength?

A

Reduced grip strength due to median nerve damage

75
Q

What are the instructions for the patient in ‘grip strength’?

A

Ask patient to squeeze your fingers and assess grip strength (comparing the patient’s hands)

76
Q

What are the instructions for the patient in ‘precision grip’?

A

Ask patient to touch each finger in turn to their thumb

77
Q

What movements does ‘precision grip’ assess?

A

Coordination of the small joints of the fingers and thumbs

78
Q

What can reduced manual dexterity (precision grip) indicate?

A

Inflammation or joint contractures of the small joints of the hands

79
Q

What is meant by ‘passive’ movement?

A

Movement of the patient which is controlled by the examiner

80
Q

What should you feel for and observe for during passive movement of a joint?

A
  • Crepitus (e.g. osteoarthritis)
  • Discomfort/restriction in range of movement
81
Q

What are the 3 steps involved in passive movement of the legs?

A
  1. Passive knee flexion
  2. Passive knee extension
  3. Passive internal rotation of hip
82
Q

What is the normal range of movement of knee flexion?

A

0-140 degrees

83
Q

How do you assess normal passive knee extension?

A

If patient is able to lay their legs flat on the bed, they are already demonstrating a normal range of movement for knee extension.

84
Q

How do you assess for knee hyperextension?

A
  • 1) On the leg being assessed, hold above the ankle joint and gently lift leg upwards
  • 2) Inspect knee joint for evidence of hyperextension, with less than 10 degrees being considered normal
85
Q

What can excessive knee hyperextension suggest?

A

pathology affecting the integrity of the knee joint’s ligament or hypermobility

86
Q

What is the normal range of movement of internal rotation of the hip?

A

40 degrees

87
Q

How do you assess a patient’s internal rotation of hip?

A

Flex patient’s hip and knee joint to 90 degrees and then rotate their foot laterally

88
Q

What 3 signs do you inspect the feet for?

A
  1. Swelling
  2. Callosities
  3. Deformity
89
Q

What test follows foot inspection?

A

Metatarsophalangeal joint squeeze

90
Q

What is involved in the MTP joint squeeze? What is tenderness associated with?

A

Gently squeeze the MTP joints and observe for verbal and non-verbal signs of discomfort. Tenderness is suggestive of active inflammatory arthropathy.

91
Q

What pathologies can cause joint effusion?

A

ligament rupture (e.g. ACL), septic arthritis, inflammatory arthritis and osteoarthritis.

92
Q

What does the patellar tap test screen for?

A

Screens for presence of moderate-to-large knee joint effusion

93
Q

Describe the steps of the patellar tap test

A
  1. With the patient’s knee fully extended, empty the suprapatellar pouch by sliding your left hand down the thigh to the upper border of the patellar
  2. Keep your hand in position and use your right hand to press downwards on the patella with your fingertips
  3. If there is fluid present, you will feel a distinct tap as the patella bumps against the femur
94
Q

What movements of the spine are assessed?

A
  1. Cervical lateral flexion
  2. Lumbar flexion
95
Q

How do you assess cervical lateral flexion?

A

Ask patient to tilt head to each side (moving their ear towards their shoulder)

96
Q

How do you assess lumbar flexion?

A
  • 1) Place two of your fingers on the lumbar vertebrae approx. 5-10 cm apart
  • 2) Ask patient to bend forwards and touch their toes
  • 3) Observe your fingers as the patient’s lumbar spine flexes (they should move apart)
  • 4) Observe your fingers as the patient extends their spine to return to a standing position (your fingers should move back together)
97
Q

Why do you assess range of lumbar flexion using fingers to palpate?

A

loss of lumbar flexion can be masked by good hip flexion, making inspection without palpation less reliable

98
Q

What is the final step of a GALS exam?

A

Examining the TMJ

99
Q

What does assessment of the TMJ screen for?

A

Assesses the temporomandibular joint’s range of movement and screens for deviation of jaw movement

100
Q

How do you assess TMJ?

A

Ask patient to open their mouth wide and put three of their fingers into their mouth.

101
Q

What further investigations could follow a GALS exam?

A
  • Focused examination of joints with suspected pathology
  • Further imaging if indicated (e.g. x-ray, MRI)

Yr 3 - Clinical Examinations (11 decks)

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