GALS

Question 1

What does GALS stand for?

Answer 1

Gait, Arms, Leg, Spine

Question 2

Why is GALS test done?

Answer 2

It is a screening test and assesses most commonly affected movements in rheumatic disease

Question 3

How should you start a GALS examination?

Answer 3

Wash hands
Introduction
Identify patient
Gain informed consent and ask about exposure and need for chaperone

Question 4

What are the initial questions you should ask after gaining consent to examine the patient?

Answer 4

1. Do you have any pain or stiffness in your muscles, joints or back?
2. Any difficulties dressing or undressing?
3. Any difficulties getting up or down the stairs?

Question 5

Describe what you would look for on inspection

Answer 5

Front and back: swelling, deformities, asymmetry, muscle wasting at joints, feet, gluteal region, popliteal fossae, calves, Achilles tendons
Sides: normal spinal curvatures - cervical lordosis, thoracic kyphosis, lumbar lordosis and hip/knee flexion or knee hyperextension

Question 6

After inspection, what would you start with and look out for?

Answer 6

Gait - walk forwards, turn and walk back
Look for: posture, pelvic tilt, armswing, stride length, turning, asymmetry - any antalgic gait? Ask if walking is painful

Question 7

After gait, what part of GALS would you move onto?

Answer 7

Arms

Question 8

What do you start the assessment of arms with?

Answer 8

Screening - hands behind head with elbows pushed back (ensure shoulders back)

Question 9

What other aspects of arm assessment follow screening position?

Answer 9

Look - arms straight palms facing down - look at wrist, hands and nails (swelling, deformities, wasting, psoriasis, nodes, nails)
Observe ability to pronate and supinate
MCP squeeze - watch patient’s face + ask pain
Move - fist, finger grip, thumb to each finger

Question 10

How do you examine the spine as part of GALS?

Answer 10

Lumbar spine flexion - place 2 fingers on adjacent vertebrae and ask patient to bend forward to touch toes and come back up (fingers come apart and then together)
Lateral neck flexion - keep shoulder still and touch shoulder with ear

Question 11

How do you assess legs in GALS?

Answer 11

Patellar tap
Bulge test
Fully flex and extend the knee and feel for crepitus
Internal and external rotation with bent knee

Question 12

How do you assess feet in GALS?

Answer 12

Inspect soles for swelling, deformities, callousities

Squeeze MTP joints - watch patient’s face and ask pain

Question 13

How would you complete the examination?

Answer 13

Thank patient
Ask them to redress
Wash hands