Rheum - The GALS Screen Flashcards
What does GALS stand for?
G - gait
A - arms
L - legs
S - spine
What do you do as part of the GALS examination?
Observe the patient walk, turn & walk back
What key questions do you ask as part of the GALS examination?
o Have you any pain in your muscles, joints or back?
o Can you dress yourself completely without any difficulty?
o Can you walk up and down the stairs without any difficulty?
What do you examine as part of the gait?
Observe the patient walk, turn & walk back
• smoothness & symmetry of leg
• normal stride length
• ability to turn quickly
When examining inflammation, what should you be looking out for?
- Rubour (red)
- Calor (hot)
- Tumour (swelling)
- Dolor (pain)
- Funcio laesa (loss of function)
Define the locomotor examination terms: Arthritis Arthralgia Dislocation Subluxation Varus deformity Valgus deformity
Arthritis
– refers to a definite inflammation of a joint(s)
Arthralgia
– refers to a pain within a joint(s) WITHOUT demonstrable inflammation by physical examination
Dislocation
– articulating surfaces are displaced and no longer in contact
Subluxation
– partial dislocation
Varus deformity
– lower limb deformity whereby distal part is directed towards the midline – e.g. varus knee with medial compartment osteoarthritis
Valgus deformity
- lower limb deformity whereby distal part is directed distally from the midline – e.g. hallux valgus.
What is a good example of arthritis and explain it
Acute gout
• disease where deposition of MSU crystals in the tissue
• due to hyperuricemia
MSU - monosodium urate
What can acute gout lead to?
Could lead to one or more of the following:
- Gouty arthritis
• commonly affects the 1st MTP joint (podagara)
• abrupt onset, painful, all cardinal inflammation signs, resolved over 3-10days - Tophi
• aggregated deposits of MSU in tissue
For joint swelling, identify:
(1) site of swelling
(2) tissue involved
(3) Indicative of
- Articular soft tissue
• joint synovium OR effusion
• inflammatory joint disease - Periarticular soft tissue
• subcutaneous tissue
• inflammatory joint disease - Non-articular synovial
• bursa/tendon sheath
• inflammation of structure - Bony areas
• articular ends of bones
• osteoarthritis
Explain what is meant by enthesopathy
Pathology at the enthesis
• where the ligament/tendon inserts into the bone
Example
• achilles tendonitis, plantar fasciitis
Signs of irreversible joint damage?
Joint deformity
• malalignment of 2 articulating bones
Crepitus
• sound upon articulating joint (i.e. in osteoarthritis)
Loss of joint range OR abnormal movement
What chronic condition is a good example of where joint deformity may occur?
Ankylosing Spondylitis
Leads to/affects • sacroiliac joints & spine • Entheses --> chronic enthesopathy • Non-axial joints (i.e. hips & shoulders) • RF is -VE
Signs of mechanical defect?
May be due to inflammation, degenerative arthritis OR trauma
Identify by:
• painful restriction of motion in absence of features of inflammation (e.g. knee locking)
• Instability (e.g. side-to-side movement of tibia on femus)
So, what do you ALWAYS ask in terms of the NATURE of the joint abnormality?
- Is there INFLAMMATION?
- Is there IRREVERSIBLE JOINT DAMAGE?
- Is there a MECHANICAL DEFECT
What do you ask after finding out the nature of the joint abnormality?
What is the EXTENT (distribution) of the joint involvement?
