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?
Explain how you would measure the EXTENT of joint involvement
Determine the number of joints involved:
• Polyarthritis >4
• Oligoarthritis 2-4
• Monoarthritis 1
Note symmetrical involvement
Note size of involved joints
Note any axial involvement
Examples of conditions and the extent of joint involvement?
- RA
• bilateral, symmetrical
• large & small joints - ReA
• lower limb, asymmetrical
• oligoarthritis
• axial involvement - Gout
• exclusive 1st MTP joint involvement
(onenote!!)
Final question you ask and describe it
Are any OTHER FEATURES of diagnostic importance present?
RA = subcutaenous nodules Gout = tophi SLE = malar rash
What is synovial fluid and how is it synthesised?
Viscous fluid present in the space of synovial joints
Synthesised by synovial living cells, type A and type B
• Type A - macrophage-like cells
• Type B - fibroblast-like cells
Type B secrete hyaluronic acid = increased viscosity of synovial fluid
What is meant by synovial effusion?
Abnormal increase in synovial fluid volume
2 ways synovial effusion can form?
- Normal composition
• abnormal mechanical stimulation (i.e. osteoarthritis) = increases hyaluronic acid production
• more oncotic pressure = increased synovial fluid volume - Abnormal composition
• synovitis due to inflammation = inflammatory exudate
Types of synovial effusions?
- Normal
- Non-inflammatory
• osteoarthritis
• 10-20% neutrophils - Inflammatory
• gout
• 20-70% neutrophils - Infectious
• bacterial infections
• 70%+ neutrophils
When is synovial fluid examination mandatory?
When joint infection is suspected
Confirms diagnosis of suspected crystal arthritis as well
Explain how synovial fluid examination is conducted, contraindications and complications
Performed using needle aspiration – “arthrocentesis”
Contraindications include:
• bleeding disorders (genetics or drugs like warfarin), overlying skin infection
Complications include:
• introducing infection, Haemarthrosis, damage to structures
