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Musculoskeletal > 8. The GALS screen > Flashcards

8. The GALS screen Flashcards

1
Q

What does GALS stand for?

A
  • Gait
  • Arms
  • Legs
  • Spine
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2
Q

What is the GALS screen?

A

Initial rapid joint screening examination

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3
Q

How do we screen for gait?

A

Observe patient walking, turning and walking back, looking for:
• Smoothness and symmetry of leg, pelvis and arm movements
• Normal stride length
• Ability to turn quickly

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4
Q

How do we screen the spine?

A 
Observe the spine and ask yourself the following questions:
• Symmetrical para-spinal and shoulder girdle muscle bulk?
• Straight spine?
• Normal gluteal muscle bulk?
• Popliteal swellings?
• Normal Achilles tendons?
• Signs of fibromyalgia?
• Normal spinal curvatures?
• Normal lumbar spine and hip flexion?
• Normal cervical spine?
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5
Q

How do we screen the arms?

A
  • Look for normal girdle muscle bulk and symmetry
  • Check for full extension at the elbows
  • Normal shoulder joints?
  • Observe supination, pronation, grip and finger movements
  • Test for synovitis at the MCP joints
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6
Q

How do we screen the legs?

A
  • Look for knee or foot deformity or swelling
  • Assess flexion of hip and knee
  • Look for knee swellings
  • Test for synovitis at the MTP joints
  • Inspect soles of the feet
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7
Q

What do we do once the GALS screen is completed?

A

Locomotor examination - detailed examination of any abnormal

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8
Q

Describe the detailed examination of abnormal joints

A
  • Inspection - swelling, redness, deformity
  • Palpation - warmth, crepitus, tenderness
  • Movement - active, passive, against resistance
  • Function - loss of it
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9
Q

What does arthralgia refer to?

A

Pain within a joint without demonstrable inflammation by physical examination

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10
Q

What is subluxation?

A

Partial dislocation

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11
Q

What is a varus deformity?

A
  • Lower limb deformity

* Distal part is directed towards the midline

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12
Q

What is a valgus deformity?

A
  • Lower limb deformity

* Distal part is directed away from the midline

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13
Q

Where is acute gout typically seen in arthritis?

A

First metatarsal-phalangeal joints

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14
Q

What causes gout?

A
  • Tissue deposition of monosodium urate (MSU) crystals
  • Result of hyperuricaemia
  • Can lead to gouty arthritis and tophi (aggregated deposits of MSU in subcutaneous tissue)
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15
Q

When does gout usually resolve?

A

Spontaneously over 3-10 days

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16
Q

What are the 3 signs of irreversible joint damage?

A
  • Joint deformity e.g. mal-alignment
  • Crepitus
  • Loss of joint range or abnormal movement
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17
Q

What are spondyloarthripathies?

A 
• Group of conditions where rheumatoid factor comes back negative
• Includes:
- reactive arthritis
- Reiter's syndrome
- ankylosing spondylitis
- psoriatic arthritis
- enteropathic synovitis
18
Q

What questions do you ask yourself to determine the type of arthritis (when looking at the joints)?

A
  • Number of joints involved
  • Symmetrical?
  • Size?
  • Axial (spine) involvement?
19
Q

How do you classify arthritis by the number of joints involved?

A
  • Monoarthritis - single joint
  • Ligoarthritis - 2-4 joints
  • Polyarthritis - >4 joints
20
Q

Which type of arthritis is bilateral and symmetrical involvement of large and small joints typical of?

A

Rheumatoid arthritis

21
Q

Which type of arthritis is lower limb asymmetrical oligo-arthritis and axial involvement typical of?

A

Reactive arthritis

22
Q

What condition is exclusive inflammation of the first metatarsophalangeal joints highly suggestive of?

A

Gout

23
Q

Which type of arthritis is the exclusive inflammation of the distal interphalangeal joints of the fingers suggestive of?

A

Psoriatic arthritis

24
Q

Which joints are commonly involved in polyarticular gout?

