GALS screening examination Flashcards
What does GALS stand for?
Gait
Arms
Legs
Spine
What are the 3 main purposes of the GALS screening?
Joint pathology
Fine motor impairment
Gross motor deficits
Before physical examinations, what 3 questions must you ask the patient?
“Do you have any pain or stiffness in your muscles, joints or back?”
“Do you have any difficulty getting yourself dressed without any help?”
“Do you have any problem going up and down the stairs?”
Why do you ask the patient if they have any pain or stiffness in muscles, joints or back?
Screens for common joint pathologies
eg. RA, AS, OA
Why do you ask the patient if they have any difficulty getting dressed without help, for 2 reasons?
Screens for fine motor impairment and restriction of joint ROM
Screens for general mobility in upper limb
Why do you ask the patient if they have any problems going up and down the stairs, for 2 reasons?
Screens for gross motor deficits eg. muscle wasting, lower motor neuron lesions
Screens for general mobility issues in lower limb
From what angles should you look at the patient, in GALS?
Anterior
Lateral
Posterior
Lateral
In order should you look for abnormalities from every view, in GALS?
From head to toe
(Cranial-caudal direction)
In GALS, what abnormalities do you look for in the anterior view, cranial-caudal?
Asymmetry or shoulder tilt: scoliosis
Joint swelling, erythema
Scarring
Muscle bulk
Elbow normal carrying angle, cubitus varus or valgus deformity
Pelvic tilt
Leg length discrepancy
Valgus or varus deformity of knees
Fixed flexion deformity of toes eg. hammer toe, mallet toe
Great toe angulation
In GALS, what abnormalities do you look for in the lateral view, cranial-caudal?
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Hip fixed flexion deformity
Knee hyperextension or fixed flexion deformity
Foot arch
In GALS, what abnormalities do you look for in the posterior view, cranial-caudal?
Muscle bulk
Joint swelling, erythema
Shoulder tilt
Normal carrying angle of elbow, cubitus valgus or varus deformity
Spinous processes alignment, off-centred
Iliac crest alignment
Pelvic tilt, scoliosis
Leg length discrepancy
valgus or varus deformity of knees
Popliteal swellings
Achilles tendonitis
Valgus or varus deformity of ankle joint
In GALS, after looking at the patient, what should you ask them to do?
Walk so you can assess their gait for abnormalities
When assessing gait in GALS, what abnormalities should you look for in the gait cycle?
Heel strike
Foot flat
Mid-stance
Heel-off
Toe-off
Swing
If someone has a limp or antalgic gait, what cause does this indicate, in GALS?
Joint pain or weakness
If someone struggles to turn around when assessing gait in GALS, what cause does this indicate?
Joint disease, which causes weakness and instability
Describe the appearance of a Trendelenburg gait in GALS, and 2 common underlying causes?
Pelvis drops on unaffected side, causing a pelvic tilt when walking
Unilateral weakness of hip abductor muscles, secondary to L5 radiculopathy or superior gluteal nerve lesion
What is the underlying cause of waddling gait, in GALS?
Bilateral weakness of hip abductor muscles, causes by myopathies
After assessing gait in GALS, why should you inspect their shoes?
Unequal sole wearing can indicate abnormal gait
What are the 2 main steps in assessing arms, in GALS?
Compound movements
Metacarpophalangeal joint squeeze
In GALS arm assessment, what compound movement is done to test ROM of shoulder abduction, external rotation and elbow flexion?
Ask the patient to put their hands behind their head and point their elbows out to the side
In GALS arm assessment, what compound movement is done to test ROM of shoulder flexion, elbow wrist hand extension, and what else should you inspect?
Ask the patient to hold their hands out in front of them, with their palms facing down and fingers outstretched
Inspect dorsum of hand for hand and nail changes
In GALS arm assessment, what compound movement is done to test ROM of elbow and wrist supination, and what else should you inspect?
Ask the patient to turn their hands over (demonstrating supination)
Muscle bulk of thenar and hypothenar muscles
In GALS arm assessment, what compound movement is done to test ROM of finger flexion, and what else should you inspect?
Ask patient to make a fist
Fixed flexion deformities of fingers eg. swan neck, z-thumb
In GALS arm assessment, what compound movement is done to test grip strength?
Ask the patient to squeeze your fingers and assess grip strength (comparing the patient’s hands)
Lower motor neuron lesions
In GALS arm assessment, what compound movement is done to test co-ordination of the thumb and fingers?
Ask the patient to touch each finger in turn to their thumb (known as ‘precision grip’)
What does the metacarpophalangeal joint squeeze screen for in arms GALS?
Active inflammatory arthropathy
In the legs GALS assessment, which 3 passive movements should you test?
Knee flexion
Knee extension
Hip internal rotation
In the legs GALS assessment, how should you test the foot?
Metatarsophalangeal joint squeeze
In the legs GALS assessment, what special test should you do on the knee?
Patella tap
In the spine GALS assessment, which 2 active movements should you test?
Cervical lateral flexion
Lumbar flexion
In the GALS assessment, which facial joint should you test and how?
Temporomandibular joint (TMJ)
Ask the patient to open their mouth wide and put three of their fingers into their mouth (demonstrate using your own fingers and mouth)
assesses the temporomandibular joint’s range of movement and screens for deviation of jaw movement.
