Musculoskeletal (GALS)

Question 1

What is a GALS screening test and what is it used for?

Answer 1

An assessment of the first, most commonly affected movement of a joint with rheumatoid arthritis
Not diagnostic but used to dictate further examination of Gait, Arms, Legs and Spine

Question 2

What are the initial questions you should ask?

Answer 2

Do you have any pain/stiffness in your muscles, joints or back? (also ask if pain is felt during the movements)
Are you able to completely dress and undress yourself without any difficulty?
Are you able to climb up and down the stairs without any difficulty?

Question 3

What are you looking for on initial inspection?

Answer 3

From the front: abnormalities in shoulders/elbows/wrists/chest/hips/things/knees/feet
From the side: presence of normal spine curvature (lordosis-kyphosis-lordosis), hip/knee flexion deformity or hyper-extension
From the back: abnormalities in shoulders/spine+muscles/level of iliac crests/gluteal region/popliteal fossae/calves/Achilles tendons

Question 4

How do you assess a persons gait?

Answer 4

Ask the patient to walk a few steps, turn and walk back

Comment on: arm swing, pelvic tilt, stride length, ability to turn quickly, any antalgic gait (painful)

Question 5

How do you assess a persons spine?

Answer 5

Assess lumbar flexion by placing two fingers on two adjacent lumbar vertebrae
Ask patient to reach forward and touch their toes
Observe fingers moving apart as patient bends forward
Assess lateral flexion of the neck by asking a patient to tilt their head sideways so their ear touches their shoulder

Question 6

How do you assess a persons upper limb?

Answer 6

Shoulders: ask the patient to place both hands behind their head and push elbows back as far as possible, observe proper range of movement
Wrists/hands: observe any deformities or associated symptoms first; feel for tenderness by performing lateral squeeze of MCPs; ask patient to make a full fist covering the nails, then ask them to repeat it whilst squeezing your fingers to assess grip strength, also get patient to bring thumb and finger tips together rapidly

Question 7

How do you test a persons lower limb?

Answer 7

Ask the patient to lie on the couch with their legs out in front of them
Hips/knees: place hand on patients knee and get them to fully flex end extend, assess for crepitus; bend the knee and hip both to 90 degrees, hold the ankle and move the leg to assess internal/external rotation; perform a patella tap by placing one hand on the superior border of the patella, squeezing and pushing down on the patella with the other hand - should make a tap sound in the presence of an effusion
Feet: inspect the soles of the feet for swelling, deformity or calluses; squeeze MTP joints for tenderness

Question 8

How can you record the findings of a GALS screen?

Answer 8

In a 3x6 table with appearance and movement on top and GALS down the side with an additional box at the bottom detailing findings. In the columns are placed ticks (to indicate ‘normal’) or crosses