Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2b Sheffield Medicine > GALS screening (Gait, Arms, Legs and Spine) > Flashcards

GALS screening (Gait, Arms, Legs and Spine) Flashcards

1
Q

What is the purpose of a GALS exam?

A

● GALS examination (gait, arms, legs and spine), is often used as a quick screening tool to detect locomotor abnormalities and functional disability in a patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the three screening questions during a GALS exam?

A

● 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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the aim of the first screening question in a GALS exam?

A

● This question screens for common symptoms present in most forms of joint pathology (e.g. osteoarthritis, rheumatoid arthritis, ankylosing spondylitis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the aim of the second screening question in a GALS exam?

A

● This question screens for evidence of fine motor impairment and significant restriction joint range of movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the aim of the third screening question in a GALS exam?

A

● This question screens for evidence of impaired gross motor function (e.g. muscle wasting, lower motor neuron lesions) and general mobility issues (e.g. restricted range of movement in the joints of the lower limb).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What clinical signs could be suggestive of an underlying pathology during the general inspection portion of a GALS exam?

A

● Body habitus: obesity is a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis).
● Scars: may provide clues regarding previous surgery.
● Wasting of muscles: suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron injury.
● Psoriasis: typically presents with scaly salmon coloured plaques on extensor surfaces (associated with psoriatic arthritis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What objects or equipment could be suggestive of an underlying pathology during the general inspection of a GALS exam?

A

● Aids and adaptations: examples include support slings, splints, walking aids and wheelchairs.
● Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g. analgesia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What three anatomical positions should you assess the patient in, during a closer inspection of a GALS exam?

A

Ask the patient to stand in the anatomical position and turn in 90 degree increments
● Anterior position
● Lateral position
● Posterior position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would you note about posture during the anterior portion of a closer inspection in a GALS exam?

A

● Posture: note any asymmetry which may indicate joint pathology or scoliosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What would you note about scars during the anterior portion of a closer inspection in a GALS exam?

A

● Scars: note the location of any scars as they may provide clues as to the patient’s previous surgical history and/or indicate previous joint trauma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What would you note about joint swelling during the anterior portion of a closer inspection in a GALS exam?

A

● Joint swelling: note any evidence of asymmetry in the size of joints that may suggest unilateral swelling (e.g. effusion, inflammatory arthropathy, septic arthritis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would you note about joint erythema during the anterior portion of a closer inspection in a GALS exam?

A

● Joint erythema: suggestive of active inflammation (e.g. inflammatory arthropathy or septic arthritis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What would you note about muscle bulk during the anterior portion of a closer inspection in a GALS exam?

A

● Muscle bulk: note any asymmetry in upper and lower limb muscle bulk (e.g. deltoids, pectorals, biceps brachii, quadriceps femoris). Asymmetry may be caused by disuse atrophy (secondary to joint pathology) or lower motor neuron injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What would you note about elbow extension during the anterior portion of a closer inspection in a GALS exam?

A

● Elbow extension: inspect the patient’s carrying angle which should be between 5-15°.
● An increased carrying angle is known as cubitus valgus. Cubitus valgus is typically associated with previous elbow joint trauma or congenital deformity (e.g. Turner’s syndrome).
● A decreased carrying angle is known as cubitus varus or ‘gunstock deformity’. Cubitus varus typically develops after supracondylar fracture of the humerus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What would you note about valgus joint deformity during the anterior portion of a closer inspection in a GALS exam?

A

● Valgus joint deformity: the bone segment distal to the joint is angled laterally. In valgus deformity of the knee, the tibia is turned outward in relation to the femur, resulting in the knees ‘knocking’ together.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would you note about varus joint deformity during the anterior portion of a closer inspection in a GALS exam?

A

● Varus joint deformity: the bone segment distal to the joint is angled medially. In varus deformity of the knee, the tibia is turned inward in relation to the femur, resulting in a bowlegged appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would you note about pelvic tilt during the anterior portion of a closer inspection in a GALS exam?

A

● Pelvic tilt: lateral pelvic tilt can be caused by scoliosis, leg length discrepancy or hip abductor weakness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What would you note about fixed flexion deformity of the toes during the anterior portion of a closer inspection in a GALS exam?

A

● Hammer toe?
● Mallet toe?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What would you note about the big toe during the anterior portion of a closer inspection in a GALS exam?

A

● Big toe: note any evidence of lateral (hallux valgus) or medial (hallux varus) angulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What 11 points should you cover during the anterior portion of a closer inspection in a GALS exam?

A

● Posture
● Scars
● Joint swelling
● Joint erythema
● Muscle bulk
● Elbow extension
● Valgus joint deformity
● Varus joint deformity
● Pelvic tilt
● Fixed flexion deformity of toes
● Big toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What 5 points should you cover during the lateral portion of a closer examination in a GALS exam?

A

● Cervical lordosis
● Thoracic lordosis
● Lumbar lordosis
● Knee joint hyperextension
● Foot arch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What would you note about cervical lordosis during the lateral portion of a closer inspection in a GALS exam?

A

● Cervical lordosis: hyperlordosis is associated with chronic degenerative joint disease (e.g. osteoarthritis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What would you note about thoracic lordosis during the lateral portion of a closer inspection in a GALS exam?

A

● Thoracic kyphosis: the normal amount of thoracic kyphosis is typically between 20-45º. Hyperkyphosis is associated with Scheuermann’s disease (congenital wedging of the vertebrae).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would you note about lumbar lordosis during the lateral portion of a closer inspection in a GALS exam?

A

● Lumbar lordosis: loss of normal lumbar lordosis suggests sacroiliac joint disease (e.g. ankylosing spondylitis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What would you note about knee joint hyperextension during the lateral portion of a closer inspection in a GALS exam?

A

● Knee joint hyperextension: causes include ligamentous damage and hypermobility syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What would you note about foot arch during the lateral portion of a closer inspection in a GALS exam?

A

● Foot arch: inspect for evidence of flat feet (pes planus) or an abnormally raised foot arch (pes cavus).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What 7 points should you cover during the posterior portion of a closer examination during a GALS exam?

A

● Muscle bulk
● Spinal Alignment
● Iliac crest alignment
● Popliteal swelling
● Achilles’ tendon thickening
● Valgus joint deformity
● Varus joint deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What would you note about muscle bulk during the posterior portion of a closer inspection in a GALS exam?

A

● Muscle bulk: note any asymmetry in upper and lower limb muscle bulk (e.g. deltoid, trapezius, triceps brachii, gluteal muscles, hamstrings, calves).
● Asymmetry may be caused by disuse atrophy (secondary to joint pathology) or lower motor neuron injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What would you note about spinal alignment during the posterior portion of a closer inspection in a GALS exam?

A

● Spinal alignment: inspect for lateral curvature of the spine suggestive of scoliosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What would you note about iliac crest alignment during the posterior portion of a closer inspection in a GALS exam?

A

● Iliac crest alignment: misalignment may indicate a leg length discrepancy or hip abductor weakness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What would you note about popliteal swelling during the posterior portion of a closer inspection in a GALS exam?

A

● Popliteal swellings: possible causes include a Baker’s cyst or popliteal aneurysm (typically pulsatile).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What would you note about Achilles’ tendon thickening during the posterior portion of a closer inspection in a GALS exam?

A

● Achilles’ tendon thickening: associated with Achilles’ tendonitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What would you note about valgus joint deformity during the posterior portion of a closer inspection in a GALS exam?

A

● Valgus joint deformity: the bone segment distal to the joint is angled laterally. In valgus deformity of the ankle, the foot is turned outward in relation to the tibia.

34
Q

What would you note about varus joint deformity during the posterior portion of a closer inspection in a GALS exam?

A

● Varus joint deformity: the bone segment distal to the joint is angled medially. In varus deformity of the ankle, the foot is turned inward in relation to the tibia.

35
Q

How would you assess a patients gait during a GALS exam?

A

● Ask the patient to walk to the end of the examination room and then turn and walk back whilst you observe their gait paying attention to the various parameters.

36
Q

What parameters should you asses for gait during a GALS exam?

A

● Gait cycle
● Range of movement
● Limping
● Leg length
● Turning
● Trendelenburg gait
● Waddling gait
● Waddling gait
● Assess the patient’s footwear

37
Q

What would you note about gait cycle during the gait observation of a GALS exam?

A

● Gait cycle: note any abnormalities of the gait cycle (e.g. abnormalities in toe-off or heel strike).

38
Q

What would you note about range of movement during the gait observation of a GALS exam?

A

● Range of movement: often reduced in the context of chronic joint pathology (e.g. osteoarthritis, inflammatory arthritis).

39
Q

What would you note about limping during the gait observation of a GALS exam?

A

● Limping: may suggest joint pain (i.e. antalgic gait) or weakness.

40
Q

What would you note about leg length during the gait observation of a GALS exam?

A

● Leg length: note any discrepancy which may be the cause or the result of joint pathology.

41
Q

What would you note about turning during the gait observation of a GALS exam?

