#7543 - P Gals - Medical Finals & OSCEs Notes

GALS: Gait, Arms, Legs, Spine Assessment

For routine clerking of a patient, supposed to be prefaced by three questions:

1. Do you have any pain or stiffness in your joints, muscles or back?

2. Do you have any problems dressing yourself?

3. Do you have any problems climbing stairs?

Gait - symmetry, smoothness, turning ability

Observation

• From the back

  • Straight spine –Scoliosis?

  • Normal muscle bulk

  • Level iliac crests

  • Swelling e.g. popliteal fossa

  • Foot abnormalities

• From the side

  • Fixed joint flexion or extension?

  • Straight spine – kyphosis or lordosis?

• From the anatomical position

  • Normal muscle bulk

  • Knee or elbow deformity

  • Feet deformities e.g. flat feet (pes planus), high arches (pes cavus)

Spine

• Ask them to bend over and touch their toes

• Assess lumbar flexion by using fingers

• Properly, do a Schober’s test

• Lateral flexion of the cervical spine (‘touch ear to shoulder’)

• Temporomandibular joints (‘stick your jaw out, move it from side to side’)

Arms

• Ask them to put their hands behind their head

  • Assess shoulder abduction and external rotation

• Look at hands.

  • Muscle bulk

  • Problems with wrist or finger joints

  • Signs of rheumatological disease – ulnar deviation, z-thumb, swan neck, etc.

• Hand power grip, squeezing examiner’s fingers

• Hand function, touching thumb to each finger in turn

• Assess joint inflammation by gently squeezing metacarpophalangeal joints

Legs – on couch

• Assess knee flexion

• Assess hip flexion and rotation

• Do a patellar tap to exclude knee effusions

• Inspect soles of feet for calluses

• Assess joint inflammation by gently squeezing the metatarsophalangeal joints

Results

Results are recorded in a table as so: