Musc 7 - The GALS Screen (Gait, arm, legs, spine) screen

Question 1

What is arthralgia

Answer 1

Pain in joint WITHOUT demonstrable inflammation by physical examination (e.g. SLE)

Question 2

What is dislocation

Answer 2

Articular surfaces displaced —> no longer in contact

Question 3

What is subluxation

Answer 3

Subluxation = partial dislocation (still some contact of articular surfaces)

Question 4

What is synovitis

Answer 4

Inflammation of synovial membrane

Question 5

What is varus deformity

Answer 5

Varus deformity = Lower limb deformity - distal part of limb directed TOWARDS midline

Question 6

What is valgus deformity

Answer 6

Valgus deformity = lower limb deformity - distal part of limb is directed away from midline

Question 7

When is the locomotor investigation done

Answer 7

it is a specific investigation after GALS

Question 8

How is Gait assessed

Answer 8

Observe the patient walking, turning, and walking back.

Look for:

• smoothness and symmetry of leg, pelvis and arm
• normal stride length
• ability to turn quickly

Question 9

How is Spine assessed

Answer 9

Is paraspinal and shoulder girdle muscle bulk symmetrical?

Is spine straight?

Are iliac crests level?

Is gluteal muscle bulk normal?

Are there popliteal swellings?

Are the Achilles tendons normal?

Note spinal curvatures, ask patient to bend forward and touch their toes with straight knees - assess lumbar spine and hip flexion

Test cervical spine (lateral flexion) by telling patient to place ear on shoulder

Question 10

If you press over the midpoint of each supraspinatus and squeeze the skin fold over the traps, and there is tenderness, what does this suggest?

Answer 10

Fibromyalgia

Question 11

How do you assess the Arms

Answer 11

1. check normal girdle muscle bulk and symmetry - elbows flexed and in full extension
2. Hands behind head, push elbows back
3. Examine hands palms down, with straight fingers. Observe normal supination and pronation
4. Observe grip
5. Assess normal dexterity and precision grip. Also do metacarpal squeeze test - discomfort suggests synovitis

Question 12

How do you assess Legs

Answer 12

1. Observe knee/foot deformity
2. Assess hip and knee flexion, whilst supporting knee
3. Passively internally rotate each hip, in flexion
4. Examine each knee for fluid presence using bulge sign and patella tap sign
5. Metatarsal squeeze for synovitis
6. Inspect soles of the feet for rashes/callosities

Question 13

What are the components of the locomotor examination

Answer 13

Detailed examination of abnormal joints

1. Inspection - swelling, redness, deformity
2. Palpation - warmth, crepitus, tenderness
3. Movement - active, passive, against resistance
4. Function - loss of function

Question 14

What are the signs of active inflammation?

Answer 14

1. Swelling - main
2. Warmth
3. Erythema
4. Tenderness - main
5. Loss of function