A

● Turning: patients with joint disease may turn slowly due to restrictions in joint range of movement or instability.

42
Q

What is Trendelenburg’s gait and what would it suggest?

A

● Trendelenburg’s gait: an abnormal gait caused by unilateral weakness of the hip abductor muscles secondary to a superior gluteal nerve lesion or L5 radiculopathy.

43
Q

What is waddling gait and what would it suggest?

A

● Waddling gait: an abnormal gait caused by bilateral weakness of the hip abductor muscles, typically associated with myopathies (e.g. muscular dystrophy).

44
Q

What would you note about the patient’s footwear during the gait observation of a GALS exam?

A

● Assess the patient’s footwear: unequal sole wearing is suggestive of an abnormal gait.

45
Q

What are the 6 phases of a gait cycle?

A
  1. Heel-strike: initial contact of the heel with the floor.
  2. Foot flat: weight is transferred onto this leg.
  3. Mid-stance: the weight is aligned and balanced on this leg.
  4. Heel-off: the heel lifts off the floor as the foot rises but the toes remain in contact with the floor.
  5. Toe-off: as the foot continues to rise the toes lift off the floor.
  6. Swing: the foot swings forward and comes back into contact with the floor with a heel strike (and the gait cycle repeats).
46
Q

What compound movements should be assessed during the arm portion of a GALS exam?

A

● Hands behind head
● Hands held out in front with palms facing down
● Hands held out in front with palms facing up
● Making a fist
● Grip strength
● Precision grip
● Metacarpophalangeal joint squeeze

47
Q

What would an assessment of holding the hands behind the head achieve in a GALS exam?

A

● This compound movement assesses shoulder abduction and external rotation in addition to elbow flexion.

48
Q

What would restrictive range of movement suggest when asking a patient to hold their arms behind their head during a GALS exam?

A

● Restricted range of movement is suggestive of shoulder or elbow pathology (e.g. osteoarthritis).

49
Q

What would excessive range of motion suggest when asking a patient to hold their arms behind their head during a GALS exam?

A

● Excessive range of movement indicates hypermobility.

50
Q

What would an assessment of holding the hands out in front with palms facing down achieve in a GALS exam?

A

● This compound movement assesses forward flexion of the shoulders, elbow extension, wrist extension and extension of the small joints of the fingers.

51
Q

What would you inspect when asking a patient to hold their arms out in front and palms facing down during a GALS exam?

A

● Inspect the dorsum the hands for asymmetry, joint swelling and deformity.
● Inspect the nails for signs associated with psoriasis (e.g. nail pitting).

52
Q

What would an assessment of holding the hands out in front with palms facing up achieve in a GALS exam?

A

● This compound movement assesses wrist and elbow supination.

53
Q

What would restrictive range of movement suggest when asking a patient to hold their hands out in front with their palms facing up during a GALS exam?

A

● Restriction of supination is suggestive of wrist or elbow pathology (e.g. osteoarthritis).

54
Q

What would you inspect when asking a patient to hold their arms out in front and palms facing up during a GALS exam?

A

● Inspect the thenar and hypothenar eminences for evidence of muscle wasting.

55
Q

What would an assessment of making a fist achieve in a GALS exam?

A

● This movement assesses flexion of the small joints of the fingers as well as overall hand function.

56
Q

If a patient is unable to make a fist during the arm inspection portion of a GALS exam, what would this indicate?

A

● The patient may be unable to make a fist if they have joint swelling (e.g. inflammatory arthritis or joint infection) or if they have other deformities of the small joints of the hands.

57
Q

What would reduced grip strength suggest when asking a patient to squeeze your fingers during a GALS exam?

A

● Grip strength may be reduced due to pain (e.g. swelling of the small joints of the hand)
● Or due to lower motor neuron lesions (e.g. median nerve damage secondary to carpal tunnel syndrome).

58
Q

How would you assess precision grip during the arm portion of a GALS exam?

A

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

59
Q

What does the precision grip test achieve during a GALS exam?

A

● This sequence of movements assesses co-ordination of the small joints of the fingers and thumbs.

60
Q

What would reduced manual dexterity indicate when asking the patient to perform a precision grip test during a GALS exam?

A

● Reduced manual dexterity may suggest inflammation or joint contractures of the small joints of the hand.

61
Q

What is the metacarpophalangeal joint squeeze used for during the arm portion of a GALS exam?

A

● Gently squeeze across the metacarpophalangeal (MCP) joints and observe for verbal and non-verbal signs of discomfort. Tenderness is suggestive of active inflammatory arthropathy.

