GALS examination Flashcards by Bethany Smith

What is the first part of any introduction to an examination?

Wash hands
Intro self
Pt details

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Explain a GALS exam to a patient

I’ve been asked to do a quick examination to screen for any joint problems, it’s going to involve me having a general inspection, watching you walk and getting you to do some head, arms and legs movement.

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What else would you include in your intro?

Expose ok?
Chaperone?
Pain or discomfort?

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What is the appropriate exposure for a GALS exam?

top, trousers, socks and shoes off

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What screening questions do you ask in a GALS exam?

Do you have any pain or stiffness in your muscles, joints or back?
Are you able to completely dress and undress yourself without any difficulty?
Are you able to climb up and down stairs without any difficulty?

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When inspecting from the front what are you looking at?

Posture

Body habitus

Skin rashes

Shoulders

Elbows

Leg length + alignment

Quadriceps

Knees

Ankles

Feet

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When inspecting from the side what are you looking at?

Cervical spine

Thoracic spine

Lumbar spine

Knee joints

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When inspecting from the back what are you looking at?

Shoulder muscles

Spinal alignment

Iliac crest alignment

Gluteal muscle bulk

Popliteal swellings

Hind-food abnormalities

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When inspecting from the front what might you see when inspecting the following and what may they indicate?
a) Posture
b) Body habitus
c) Skin rashes

a) Any asymmetry/scoliosis.

b) Obesity can be associated with joint pathology like
early-onset osteoarthritis in the knees.
A thin, malnourished adult may be at increased risk of
fractures of osteomalacia.

c) Salmon coloured plaques with silvery scale over
extensor surfaces in psoriasis
Associated with psoriatic arthritis.

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When inspecting the shoulders from the front what do you assess

What may changes indicate?

Assess shoulder bulk

Muscle wasting suggests chronic joint disease.

Asymmetry of the shoulders may be due to unilateral wasting or scoliosis of the spine.

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When inspecting the elbows from the front what do you assess

What may changes indicate?

Assess the patient’s carrying angle (normal 5–15°).

Joint contractures can result in inability to extend elbow at rest.

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When inspecting leg length and alignment from the front what do you assess?

What may changes indicate?

Note any leg length inequality.

Valgus (knock-knees)/varus (bowed legs) + deformity of the hip/knee may result in misalignment of the limb.

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When inspecting the quadriceps from the front what do you do?

What may changes indicate?

Assess muscle bulk + symmetry.

Muscle wasting suggests chronic joint disease.

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When inspecting the knees from the front what do you assess

What may changes indicate?

Swelling + erythema of a knee joint may suggest inflammatory arthritis or joint sepsis.

Valgus/varus deformity.

Any asymmetry from joint effusion.

Any hyperextension of the knee joints (hypermobility).

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When inspecting the ankles from the front what do you assess

What may changes indicate?

Swelling + erythema of an ankle joint may suggest inflammatory arthritis or joint sepsis.

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When inspecting the feet from the front what do you assess?

Note any mid-foot/fore-foot deformity (flat feet).

Note any asymmetry between the feet (bunion).

When inspecting from the side what are you assessing in the following?
a) Cervical spine
b) Thoracic spine
c) Lumbar spine
d) Knee joints

a) Inspect for hyperlordosis (slipped vertebra).

b) Inspect degree of thoracic kyphosis (normal 20–40°).
Hyperkyphosis = >45°

c) Inspect degree of lordosis.
Loss of lumbar lordosis may suggest sacroiliac joint
disease.

d) Note degree of flexion.
Look for any hyperextension of the knee joints
(hypermobility).

When inspecting from the back what do you assess in the following?
a) Shoulder muscles
b) Spinal alignment
c) Iliac crest alignment
d) Gluteal muscle bulk
e) Popliteal swellings
f) Hind-food abnormalities

What may changes indicate?

a) Assess shoulder bulk…
Muscle wasting suggests chronic joint disease.
Asymmetry of the shoulders may be due to unilateral
wasting or scoliosis of the spine.

b) Look for evidence of scoliosis (S-shaped spine).

c) Pelvic tilt may suggest hip abductor weakness.

d) Wasting of gluteal muscles suggests reduced mobility.

e) Baker’s cyst (non-pulsatile).
Popliteal aneurysms (pulsatile).

f) Thickening of the Achille’s tendon may suggest
tendonitis.

When assessing gait what do you look for?

What should you ask the patient?

Inspect the gait cycle (heel strike, toe-off) + coordination.
Any evidence of antalgic (painful) gait?
Is their arm swing normal?
Any pelvic tilt?
Are they able to turn quickly without issues.
Are foot arches normal or absent?

Ask if walking is painful/painless.

When assessing the spine what tests should you do?

Cervical spine - Lateral flexion

Lumbar spine - flexion

How do you assess lateral flexion of the cervical spine

Ask the patient to touch their ear to their shoulder on each side

How do you assess Lumbar flexion?

Place fingers on two adjacent lumbar vertebrae.
Ask patient to bend forward to touch their toes.
Observe fingers moving apart (bend forward) and then coming together (bend backward).

If a patient is able to place their hands on the floor when testing lumbar flexion what does it suggest?

Joint hypermobility

When assessing the shoulders what do you want to ask the patient to do?

Why?

What can different ROMs suggest?

“Can you place your hands behind your head and push your elbows back as far as you can?”

Assesses shoulder abduction + external rotation and elbow flexion.

Restricted ROM suggests shoulder/elbow pathology.
Excessive ROM suggests hypermobility.

When assessing the wrist and hands what do you ask the patient to do first? Why? What do you want to inspect?

“Can you put your hands out in front of you with your palms down?” Assesses shoulder flexion, elbow extension, wrist extension + extension of small joints of fingers. Inspect the backs of hands for asymmetry, joint swelling + deformity. Inspect the nails for signs associated with psoriasis (nail pitting).

When assessing the wrist and hands what do you ask the patient to do next? Why? What do you want to inspect?

“Can you turn your hands over now?” Assesses wrist + elbow supination. Inspect the muscle bulk of the palms (thenar/hypothenar eminences) for muscle wasting. Restriction of supination suggests wrist/elbow pathology.

What do you want to text when palpating the wrist / hands Why?

Lateral squeeze of the metacarpophalangeal joints. Check for non-verbal signs of discomfort. Tenderness indicates active inflammatory arthropathy.

What movements should you ask a patient to do with their hands? Why? What may changes / difference suggest?

“Can you make a fist?” Assesses flexion of small joints of the fingers + hand function. Patient may be unable to make a fist if they have joint swelling (inflammatory arthritis/infection) or if they have other deformities of the small joints of the hands. “Can you squeeze my fingers?” Assesses grip strength. Grip strength may be reduced due to pain (swelling of the small joints of the hand) or due to nerve pathology (carpal tunnel syndrome). “Can you touch each finger to your thumb?” Assesses precision grip, coordination + overall manual dexterity in the small joints of the fingers + thumbs. Reduced manual dexterity may suggest inflammation or joint contractures of the small joints of the hand.

To examine the legs of a patient how do you want them to be positioned?

lying down on the examination couch

When assessing the hips and knees what do you want to ask a patient to do? Why? What should you note when doing this?

“Can you bring your foot to your bum and straighten it out again whilst I hold your knee? Assesses active knee flexion/extension, one limb at a time. Feel for crepitus over the patella. Note the ROM + any asymmetry between knee joints.

What other test should be performed on the knee?

Patellar tap

What do you inspect for in the feet? What do you palpate in the feet?

Inspect the soles of the feet for swelling, deformity or callosities. Lateral squeeze of the metatarsophalangeal joints; Check for non-verbal signs of discomfort. Tenderness indicates active inflammatory arthropathy.

Upon completing the exam what do you do first?

Thank patient Wash hands

To complete my exam....

if any abnormalities were detected, I would perform a regional examination of the musculoskeletal system

Summarise a normal GALS examination

Today I performed a GALS examination on ___ a __ y/o ____. On general inspection ____ appeared comfortable at rest Normal appearance in gait, arms, legs and spine Full ROM in all modalities tested To conclude this is consistent with a normal GALS examination