GALS + REMS Flashcards
GALS general inspection
Body habitus
Scars
Muscle wasting
Psoriasis
Objects - aids, adaptations, prescriptions
GAIT
Gait cycling abnormalities
Range movement
Limping
Leg length
Turning
Trendelenburg
Waddling gait
Footwear
Anterior inspection GALS
Posture
Scars
Joint swell
Joint erythema
Muscle bulk
Elbow extension
Valgus joint deformity
Varus joint deformity
Pelvic tilt
Varus vs valgus
Varus = excessive inward angulation
Valgus = excessive outward angulation
Lateral inspection patient position
Ask patient turn 90 degrees
Lateral inspection
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Knee joint hyper extension
Foot arch
How much should knee be able to extend
Comfortably 10 degrees - beyond = joint laxity
Posterior inspection
Muscle bulk
Spinal alignment
Iliac crest alignment
Popliteal swellings
Thickened Achilles’ tendon
Valgus or Varus deformity
ARMS inspection
Hands behind head - interlock hands elbows out
What look for arms inspection hands behind head
Shoulder abduction
External rotation
Elbow flexion
Range of elbow and shoulder movement
What look for arms hands in front palms down
Forward flexion shoulders
Elbow and wrist extension
Extension small joints fingers
For sun hands
Nails
Psoriasis
2nd arm inspection position
Hold hands out in front
Palms facing down
Fingers outstretched
What look for palms up arms inspection
Supination movement
Thenar and hypothenar eminences
What condition is thenar and hypo wasting seen in?
Carpal tunnel
3rd step arms inspect
Flip hands over
4th step arms inspect
Make a fist
What look for when make a fist
Wrist and elbow supination
5th step arms
Grip strength - squeeze fingers as hard as you can’t
What look for in grips strength
Should be bilaterally equal - compare
Swelling hand, Lower motor neurone
Precision grip look for
Coordination small joints
Speed -Brady or tachy
Osteo, gout, RA, traumatic injury
What is metacarpopharyngeal squeeze?
Feel over joints of hand
What look for in MCP squeeze
Verbal discomfort
Non verbal
Acute inflammatory arthropathy
Boxers fracture - punch wall
Colour and warmth
Legs steps exam
Lying down
Passive knee flexion
Passive knee extension - hold leg gently above knee
What look for on knee flex
Hyperextension start
Click, grind, pop
Pain
Discomfort
Locked joint
Decreased ROM
OA, meniscus pathology
What is normal knee range of flexion movement
0-140 degrees
Always compare
Scars knee
Either side - arthroscopy
Straight line - knee replacement
Why is lock joint a red flag
Need imaging asap
Meniscus pathology
Tibia moving away from fibula
ACL/ligament injury
What look for passivelnee extension
Signs discomfort
Beyond 10 degrees
Ligament laxity, ruptured ligaments
What look for passive internal hip rotation
Signs discomfort
10 degrees discomfort
OA of hip
What hip fracture would you never move
Neck of femur fracture
What condition can a metatarsalphalangeal joint squeeze show
Inflammatory arthropathy eg RA
Compare symmetry
Spine exam steps
Cervical spine flexion - ear to shoulder
What look for on cervical spine flexion
Discomfort/pain
Decreased ROM
Lumbar flexion what look for
Fingers move apart from adjacent spinal processes
TMJ JOINT INSPECT
Decreased ROM, pain
Cracking, locking
High impact trauma
Normal to be able to fit three fingers vertically into mouth
When to use REMS
After GALS - found problem, inspect region in more detail
Basis of joint exam
Look, feel, move
Feel at same time to compare
Joint specific movements and what test for
Anterior drawer test - ACL
empty can test - supraspinatus - motion like emptying can
Simmonds test - Achilles’ tendon - feel calf
