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
