The GALS Screen Flashcards
what is the purpose of the locomotion examination?
identify abnormal joints
what does GALS stand for?
Gait
Arms
Legs
Spine
what is observed in gait?
observe the patient walk, turn and walk back
o Smoothness and symmetry of legs.
o Normal stride length.
o Ability to turn quickly.
what are the key questions asked in 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 are the signs inflammation?
o Rubor (Red) o Calor (Hot) o Tumor (Swelling) o Dolor (Pain) o Funcio laesa (Loss of function)
or SWELT: Swelling Warmth Erythema Loss of function Tenderness
what can be examined in the arms?
pronation and supination grip MCP squeeze tip of fingers to thumb shoulder movement
what is the significance of the MCP and MTP squeeze?
indicative of synovitis when there is discomfort
what is examined in the legs?
- flexion of hip and knees
- examine knee for fluid (patellar tap sign where patella bounces)
- MTP squeeze
- sole of feet inspected for rashes/callosities
what is the difference between arthritis and arthralgia?
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
what is dislocation and subluxation?
Dislocation – articulating surfaces are displaced and no longer in contact.
Subluxation – partial dislocation.
what is the difference between varus deformity and valgus deformity?
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 are some indicators of inflammation occurring?
- gout (example of arthritis)
- joint swelling
- enthesopathy (enthesis)
what is the enthesis?
where the ligament/tendon connective inserts into the bone
e.g. in the spine or knee
what does deposition of monosodium urate (MSU) crystals in the tissue lead to?
o Gouty arthritis (commonly affects the 1st MTP joint) aka podagra.
o Tophi
– aggregated deposits of MSU in tissue
what is the cause of deposition of monosodium urate (MSU) crystals in the tissue?
hyperuricaemia
what are the different sites of inflammation?
- Articular soft tissue (Inflammatory joint disease)
- Peri-articular soft tissue (Inflammatory joint disease)
- Non-articular synovial (Inflammation of structure)
- Bony areas (Osteoarthritis)
what are some example of enthesopathies?
Achilles tendonitis
plantar fasciitis
what are some signs of irreversible joint damage?
o Joint deformity.
o Crepitus
– sound upon articulating joint i.e. in osteoarthritis.
o Loss of joint range or abnormal movement.
what are the signs of mechanical defects due to inflammation, degenerative arthritis or trauma?
o Painful restriction of motion in absence of features of inflammation
– e.g. knee “locking”.
o Instability
– e.g. side-to-side movement of tibia on femur.
what are the terms to indicate the number of joints involved the arthritis?
o Polyarthritis= >4.
o Oligoarthritis= 2-4.
o Monoarthritis= 1.
what is observed when describing the pattern of arthritis?
- Note symmetrical involvement.
- Note size of involved joints.
- Note any axial involvement.
how is the pattern of arthritis described in RA?
Bilateral
symmetrical
large and small joints
how is the pattern of arthritis described in ReaA?
Lower limb
asymmetrical
Oligoarthritis
axial involvement.
what joint is commonly affected in gout?
1st MTP joint involvement.
name an additional diagnostic feature of RA
subcutaneous nodules
name an additional diagnostic feature of gout
tophi (monosodium urate deposition due to hyperuricaemia)
name an additional diagnostic feature of SLE
malar rash sparing nasolabilal folds
where is synovial fluid produced?
synovial lining cells(1-3 cells deep).
o Type A – macrophage-like cells.
o Type B – fibroblast-like cells – secrete hyaluronic acid and increased viscosity of synovial fluid.
what is synovial effusion?
abnormal increase in synovial fluid volume
can be: • Normal. • Non-inflammatory (Osteoarthritis) • Inflammatory (Gout) • Infectious (Bacterial infections)
what happens to the composition of synovial in OA? how does this change the volume of synovial fluid?
increases hyaluronic acid production
more oncotic pressure increased synovial volume.
how does synovial fluid normally look? how does it change in inflammation?
normally clear or pale yellow
becomes more turbid in disease
how is synovial fluid sampled?
arthrocentesis
look for pathogens (ABs assay) and crystals (polarising light microscopy)
what are the contraindications and complications of arthrocentesis?
o Contraindications
– bleeding disorders (genetics or drugs like warfarin), overlying skin infection.
o Complications
– introducing infection, Haemarthrosis, damage to structures.
what diseases can be determined with synovial fluid examination?
- septic arthritis (postive gram stain and culture)
- olecranon bursitis (crystals present)
name some connective tissue disorders
o SLE.
o Inflammatory muscle diseases – polymyositis, dermatomyositis.
o Systemic sclerosis.
o Sjogren’s syndrome.
o Overlap syndrome – a mixture of the above.
what is the Raynaud’s phenomenon?
is often associated with arthritis and arthralgia in connective tissue disorders (not exclusively)
- Intermittent vasospasm of digits on exposure to the cold.
- Colour changes (blue to red)
– vasospasm blanches digit, cyanosis as static venous blood deoxygenates, reactive hyperaemia.
what is Sjogren’s Syndrome?
Autoimmune exocrinopathy
– lymphocytic infiltration of exocrine glands e.g parotid, hence the parotid gland enlargement
what does Sjogren’s Syndrome result in? what are signs in relation to connective tissue disorders in general?
o Dry eyes – xerophthalmia. o Dry mouth – xerostomia. o Parotid gland enlargement
importantly non-erosive arthritis and Raynaud’s phenomenon.
“Secondary Sjogren’s syndrome” if occurs with another connective tissue disorder like SLE
what is inflammatory muscle disease?
Proximal myopathy (AI-mediated inflammation) with either dermatomyositis (rash) or polymyositis (no rash).
what is systemic sclerosis?
thickened skin with raynauds syndrome (skin changes are diffuse or limited)
what is Overlap Syndrome?
has features of more than one connective tissue disorder e.g. SLE plus inflammatory muscle disease
