GALS Screen
GALS stands for;
Gait
Arms
Legs
Spine
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
The 2010 ACR-EULAR classification criteria for rheumatoid arthritis
Score
|
|
Target population (Who should be tested?): Patients
who
|
|
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)‡ |
|
0
|
|
2-10 large joints
|
1
|
2
|
|
4-10 small joints (with or
without involvement of large joints)
|
3
|
5
|
|
Negative RF and negative ACPA
|
0
|
Low-positive R/F or low-positive ACPA
|
2
|
High-positive RF or high-positive ACPA
|
3
|
Normal CRP and normal ESR
|
0
|
Abnormal CRP or abnormal ESR
|
1
|
<6 weeks
|
0
|
≥6 weeks
|
1
|
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