GALS screening examination

Question 1

What does GALS stand for?

Answer 1

Gait
Arms
Legs
Spine

Question 2

What are the 3 main purposes of the GALS screening?

Answer 2

Joint pathology

Fine motor impairment

Gross motor deficits

Question 3

Before physical examinations, what 3 questions must you ask the patient?

Answer 3

“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?”

Question 4

Why do you ask the patient if they have any pain or stiffness in muscles, joints or back?

Answer 4

Screens for common joint pathologies

eg. RA, AS, OA

Question 5

Why do you ask the patient if they have any difficulty getting dressed without help, for 2 reasons?

Answer 5

Screens for fine motor impairment and restriction of joint ROM

Screens for general mobility in upper limb

Question 6

Why do you ask the patient if they have any problems going up and down the stairs, for 2 reasons?

Answer 6

Screens for gross motor deficits eg. muscle wasting, lower motor neuron lesions

Screens for general mobility issues in lower limb

Question 7

From what angles should you look at the patient, in GALS?

Answer 7

Anterior
Lateral
Posterior
Lateral

Question 8

In order should you look for abnormalities from every view, in GALS?

Answer 8

From head to toe

(Cranial-caudal direction)

Question 9

In GALS, what abnormalities do you look for in the anterior view, cranial-caudal?

Answer 9

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

Question 10

In GALS, what abnormalities do you look for in the lateral view, cranial-caudal?

Answer 10

Cervical lordosis

Thoracic kyphosis

Lumbar lordosis

Hip fixed flexion deformity

Knee hyperextension or fixed flexion deformity

Foot arch

Question 11

In GALS, what abnormalities do you look for in the posterior view, cranial-caudal?

Answer 11

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

Question 12

In GALS, after looking at the patient, what should you ask them to do?

Answer 12

Walk so you can assess their gait for abnormalities

Question 13

When assessing gait in GALS, what abnormalities should you look for in the gait cycle?

Answer 13

Heel strike

Foot flat

Mid-stance

Heel-off

Toe-off

Swing

Question 14

If someone has a limp or antalgic gait, what cause does this indicate, in GALS?

Answer 14

Joint pain or weakness

Question 15

If someone struggles to turn around when assessing gait in GALS, what cause does this indicate?

Answer 15

Joint disease, which causes weakness and instability

Question 16

Describe the appearance of a Trendelenburg gait in GALS, and 2 common underlying causes?

Answer 16

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

Question 17

What is the underlying cause of waddling gait, in GALS?

Answer 17

Bilateral weakness of hip abductor muscles, causes by myopathies

Question 18

After assessing gait in GALS, why should you inspect their shoes?

Answer 18

Unequal sole wearing can indicate abnormal gait

Question 19

What are the 2 main steps in assessing arms, in GALS?

Answer 19

Compound movements

Metacarpophalangeal joint squeeze

Question 20

In GALS arm assessment, what compound movement is done to test ROM of shoulder abduction, external rotation and elbow flexion?

Answer 20

Ask the patient to put their hands behind their head and point their elbows out to the side

Question 21

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?

Answer 21

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

Question 22

In GALS arm assessment, what compound movement is done to test ROM of elbow and wrist supination, and what else should you inspect?

Answer 22

Ask the patient to turn their hands over (demonstrating supination)

Muscle bulk of thenar and hypothenar muscles

Question 23

In GALS arm assessment, what compound movement is done to test ROM of finger flexion, and what else should you inspect?

Answer 23

Ask patient to make a fist

Fixed flexion deformities of fingers eg. swan neck, z-thumb

Question 24

In GALS arm assessment, what compound movement is done to test grip strength?

Answer 24

Ask the patient to squeeze your fingers and assess grip strength (comparing the patient’s hands)

Lower motor neuron lesions

Question 25

In GALS arm assessment, what compound movement is done to test co-ordination of the thumb and fingers?

Answer 25

Ask the patient to touch each finger in turn to their thumb (known as ‘precision grip’)

Question 26

What does the metacarpophalangeal joint squeeze screen for in arms GALS?

Answer 26

Active inflammatory arthropathy

Question 27

In the legs GALS assessment, which 3 passive movements should you test?

Answer 27

Knee flexion

Knee extension

Hip internal rotation

Question 28

In the legs GALS assessment, how should you test the foot?

Answer 28

Metatarsophalangeal joint squeeze

Question 29

In the legs GALS assessment, what special test should you do on the knee?

Answer 29

Patella tap

Question 30

In the spine GALS assessment, which 2 active movements should you test?

Answer 30

Cervical lateral flexion

Lumbar flexion

Question 31

In the GALS assessment, which facial joint should you test and how?

Answer 31

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.