Images in this article Image on p. Now test for stiffness or pain flexing or extending the cervical spine: The work dynamics of the person with rheumatoid arthritis. Audit of medical inpatient examination: This site uses functional cookies and external scripts to improve your experience. You may also do a metacarpal gwls at this point to test for metacarpal phalangeal tenderness.
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Gait Ask the patient to walk a short distance, turn and then walk back. Observation: looking for symmetry, smoothness of movement, normal stride length, pelvic tilt, arm swing, normal heel strike, stance, toe-off, swing through and ability to turn with ease.
Note any antalgic , trendelenburg , hemiplegic or parkinsonian gait features. Arms, legs and spine From behind Inspect for: a straight spine note any scoliosis , normal paraspinal muscle bulk, symmetrical shoulder and gluteal muscle bulk, symmetry of iliac crests, absence of popliteal swellings, absence of foot or hindfoot swellings.
Palpate: over mid supraspinatus and roll the skin over the trapezius to test for signs of hyperalgesia or fibromyalgia. From the side Inspect for: normal cervical and lumbar lordosis and normal thoracic kyphosis.
Whilst standing beside the patient place your index finger on one of the lumbar vertebral spinous processes, and your middle finger on the next one down and ask the patient to bend over and touch their toes, keeping their legs straight.
Normally, as the patient bends, the spinous processes will move apart, so your fingers will move apart also. Note whether this is the case. From the front Inspect for: normal and symmetrical shoulder and quadriceps muscle bulk, no knee swellings, no deformity of mid or hind feet.
Now ask the patient to do the following noting any painful, restricted or asymmetrical movements: Test rotation of the thoracic and lumbar spine. Now test for stiffness or pain flexing or extending the cervical spine: "bend your neck forwards to try to touch your chin against your chest.
Now try to touch the small of your back" to test for normal sterno-clavicular, gleno-humeral and acromio-clavicular joint movement. Inspect the palms for any signs or swellings. You may also do a metacarpal squeeze at this point to test for metacarpal phalangeal tenderness.
Now lay the patient down. For both legs compare true ASIS to medial malleolus and apparent umbilicus to medial malleolus leg length. Ask the patient to: "put your heel onto your bottom" to test knee flexion. Place your hand over the knee and then the hip joints feeling for crepitus as the patient moves these joints. Now test internal rotation of the hip with the knee joint flexed to 90 degrees moving the foot laterally with the knee flexed causes internal rotation of the hip joint - early OA causes pain and limitation of this movement.
Test for the balloon sign on the knees. Inspect the soles of the feet for any calluses, or skin changes. Squeeze the metatarsal joints to test for any tenderness.
GALS LOCOMOTOR SCREEN PDF
The 'GALS' locomotor screen.
GALS Examination – OSCE Guide