GALS screen Flashcards
What are the main things checked during a GALS screen?
any of the joint abnorman
What is the nature of the abnormality-inflammation or mechanical
What is the extent of the the joint involvment-patters can clue diagnosis
Any other features of diagnostic importance (Eg: buttefly rash in lupus)
recall the 3 key questions asked in the gals screen?
Have you any pain/stiffness in muscle joint or back
-eg stiffness in morning
can you dress yourself completely without difficulty
Can you walk up and down stairs
must consider other issues: neurological and more
What does GALS stand for?
Gait, arm, legs, Spine
How do we examine GAIT in gals?
Observe patient walking, turning and walking back
Need to check for specific:
Smoothness and symmetry of leg, pelvis and arm –want to see early signs-because late sigs are usually easy
How do we examine Spine in gals?
Bulk muscle symetrical, spine straight, illiac crest level, gluteal muscle
spinous curvation normal-lumbar spine first to go-sublte
For neck-lot of thing but check if can move it right/left
flextion of lumbar spine, cervical spine
in fibromyalgia-pain in specific pressure points in muscle-can check
How do we examine arms in Gals?
Look for normal muscle bulk and symmetry
Full extension of shoulders/elbows-put hand straight out. etc–again all signs of early disease-eblow goes early
-again late signs its very gone
tight grips, put hands behind head-shoulder check
Examine hands palmdown-fingers straight
Supination, pronation, girp and finger movement
test for synovitis at MCP joint-rheumathoid -if swollen easy, or squeeze gently at mcp joint-tender in rheumathoid
How do we examine legs in gals?
Knee/foot deforminty
FLexion of hip -external rotation
FLexion of knee
Knee swelling-press on other part of leg-patella rise
test for synovitis at MTP (like for MCP)
Inspect sole of feet-secondary to disease-flat feet etc
What is the main information obtained from a GALS screen?
Inflammatory or mechanical-
Once see a abnormal joint-want to see that difference
Inspection-swelling, redness, deformity
Warmth, crepitus, tenderness
active, passive, against resistance movement
nature-inflammation, ireeversible joint damage, mechanical defect
SPECIFIC INFLAM-
What are the signs of inflamation for joint issues?
Swelling, warmth, erythema, tenderness, loss of function (4 Ors of inflammation)
What does arthiritis/arthralgia and dislocatio/subluxation mean?
arthiritis-means inflammation of join
arthralgia-pain in joint but looks without inflammation on clincal examination-in lupus arthalgia, RA-arthirits
Dislocation-articulating surfaces are displaces and no longer in contact
Subluxation-partial
Varus deformity-lower limb defomity where distal part is directed towards midline
Valgus deforminty-distal part directed away from midline
What is gout? clinical signs?
Acute gout is good exemple of arthiritis
single, very inflammed joint
Deposits of monosodium urate crystals in joint-arthirits or tophi (in tissue)-diet related
NEED TO CHECK FOR INFECTION-synovial aspirate
commonly affect 1st MTP or knee-but can deposit in a lot of places (infection rare in MTP-but knee need to be careful)
abruput onset, PAINFUL, joint red, warm, tender
Resolves spontaneously within 3-10 days -anti-inflammatories + reduce uric acid (diet)
Describe articular soft tissue, periartherial soft tissue, non articukar synovia, bony swelling
Articular-joint synovium or effusion-
Periarticular soft tissue-subcutaneous–not in joint swelling eg Tenosynovitis
both these inflammation joint disease
Non articular-bursa/tendon sheath-
What are signs of irreversibke joint damage?
Joint deforminties
Crepitus
Loss of joint range/abnormal movement
What is ankylosing spondylitis?
Entheses around the spine-results in chrinic enthesopathy
Tendons very inflemmed between spine–start fusing together and back stuck in “looking down position”
=> good exemples of irreverible joint damage
What are signs of mechanical defects?
signs of locking, very abnormal movement-no features of inflammation, clinical history
