GALS (Gait/Arms/Legs/Spine) (geekymedics)

Question 1

(1) What three questions do you ask at the start of the examination?

Answer 1

• Do you have any pain or stiffness in your joints and muscles?
• Can you dress independently without any pain?
• Can you walk up and down stairs without any pain?

Question 2

(2) What are the five S’s of gait?

Answer 2

• Speed of turn
• Stride
• Symmetry
• Swing
• Smoothness

Question 3

(3) What abnormal gaits are there? (4 - probably many more!!)

Answer 3

• Parkinsonion
• Antalgic
• Hemiplegic
• Ataxic

Question 4

(4) What abnormalities may be observed when assessing the patients gait? (5)

Answer 4

• antalgia / waddling / festinant (Parkinson’s)/ broad based / high stepping (foot drop)

Question 5

(5) What is a normal carrying angle? What may an abnormal angle indicate?

Answer 5

• 5-15 degrees

* hyper mobility / fractions that haven’t healed correctly

Question 6

(6) When inspecting the patients feet from the front when standing what abnormality may be present?

Answer 6

• Bunions (hallux valgus)

Question 7

(7) What is assessed when inspecting the patient from the side? (4)

Answer 7

> Cervical lordosis
•assess for hyperlordosis: spondylolisthesis / osteoporosis / discitis

> Thoracic kyphosis:
• normal is 25-45 degrees - hyperkyphosis (>45) - Scheuermann’s kyphosis

> Lumbar lordosis:
•assess for hyperlordosis: spondylolisthesis - common causes include obesity / tight lower back muscles
•loss of lumbar lordosis (flat back syndrome): compression fractures / ankylosing spondylitis

> Assess degree of knee flexion / hyperextension

Question 8

(8) What are you looking for assessing foot arches? (2)

Answer 8

> flat feet (pes planus)

> high arched feet (pes cavus) - e.g. Charcot-Marie-Tooth disease

Question 9

(9) What abnormality may be visible when inspecting the toes from the side?

Answer 9

> Toe clawing - e.g. plantar fascial fibromatosis

Question 10

(B1) When inspecting the back what spinal abnormality are you checking for?

Answer 10

• Spinal scoliosis (S -shaped curvature)

Question 11

(B2) What may a pelvic tilt suggest? (2)

Answer 11

• hip aductor weakness / paralysis

Question 12

(B3) What does wasting of the gluteal muscles suggest?

Answer 12

> Reduced mobility

Question 13

(B4) What does popliteal swelling indicate? (2)

Answer 13

• baker’s cyst - may suggest OA, inflammatory arthritis, or gout
• popliteal aneurysm (pulsatile)

Question 14

(B5) When asking the patient to place their hands behind their head, what may swelling of the wrists & hands suggest?

Answer 14

•may suggest rheumatoid arthritis

Question 15

(B6) If there is tenderness when squeezing the MCP (metacarpophalangeal) joints what may this indicate?

Answer 15

• often present in inflammatory - e.g. rheumatoid arthritis

Question 16

(B7) When assessing passive full knee flexion and extension what should you be feeling for?

Answer 16

> Crepitus - OA / RA / bone fracture

Question 17

(B71) Describe the mechanism underlying the patella tap.

Answer 17

> By sliding your hand down the thigh and pushing down over the supra patella pouch, any effusion is forced behind the patella.

> A bounce and ‘tap’ indicates the presence of an effusion.

Question 18

(B8) If calluses are observed when inspecting the soles of the feet what may this suggest?

Answer 18

•a gait abnormality

Question 19

(B9) If there is pain when squeezing the MTJ’s (mid tarsal joint) what may this indicate? (2)

Answer 19

• gout

* septic arthritis

Question 20

(B91) When assessing lumbar flexion why is it important to place two fingers on the lumbar vertebrae and watch to see if they move apart on flexion and back together on extension?

Answer 20

> This movement can be achieved by relying on good hip flexion, so it is important to palpate for normal movement of the vertebrae.

Question 21

(C1) What further investigations and assessments should be suggested after completing the GALS exam? (2)

Answer 21

> Perform a focused examination on joints with suspected pathology
Request further imaging of joints with suspected pathology (X-ray / CT / MRI)

Question 22

(C2) Say an appropriate summary of a normal GALS examination.

Answer 22

> In summary, this was Pt X, a 20 y/o male, who had normal appearance of movement of gait, arms legs and spine. This was normal musculoskeletal examination.

> If any abnormalities were found on the screening examination, I could do an appropriate regional examination of the musculoskeletal system.