GALS

Page 1

GALS Exam

Undress down to underwear

1) Any pain or stiffness in the back, muscles or joints?

2) Can you dress yourself completely without difficulty?

3) Can you walk up and down the stairs without difficulty?

Asses Gait- smooth heel strike toe off, speed, symmetry, stride length, stepping gait, turn, any pain (antalgic gait)

Inspection from front->

- Good deltoid bulk

- Elbow extension and carrying angle

- Normal quadriceps bulk

- Knee deformity- varus or valgus

- Forefoot, midfoot abnormalities

Inspection behind ->

- Normal and symmetrical scapulae

- Spinal allignment- scoliosis

- Level iliac crests

- Normal gluteal muscle bulk

- Popliteal swellings

-Normal calf muscle bulk

Inspection side->

-Hindfoot, achilles abnormalities

- Cervical and lumbar lordosis

-Thoracic kyphosis

- Knee hyperextension or fixed flexion deformity

5 movements ->

1) As patient to keep shoulders still and touch their ear to their shoulder on each side. Normal lateral cervical flexion (OA, RA)

2) Patient to open and close their mouth. Patient to move jaw from side to side. Normal painless movements (RA)

3) Patient to put their arms up and behind their head with elbows out and back. Normal abduction and external rotation of the shoulder.

4) Hip and lumbar spine flexion. 2 fingers on adjacent spinous processes, patient bend and touch toes. Fingers should move apart.

5) Presses over midpoint of each supraspinatous -> hyperalgesia in fibromyalgia

Patient to hold out arms palms down and fingers outstretched ->

- Normal extension of the fingers

-No obvious deformities, (MCP and PIP in RA) , heberdens nodes on the DIP joints (OA)

- No pitting of the nails

Patient to turn their hands over->

- Normal supination

- No erythema

- Feel for dupuytren's contracture

- Feel for any tendon sheath sweelings of palm or hypothenar and thenar wasting

3 things for hand->

- MCP joint squeeze and tenderness

- Check power grip- fist and pull fingers out

-Finger dexterity- each finger to thumb

Patient to lie down on couch ->

-Passive flexion and extension hip. Feel for crepitus

- Passive internal and external rotation of the hip

- Press on patella for tenderness

- Patella tap for effusion

Look feel move ankle->

- Look at feet for deformity, swelling, callosities (see shoes for wear)

- Squeeze MTP joint for tenderness

- Ankle active dorsiflexion, plantarflexion, inversion and eversion