GALS Screening

GALS Screen

GALS stands for;

Gait
Arms
Legs
Spine

this is a systematic approach to a rheumatological system examination.

Order of examination - throughout the GALS screen

o    ask

o    Look

o    Feel

o    Move

Ask

o    Stiffness / pain  in any joints

o    Climb up / down stairs with ease?

o    Can you clothe yourself?

Gait

o    Walking rhythm

o    Pelvis and arm symmetry

o    Normal stride length

o    Ability to Turn quickly

Arms

o    Shoulder joint

§  Scars

§  Deformities

§  Normal muscle bulk

§  External rotation of shoulder

§  Full elbow extension

o    Hands

§  inspection

·         Swelling

·         Interosseous muscle wasting

o    Disuse atrophy

·         Swelling in PCP, MCP etc

·         Thenar and hypothenar wasting

o    Carpal tunnel $

·         Palmar erythyma

o    Occurs in 30% of RA patients

§  Palpation

·         Feel temperature

·         Squeeze the MCP joints

o    Any tenderness - inflammatory joint pathology

·         Press / feel individual joints

o    Cystic

§  Ganglion, abscess

o    Bony

§  Nodes (herbaden’s, bouchard’s)

o    Boggy

§  cynovitis

§  movement

·         Ask to make tight fist

·         OK sign

o    Nails

§  Psoriasis

§  Vasculitis

·         SLE

o    Elbows

§  Psoriatic patches

§  Rheumatic nodules

§  Straighten elbow

o    Compound

§  Hand to head

§  External rotation of shoulder

Legs

·         Feet

o    Metatarsal squeeze

o    Any eythyma

o    Swelling

o    Deformities

o    Callosities of sole

o    crepitus

·         Knees

o    Scars

o    Deformity

·         Knees

o    Feel for any bulge

o    Flexion of knees

o    Flex knees - and rotate externally - test pelvic joint

Spine

·         Kyphoscoliosis

·         Symmetrical muscle bulk

·         Level of iliac crest

·         Side

o    Curvature - scoliosis

o    Lumbar spine and hip flexion

·         Front 

• o     Lateral cervical flexion

o    Hyperalgesic response of fibromyalgia

·         Movement

o    Shober’s test

it is also good to know the RA criteria - 

The 2010 ACR-EULAR classification criteria for rheumatoid arthritis

	Score
Target population (Who should be tested?): Patients who have at least 1 joint with definite clinical synovitis (swelling)* with the synovitis not better explained by another disease†
Classification criteria for RA (score-based algorithm: add score of categories A–D; a score of ≥6/10 is needed for classification of a patient as having definite RA)‡
A. Joint involvement §
1 large joint¶	0
2-10 large joints	1
1-3 small joints (with or without involvement of large joints)#	2
4-10 small joints (with or without involvement of large joints)	3
>10 joints (at least 1 small joint)**	5
B. Serology (at least 1 test result is needed for classification)††
Negative RF and negative ACPA	0
Low-positive R/F or low-positive ACPA	2
High-positive RF or high-positive ACPA	3
C. Acute-phase reactants (at least 1 test result is needed for classification)‡‡
Normal CRP and normal ESR	0
Abnormal CRP or abnormal ESR	1
D. Duration of symptoms§§
<6 weeks	0
≥6 weeks	1