Dr. M.D. Findlay Clinical Examination and the Top 5 ©
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Finals Musculoskeletal Examination. (GALS)
Ank.Spond/Rheumatoid Arthritis/Osteoarthritis
Introduces self/obtains consent 1
Questions (Do you have any…)
Pain or stiffness in legs, arms, neck or back? 1
Difficulty washing, dressing or with stairs? 1
GAIT
Ask patient to stand from sitting 1
Ask to walk for short distance 1
Note smoothness of movement, symmetry, need for support.
Ask to turn back – notes difficulties 1
Notes abnormalities accurately 1
Antalgic gait, spastic gait, evidence of foot drop, ataxia
ARMS
Look – position: arms forward, hands rested on thighs/pillow 1
Look – erythema, swelling, deformity, scars, muscle wasting 1
Feel – temperature, swelling (tendons, joints, tender?) 1
Feel – “Metacarpal squeeze” – assess for tenderness 1
Move – Assess gross movement (make a fist) 1
Move – Assess fine movement (pincer grip, buttons) 1
Move – Power of grip – “squeeze my fingers” 1
Move – Assess pronation/supination , with elbows in 1
Move – Elbow flexion and extension 1
Move – Shoulder external rotation and abduction 1
(hands behind head with elbows pulled back)
“Move” should include firstly active (patient) then passive movements, with an examining
hand over the relevant joint to fix it and palpate for crepitus.
LEGS
Look – sole of foot for calluses (abnormal weight bearing) 1
Look – erythema, swelling, deformity, scars, muscle wasting 1
Feel – temperature, swelling (tendons, joints, tender?) 1
Feel – “Metatarsal squeeze” – assess for tenderness 1
Feel – “Patellar tap” (for effusion) 1
Move – hip internal and external rotation 1
Move – knee flexion and extension 1
SPINE
Look – Patient standing, examine at their back & side 1
Scoliosis present?, lordosis-kyphosis-lordosis intact?