A
  • First MTP
  • Ankle
  • Knee
25
Q

What is an abnormal increase in synovial fluid termed as?

A

Synovial effusion

26
Q

What happens to the production of hyaluronic acid if there is abnormal mechanical stimulation?

A
  • Increased production by synovial fibroblasts

* This increases oncotic pressure and synovial volume - normal composition

27
Q

What happens to the production of hyaluronic acid in inflammation?

A
  • Effusion is inflammatory exudate
  • Inflammatory cells, mediators => reduced hyaluronic acid
  • Abnormal composition
  • More neutrophils - still more viscous
28
Q

Why is it important not to confuse gout with an infection?

A

Bacteria release metalloproteinases which destroy the articular cartilages

29
Q

How is the synovial fluid examination performed?

A

Needle aspiration under aseptic conditions (arthrocentesis)

30
Q

What are the contraindications and possible (rare) complications of arthrocentesis?

A
  • Conditions that increase risk of bleeding into joint
  • Overlying skin infection
  • Bleeding into joint
  • Risk of introducing infection e.g. creating a septic arthritis
  • Damage to structures within the joint e.g. cartilage
31
Q

What are synovial fluid samples routinely examined for?

A
  • Pathogens - rapid Gram stain followed by culture and antibiotic sensitivity assays
  • Crystals - polarising light microscopy for detection
32
Q

What is Raynaud’s phenomenon?

A
  • Intermittent vasospasm of digits on exposure to cold
  • Can be normal, but is over-represented in connective tissue disease
  • White => blue => red
  • Cyanosis as static venous blood deoxygenates
  • Reactive hyperaemia as blood flow increases
33
Q

What is Sjörgen’s syndrome and the effects of it?

A

• Connective tissue disease
• Destruction of exocrine glands - autoimmune exocrinopathy
• Associated with Anti-Ro/La and Rheumatoid factor
• Results in:
- dry eyes (xerophthalmia)
- dry mouth (xerostomia)
- parotid gland enlargement
• Extra-glandular manifestations - non-erosive arthritis and Raynaud’s
• Secondary if it occurs in the context of another CTD

34
Q

What is the inflammation of the muscle with and without skin involvement called?

A
  • With - dermatomyositis

* Without - polymyositis

35
Q

What are the skin changes in dermatomyositis?

A
  • Lilac-coloured (heliotrope) rash on eyelids
  • Red or purple flat or raised lesions on knuckles (Gottron’s papules)
  • Subcutaneous calcinosis
  • Mechanic’s hands (fissuring and cracking of skin over finger pads)
36
Q

Which autoantibodies is the inflammatory muscle disease changes associated with?

A

ANA - anti-tRNA synthetase antibodies

37
Q

What are the following like in muscle inflammatory disease tests:
• CPK (creatine phosphokinase)
• Electromyography
• Muscle biopsy

A
  • Elevated CPK
  • Abnormal electromyography
  • Abnormal muscle biopsy (polymyositis = CD8+, dermatomyositis = CD4+ and B cells)
38
Q

What does systemic sclerosis attack?

A

Skin, causing dermal fibrosis (very rare)

39
Q

What happens in diffuse (referring to skin changes) systemic sclerosis?

A
  • Fibrotic skin proximal to elbows or knees
  • Anti-topoisomerase-1 antibodies
  • Pulmonary fibrosis, renal involvement
  • Short history of Raynaud’s phenomenon
40
Q

What happens in limited (referring to skin changes) systemic sclerosis?

A
  • Fibrotic skin hands, forearms, feet, neck and face
  • Anti-centromere antibodies
  • Pulmonary hypertension
41
Q

What is overlap syndrome?

A

When feature of more than 1 connective tissue disorder are present e.g. SLE and inflammatory muscle disease

42
Q

What does mixed connective tissue disease (MCTD) refer to?

A
  • Patients with features seen of SLE, scleroderma, rheumatoid arthritis and polymyositis
  • All with the presence of anti-U1-RNP antibody

Musculoskeletal (9 decks)

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