GALS exam

Question 1

What are the initial questions asked in a GALS exam?

Answer 1

1. Do you have any pain or stiffness in your muscles, joints, or back? (screening for common symptoms of joint pathology)
2. Do you have any difficulty getting yourself dressed without any help? (screening for fine motor impairment and significant restricted range of motion)
3. Do you have any problem going up and down the stairs? (screening for impaired gross motor function)

Question 2

What are you looking for on inspection in a GALS exam?

Answer 2

From the front, sides, and back:
- posture (lordosis/kyphosis/scoliosis)
- scars (previous surgeries/trauma)
- joint swelling or erythema (suggests inflammatory arthropathy, effusion, or septic arthritis)
- muscle bulk (asymmetry = disuse atrophy or LMN injury)
- pelvic tilt (lateral = scoliosis)
- valgus/varus deformity in knees
- knee hyperextension
- foot arch (flat or raised)
- toes (fixed flexion or lateral/medial angulation)
- Achille’s tendon (thickening = tendonitis)

Question 3

How do you asses gait in a GALS exam?

Answer 3

• Stance: broad base = ataxic gait
• Stability: staggering/slow/unsteady gait = cerebellar disease
• Arm swing: absent/reduced = Parkinsonian gait
• Steps: high = foot drop, small/shuffling = Parkinsonian gait, one leg in stiff and swings round = hemiplegic gait
• Turning: difficulty turning = cerebellar disease
• Limping: antalgic gait = pain/weakness
  
  • assess patient’s footwear for unequal sole wearing (suggests abnormal gait)

Question 4

How do you assess the spine in a GALS exam?

Answer 4

Flexion of the lumbar spine:
- place your fingers on 2 adjacent lumbar vertebrae
- ask the patient to bend forwards and observe your fingers moving apart
Lateral flexion of cervical spine:
- ask the patient to tilt their head sideways so their ear touches their shoulder
- assess the ROM on both sides

Question 5

How do you assess the movement of the shoulders in a GALS exam?

Answer 5

• Ask the patient to put their hands behind their head and push their elbows back
• This assess shoulder abduction and external rotation, and elbow flexion

Question 6

How do you asses the arms and hands in a GALS exam?

Answer 6

1. Ask the patient to hold their hands in front of them with palms facing down:
   - to assess the movements of shoulder flexion, elbow and wrist extension, and finger extension
   - inspect the dorsum of the hand for asymmetry, swelling, deformity, and nail changes
2. Ask the patient to turn the hands over:
   - to assess supination
   - inspect the thenar and hypothenar eminences for wasting
3. Ask the patient to make a fist
   - to assess finger flexionand function of hands
4. Assess grip strength
   - maybe reduced due to pain or LMN lesion
5. Precision grip
   - to asses coordination
6. Metacarpophalangeal joint squeeze
   - tenderness suggests inflammatory arthropathy

Question 7

How do you assess the legs in a GALS exam?

Answer 7

• Assess the ROM of passive knee flexion and extension, and internal and external rotation of the hip
• Perform a patellar tap (to detect joint effusion)

Question 8

How do you assess the feet in a GALS exam?

Answer 8

• Inspect the soles of the feet for swelling, deformity, and calloses
• Perform a metatarsophalangeal joint squeeze (tenderness suggests inflammatory arthropathy)