The GALS screen Flashcards
What does GALS stand for?
Gait
Arms
Legs
Spine
What is looked for in the Gait?
- observe patient walking, turning and walking back
- look for:
1) smoothness and symmetry of leg, pelvis and arm movements
2) normal stride length
3) ability to turn quickly
What questions should be asked when looking at the spine?
- is paraspinal and shoulder girdle muscle bulk symmetrical? - is the spine straight? - are the iliac crests level? - is the gluteal muscle bulk normal? - are there popliteal swellings? - are the Achilles tendons normal?
What 3 things should you ask the patient to do to test the spine portion of GALS?
1) press over mid-point of each supraspinatus and squeeze skinfold over trapezius - tenderness suggests fibromyalgia
2) ask patient to bend forward and touch their toes, with knees straight, to assess lumbar spine and hip flexion. From the side note the normal spinal curvatures
3) try to place ear on the shoulder each side - tests lateral cervical flexion
What should you observe when testing the arms portion of the GALS test?
normal girdle muscle bulk
and symmetry
elbows are straight and in
full extension
What 4 things should you ask the patient to do to test the arms portion of GALS?
1) attempt to place both hands behind the head,
then push elbows back
2) examine hands palms down, with fingers straight. Observe normal supination and pronation
3) observe normal grip
4) place tip of each finger on to the tip of the thumb
to assess normal dexterity and precision grip. Squeeze across 2nd to 5th metacarpal (metacarpal ‘squeeze’ test) - discomfort suggests synovitis
What should you observe when testing the legs portion of the GALS test?
Observe any knee or foot
deformity
What 3 things should you ask the patient to do to test the legs portion of GALS?
1) assess flexion of hip and knee, whilst supporting the knee. Passively internally rotate each hip, in flexion
2) examine each knee for presence of fluid using ‘bulge’ sign and ‘patella tap’ sign. Squeeze across the metatarsals to detect any synovitis
3) inspect soles of the feet for rashes and/or callosities
How should an abnormal joint be examined?
- inspection
swelling, redness, deformity - palpation
warmth, crepitus, tenderness - movement
active, passive, against resistance - function
loss of function
What is the difference between arthritis and arthralgia?
‘Arthritis’ refers to definite inflammation of a
joint(s) i.e. swelling, tenderness and warmth of
affected joints
‘Arthralgia’ refers to pain within a joint(s) without demonstrable inflammation by physical examination
What are signs of active inflammation of a joint?
- swelling (tumor) *
- warmth (calor)
- erythema (rubor if it is red)
- tenderness (dolor) *
- loss of function (functio laesa)
Define Gout?
A disease in which tissue deposition of monosodium urate (MSU) crystals occurs as a result of hyperuricaemia and leads to one or more of the following:
- Gouty arthritis (acute joint inflammation)
- Tophi (aggregated deposits of MSU in tissue)
Where does gouty arthritis commonly affect?
Gouty arthritis commonly affects the MTP joint of the big toe (first MTP joint)
- Abrupt onset
- Extremely painful
- Joint red, warm, swollen and tender
- Resolves spontaneously over 3-10 days
What is the approach to joint swellings?
Articular soft tissue
Periarticular soft tissue
Non-articular synovial
Synovial bony areas
See slides; consider tissue involved and what it is indicative of
Describe non-articular soft tissue swelling
Enthesopathy
- pathology at the enthesis i.e. the site where ligament or tendon inserts into bone
- examples include:
plantar fasciitis
Achilles tendinitis
Define joint deformity?
malalignment of two articulating bones
Define crepitus?
- audible and palpable sensation resulting from movement of one roughened surface on another
- classic feature of osteoarthritis e.g. patellofemoral crepitus on flexing the knee
What are the features of irreversible joint damage?
Joint deformity
Crepitus
Loss of joint range or abnormal movement
Common terms used to describe peripheral joint abnormalities are: dislocation, subluxation, valgus and varus
Define dislocation
articulating surfaces are displaced and no longer incontact
Define subluxation
Partial dislocation
Define valgus
lower limb deformity whereby distal part is directed away from the midline e.g. hallux valgus
Define varus
lower limb deformity whereby distal part is directed towards the midline e.g. varus knee with medial compartment OA
What is a common term for spinal deformities?
Ankylosing spondylitis
What are common terms for hand deformities in Rheumatoid arthritis?
Joint damage and destruction
- Swan-neck and bountonniere deformaties
- erosive arthritis and deformity
Describe ankylosing spondylitis
Chronic inflammatory disease affecting
- Sacroiliac joints (sacroiliitis) and spine. Leads to spinal fusion (ankylosis) and deformity
- Enthesopathy
- Non-axial joints – hips and shoulders (common), others less frequently involved
Strong association with HLA-B27
Rheumatoid factor is negative
List some spondyloarthropathies?
- Reactive arthritis and Reiter’s syndrome
- Ankylosing spondylitis
- Arthritis associated with psoriasis (psoriatic arthritis)
- Arthritis associated with gastrointestinal inflammation (enteropathic synovitis)
In all of these rheumatoid factor is negative so sometimes these group
of conditions is termed ‘seronegative spondyloarthropathies’
What can mechanical joint defects be caused by?
May be consequence of inflammation, degenerative arthritis or trauma
Identified by:
- painful restriction of motion in absence of features of inflammation
e. g. knee ‘locking’ due to meniscal tear or bone fragment - instability. e.g. side-to-side movement of tibia on femur due to ruptured collateral knee ligaments
How do you describe arthritis following a musculoskeletal examination
Determine number of joints involved:
- polyarthritis > 4 joints involved
- oligoarthritis 2-4 joints involved
- monoarthritis single affected joint
- note if involvement is symmetrical
- note the size of the involved joints
- is there axial involvement?
How can the distribution of polyarthritis be helpful in the differential diagnosis?
- bilateral and symmetrical involvement of large and small joints is typical of rheumatoid arthritis
- lower limb asymmetrical oligoarthritis and axial involvement would be typical of reactive arthritis
- exclusive inflammation of the distal interphalangeal joints of the fingers is highly suggestive of psoriatic arthritis.
See slides 51-53
Synovial fluid analysis
See powerpoint