62
Q

What position should the patient be in when performing the leg portion of a GALS exam?

A

● Position the patient lying down on the examination couch for further assessment of the lower limbs.

63
Q

What is passive movement?

A

● Passive movement refers to a movement of the patient, controlled by the examiner. This involves the patient relaxing and allowing you to move the joint freely to assess the full range of joint movement.

64
Q

What is an important sign to try and look for when performing passive movement of a joint?

A

● It’s important to feel for crepitus as you move the joint (which can be associated with osteoarthritis) and observe any discomfort or restriction in the joint’s range of movement.

65
Q

How would you assess a patients passive knee flexion during the leg portion of a GALS exam?

A

● Whilst supporting the patient’s leg, flex the knee as far as you are able, making sure to observe for signs of discomfort.

66
Q

What would a normal range of movement be when assessing passive knee flexion during a GALS exam?

A

● Normal range of movement: 0-140°

67
Q

How would you assess a patients passive knee extension during the leg portion of a GALS exam?

A

● If the patient is able to lay their legs flat on the bed, they are already demonstrating a normal range of movement for knee extension

68
Q

How would you assess for passive hyperextension of the knee during the leg portion of a GALS exam?

A
  1. On the leg being assessed, hold above the ankle joint and gently lift the leg upwards.
  2. Inspect the knee joint for evidence of hyperextension, with less than 10° being considered normal. Excessive knee hyperextension may suggest pathology affecting the integrity of the knee joint’s ligaments or hypermobility.
69
Q

How would you assess for passive internal rotation of the hip during the leg portion of a GALS exam?

A

● Flex the patient’s hip and knee joint to 90° and then rotate their foot laterally.

70
Q

What would a normal range of movement be when assessing passive internal rotation of the hip during a GALS exam?

A

● 40°

71
Q

What passive movements of the leg would you assess during a GALS exam?

A

● Passive knee flexion
● Passive knee extension
● Passive hyperextension of the knee
● Passive internal rotation of the hip

72
Q

How would you perform a metatarsophalangeal joint squeeze during a GALS exam?

A

● Gently squeeze across the metatarsophalangeal (MTP) joints and observe for verbal and non-verbal signs of discomfort.

73
Q

What would tenderness indicate during a metatarsophalangeal joint squeeze test in a GALS exam?

A

● Tenderness is indicative of active inflammatory arthropathy.

74
Q

When performing a patellar tap, what would joint effusion indicate during a GALS exam?

A

● Joint effusion can be caused by ligament rupture (e.g. anterior cruciate ligament), septic arthritis, inflammatory arthritis and osteoarthritis.
● The patellar tap test can be used to screen for the presence of a moderate-to-large knee joint effusion.

75
Q

How would you perform a patellar tap on a patient during the leg portion of a GALS exam?

A
  1. With the patient’s knee fully extended, empty the suprapatellar pouch by sliding your left hand down the thigh to the upper border of the patella.
  2. Keep your left hand in position and use your right hand to press downwards on the patella with your fingertips.
  3. If there is fluid present you will feel a distinct tap as the patella bumps against the femur.
76
Q

What position should the patient be in when performing the spine portion of a GALS exam?

A

● Ask the patient to stand upright for this part of the assessment. Inspection of the spine does not need to be repeated if already performed.

77
Q

How would you assess lateral flexion of the cervical spine during a GALS exam?

A

● Assess lateral flexion of the cervical spine by asking the patient to tilt their head to each side, moving their ear towards their shoulder.

78
Q

How would you assess lumbar flexion of the spine during a GALS exam?

A

● Assess the range of lumbar flexion using your fingers to palpate for a normal range of movement of the lumbar vertebrae

79
Q

What are the steps for assessing lumbar flexion of the spine during a GALS exam?

A
  1. Place two of your fingers on the lumbar vertebrae approximately 5-10cm apart.
  2. Ask the patient to bend forwards and touch their toes.
  3. Observe your fingers as the patient’s lumbar spine flexes (they should move apart).
  4. Observe your fingers as the patient extends their spine to return to a standing position (your fingers should move back together).
80
Q

If a patient is able to place their hands on the floor when assessing lumbar flexion of the spine what would this indicate?

A

● If the patient is able to place their hands flat on the floor it suggests joint hypermobility.

81
Q

What further examinations and investigations could be performed after a GALS exam is complete?

A

● A focused examination of joints with suspected pathology.
● Further imaging if indicated (e.g. X-ray and MRI).

Phase 2b Sheffield Medicine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions