pGALS Flashcards
Give the overall structure of pGALS
1) Questions:
- do you have any pain or stifness in muscles, joints or back?
- any difficulty getting self dressed without help?
- any difficulty going up or down stairs?
2) General inspection:
- general
- anterior
- lateral
- posterior
3) Gait:
- standard
- heel walking
- tiptoe walking
4) Arms:
- compound movements
- MCP joint squeeze
5) Legs:
- active movement
- passive movement
- MTP joint squeeze
- patella tap
6) Spine:
- cervical lateral flexion
- lumbar flexion
7) Temporomandibular joint
What are the 3 questions initially asked at beginning of pGALS?
1) Any pain or stiffness in your back, joints or muscles?
2) Any difficulty going up and down the stairs?
3) Any difficulty getting yourself dressed without help?
What is the following question screening for: any pain or stiffness in your back, joints or muscles?
Screens for common symptoms present in most forms of joint pathology e.g. osteoarthritis, RA, ankylosing spondylitis.
What does the following question screen for: do you have any difficulty getting yourself dressed without any help?
Screens for evidence of FINE motor impairment and significant restriction of joint range of movement.
What does the following question screen for: “Do you have any problem going up and down the stairs?”
Screens for evidence of impaired GROSS motor function (e.g. muscle wasting, LMN lesion) and general mobility issues (e.g. restricted range of movement in the joints of the lower limb).
What are you looking for in general inspection?
1) Clinical signs:
- body habitus
- scars
- wasting of muscles
- psoriasis
2) Objects:
- wheelchair
- splints
- support slings
- prescriptions
What is wasting of muscles indicative of?
Disuse atrophy 2ary to joint pathology or a LMN injury.
What are you looking for in closer ANTERIOR inspection?
- Posture e.g. scoliosis
- Scars
- Leg length discrepancy
- Elbow carrying angle
- Knee valgus or varus joint deformity
- Erythema or swelling of joints
- Muscle bulk
- Pelvic tilt
- Fixed flexion deformity of the toes
- Big toe (hallux valgus or varus)
What can leg length discrepancy indicate?
1) May be congenital
2) May be 2ary to joint pathology:
- Perthes disease
- SUFE
- DDH
What can joint swelling or erythema indicate? (2)
1) Inflammatory arthropathy
2) Septic arthritis
What is the normal elbow carrying angle in a child?
5-15 degrees
what is an increased elbow carrying angle known as (i.e. hand is further from body)?
Cubitus valgus
what is a decreased elbow carrying angle known as (i.e. hand is closer to body)?
Cubitus varus (or ‘gunstock deformity’)
What is cubitus valgus typically associated with?
1) Previous elbow joint trauma
2) Congenital deformity (e.g. Turner’s syndrome)
What elbow deformity can be seen in Turner’s?
Cubitus valgus (i.e. increased carrying angle)
What is cubitus varus typically 2ary to?
Supracondylar fracture of humerus
What genetic syndrome is often associated with cubitus valgus?
Turner’s syndrome
What is valgus deformity of the knee?
When foot is further from the body i.e. causing knocked knees
Tibia is turned outward in relation to femur
What is varus deformity of the knee?
The tibia is turned inward in relation to the femur - causing bowlegged appearance.
What can a pelvic tilt be caused by?
- scoliosis
- leg length discrepancy
- hip abductor weakness
What are you looking for in closer LATERAL inspection?
1) Cervical lordosis
2) Thoracic kyphosis
3) Lumbar lordosis
4) Knee joint hyperextension or fixed flexion
5) Foot arch
What is the normal amount of thoracic kyphosis?
Typically between 20-45 degrees
what is hyperkyphosis associated with?
Scheuermann’s disease (congenital wedging of the vertebrae
What is lumbar lordosis associated with?
Sacroiliac joint disease (e.g. ankylosing spondylitis).
What are 2 causes of knee joint hyperextension?
1) ligamentous damage
2) hypermobility syndrome
What is cervical lordosis associated with?
Chronic degenerative joint disease (e.g. osteoarthritis).
What are you looking for in closer POSTERIOR inspection?
1) Muscle bulk
2) Spinal alignment e.g. scoliosis
3) Iliac crest alignment
4) Popliteal swellings
5) Achille’s tendon thickening
6) Valgus joint deformity
7) Varus joint deformity
What is Achille’s tendon thickening associated with?
Achille’s tendonitis