GALS Examination - Assessing the locomotor system Flashcards
What does GALS stand for?
What should the patient ideally be wearing?
Gait
Arm
Legs
Spine
The more logical GSAL
Just shorts or undergarments - even socks need to come off
What 3 screening questions should you ask?
Any pain, swelling, or stiffness in joints/muscles?
Any difficult getting dressed?
Any difficulty getting upstairs?
Gait:
You would observe the walk!
How many phases are there to the gait cycle?
What do you need to look at? -
What do you look for in the arms?
What must you get them to do at the end of walking?
What would you say if it was normal? - 3
6 phases
Smoothness
Heel strike
Toe off
Arm swing
Turn quickly - testing turn speed
Gait was smooth, symmetrical, with a quick turn and good arm swing.
Gait:
Waddling gait:
- What muscles are impaired?
- Is it uni/bilateral?
- What usually causes this?
Trendelenburg gait:
- What muscles are impaired?
- Is it uni/bilateral?
- What nerve pathology causes this?
Bilateral weakness of hip abductor muscles
Muscular dystrophy
====
Unilateral weakness of the hip abductors
Superior gluteal nerve or L5 radiculopathy
Inspection for arms, legs and spine:
Why is obesity something you should pay attention to?
What does wasting of muscles suggest?
What aids and adaptions may the patient have that would suggest current clinical status?
Risk of osteoarthritis
Joint pathology
LMN injury
Support slings, splints, walking aids and wheelchairs
Anterior inspection of arms, legs and spine:
What may affect posture?
Elbow position:
- Cubitus valgus - what is it?
- Cubitus varies - what is it?
Genu valgum and genu varum. What do they mean?
Scoliosis
Increased carrying angle:
- Previous elbow trauma
- Congenital deformity (Turner’s)
Decreased carrying angle
- Supracondylar fracture of the humerus
Knocked kneed
Bow leg
Anterior inspection of arms, legs and spine:
What spine problem can cause pelvic tilt?
What may be wrong with the legs themselves which result in this?
What muscle may be weak resulting in this?
Scoliosis
Leg length discrepency
Hip abductor weakness
Anterior inspection of arms, legs and spine:
Claw toe - what joint is bent? - 2
Hammer toe - what joint is bent?
Mallet toe - what joint is bent?
Big toe:
- What is hallux valgus commonly known as?
- Knowing this, what is the opposite of this?
Both proximal and distal metatarsal joint
Proximal metatarsal joint
Distal metatarsal joint
Think about C to H to M - remember in alphabetical order - C is both, H is proximal and M is distal
https://www.afacc.net/foot-problems/hammertoe-deformity/
Bunions
Hallus varum
Lateral inspection of arms, legs and spine:
What is the difference between lordosis and kyphosis?
What does cervical lordosis suggest?
Thoracic kyphosis suggests congenital wedging of the veterbrae.
What joint disease does lumbar lordosis suggest?
What is the medical name for being flat footed?
Lordosis - inner curve of spine
Kyphosis - outer curvature —-
Chronic degenerative joint disease (e.g. osteoarthritis)
Sacroilliac joint disease (AS)
Pes planus
Pes cavus is the opposite
Posterior inspection of arms, legs and spine:
What does asymmetry in muscle bulk suggest? - 2
What do you look for in the spine alignment?
What does iliac crest misalignment suggest? - 2
Popliteal swellings:
- What is the name of the cyst that can occur here?
- What vascular pathology could occur here?
What does Achilles tendon thickening suggest?
Joint pathology
LMN injury
Scoliosis
Leg length discrepency
Hip abductor weakness
Baker cyst
Popliteal aneurysm
Achille’s tendonitis
Arms:
(1) Hands behind head and point their elbows out to the side:
- What 3 movements does this assess? - do it yourself and think about it
- What does limited movement suggest?
- What does excessive movement suggest?
(2) Hands held out in front with palms facing down and fingers outstretched:
- What movements does this assess? - do it yourself and think about it
- What does nail pitting of the nails suggest?
Shoulder abduction
External rotation
Elbow flexion
Joint pathology - e.g. osteoarthritis
Hypermobiltiy ===== Flexion of the shoulders Elbow extension Wrist extension Extension of the small joints of the fingers
Psoriasis
Arms:
(3) Hands turned over:
- What movements does this assess? - do it yourself and think about it
(4) Making a fist:
- What movements does this assess? - do it yourself and think about it
(5) Grip strength:
- What may cause a LMN lesion? - think about the nerves that supply that hand
Wrist and elbow supination
Flexion of small joints of the fingers
Median nerve damage secondary to carpal tunnel syndrome
Arms:
(7) Precision grip:
- What do you ask the patient to do to assess this?
Touch each finger in turn to their thumb
Legs:
What passive movements do you do? - 3
What can be done to look for joint effusion at the knee?
Knee flexion
Knee extension
Internal rotation of the hip
Patellar tap
Spine:
You basically do the main parts of the spinal examination!
Spine:
You basically do the main parts of the spinal examination!
