The musculoskeletal examination Flashcards
Aims of locomotor exam
Abnormality?
Nature of abnormality?
Extent of involvement
Other features of importance
What does GALS stand for
G gait
A arms
L legs
S spine
What type of assessment is GALS
initial rapid joint ‘screening’ examination
Outline the gait part of GALS, what do you do, what do you look for
observe patient walking, turning and walking back
smoothness and symmetry of leg, pelvis and arm movements
normal stride length
ability to turn quickly
What do you look for with the spine part of GALS
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?
When is there tenderness around the supraspinatus part
press over mid-point of each supraspinatus and squeeze skinfold over trapezius - tenderness suggests fibromyalgia
What else is done in spine part of GALS
from the side note the normal spinal curvatures
ask patient to bend forward and touch their toes, with knees straight, to assess lumbar spine and hip flexion
(can also check for hypermobility here)
How is neck region assessed in spine in GALS
try to place ear on the shoulder each side - tests lateral cervical flexion
What is tested in arms part of GALS
normal girdle muscle bulk
and symmetry
elbows are straight and in
full extension
Place hands behind head and push elbows back
Supination and pronation
Grip
Dexterity (placing tip of each finger on tip of thumb)
Squeeze 2nd-5th metacarpal joint… suggests synovitis
Legs part of GALS
Observe deformity
Flexion of hip and knee, whilst supporting knee
Internally rotate each hip in flexion
Fluid (bulge sign), patella tap sign
Squeeze metatarsals to detect syovitis
soles of the feet for rashes and/or callosities
If joint abnormality is picked up in GALS, what would you want to determine
Is there active inflammation?
Is there irreversible joint damage?
Is there a mechanical defect?
Detailed examination of joints?
inspection
swelling, redness, deformity
palpation
warmth, crepitus, tenderness
movement
active, passive, against resistance
function loss of function
Differentiate 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
Signs of active inflammation
swelling (tumor) warmth (calor) erythema (rubor) tenderness (dolor) loss of function (functio laesa)
(clinically…. swelling and tenderness)
Example of acute joint inflammation
Gout
