How to do a GALS exam for an osce

A key point - remember that GALS is a screening exam.

THE ROUTINE

Would it be okay if I did an examination of the joints in your body
This will involve observing your walking, examining at your neck, back, arms and your legs

Ask if patient is in pain before starting.

Questions
Pain or stiffness in any muscles  or joints?
Any trouble washing or dressing?
Any trouble climbing up & Down the stairs

Examination

Gait
Walk across the room and turn around and walk back
Comment on stride length, symmetry, smoothness and ease of turn

Spine
Look from the side
for kyphosis/lordosis
Look from the back
for scoliosis
Any assymmetry
Shoulders  and iliac crest
Obvious valgus/varus in knees
Look at ankles for hindfoot alignment
Look at lumbar  spinal extension as they bend over
Test cervical spine by getting them to put their ear on their own shoulder
Press the middle of supraspinatous to check for Fibromyalgia

Arms
Hold hands out
Look for any swelling around the joints or muscle wasting in interossei
Supinate hands
Checking supination
Also look for small muscle wasting in the hands
Make a fist
Do a pincer grip
Squeeze the MCP
Indicates synovitis
Straighten arm look at elbow angles
Fixed flexion deformity
Hold hands behind head to test external rotation and abduction

Legs
Lie down on couch
Examine
Wasting or swelling
Check temeprature
Fluid shift test
Bend the knee feeling for creptiations
Check for internal rotation of hip (often first movement to go)
Bend the knee fully when doing this
Look at feet for callouses
Squeeze MTP

Indicates synovitis

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