GALs Examination Flashcards
Acute monoarthritis is ____ until proven otherwise
Septic arthritis
State the two most common causative organisms of septic arthritis
- Staphylococcus aureus
- Streptococcus
- Gonococcal (young and sexually active)
- Gram -ve bacilii
State some potential causes of chronic monarthritis; consider:
- Infections
- Inflammatory
- Non-inflammatory
- Tumours
- Infections
- TB
- Inflammatory
- Psoriatic arthritis
- Reactive arthritis
- Foreign body
- Non-inflammatory
- Osteoarthritis
- Traumatic e.g. meniscal tear
- Osteonecrosis (associated with prednisolone use)
- Neuropathic e.g. Charcot’s joint
- Tumours
Compare inflammatory vs mechanical disease, include:
- Morning stiffness
- Effect of activity
- Effect of resting
- Fatigue
- Systemic involvement
What assessment do we use to screen for MSK disorders?
GALS (gait, arms, legs)
Outline the 8 main stages in your GALS examination
- Introduction
- Screening questions
- Gait
- Inspection: general, anterior, posterior, lateral
- Arms
- Legs
- Spine
- Tempormandibular joint
What 3 screening questions should you ask at the start of your GALs examination?
- Do you have any pain or stiffness in your muscles, joints or back?
- Do you have any difficult getting yourself dressed without any help?
- Do you have a problem going up and down stairs?
Describe how you assess the pts gait
Get pt to walk to end of room, turn around, and walk back whilst you observe for:
- Gait cycle
- Range of movement
- Limping
- Leg length
- Turning
- Trendelenburg’s giat
- Waddling gait
- Assess pts footwear (lookign for unequal sole wearing)
Inspection has 4 parts: general, anterior, posteior & lateral. What would you look for in the general inspection stage of your GALs examination?
- General inspection of pt
- Body habitus
- Scars
- Wasting of muscles
- Psoriais
- Inspection of surroundings
- Aids & adaptations e.g. support slings, splints, walking aids
- Prescriptions or medciations
What would you look for in the anterior inspection?
- Posture
- Scars
- Joint swelling
- Joint erythema
- Muscle bulk
- Elbow extension (e.g. cubitus varus or valgus)
- Valgus joint deformity (e.g. knees knocking together)
- Varus joint deformity (e.g. bow-legged)
- Pelvic tilt
- Fixed flexion deformities of toe e.g. hammer toe, mallot toe
- Big toe e.g. evidence of hallux valgus or varus
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What would you look for in the lateral inspection?
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
- Knee joint hyperextension
- Foot arch
What would you look for in posterior inspection?
- Muscle bulk
- Spinal alignment
- Iliac crest alignment
- Popliteal swellings
- Achilles tendon thickening
- Valgus joint deformity e.g. of ankle
- Varus joint deformity e.g. of ankle
What would you do in the arms section of your GALS examintion?
- Test movement
- Hands behind head
- Hands held out in front iwth palms facing down
- Hands held out in front with palms facing up
- Make a fist
- Grip strength
- Precision grip (ask pt to touch each finger with their thumb)
- Metacaropphalangeal squeeze
What would you do in the legs section of your GALs examination?
Position pt lying down:
- Passive movement
- Knee flexion
- Knee extension
- Internal hip rotation
- Patellar tap (use left hand to empty suprapatellar pouch by sliding hand down thigh to upper border of patella. Keep left hand in position and use right hand to press downwards on patella with fingertips. If fluid present you will feel a distinct tap as patella bumps against femur)
What would you do in the spine section of your GALS examination?
NOTE: if already perfomed this in general inspection don’t need to repeat. Assess:
- Cervical lateral flexion
- Lumbar flexion (place two fingers on lumbar vertebrate ~5-10cm apart, ask pt to bend over and observe your fingers. They should move apart)
