GALS Screening OSCE Examination Quiz

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In the GALS arm screen, which instruction screens shoulder abduction and external rotation together with elbow flexion?

A Ask the patient to bend both elbows fully and then place the hands on the top of the shoulders
B Ask the patient to raise both arms out to the sides until they are horizontal, keeping the elbows straight
C Ask the patient to place both hands behind the head with the elbows pointing out to the sides ✓
D Ask the patient to place both hands behind the small of the back with the elbows pointing backwards
E Ask the patient to place both hands behind the head with the elbows pointing forwards

The answer is C: Ask the patient to place both hands behind the head with the elbows pointing out to the sides

Explanation

Why C is correct

See Arms. Option C is correct. GALS stands for Gait, Arms, Legs and Spine, a quick screening examination for problems of the joints and muscles. In the arm screen each instruction tests a different joint or movement. Asking the patient to place both hands behind the head, with the elbows pointing out to the sides screens the shoulder joints and their neighbours: it needs abduction (lifting the arm out to the side) and external rotation (turning the arm outwards) at the shoulder, together with bending (flexion) of the elbow. It is a compact movement that is often limited early in shoulder disease, such as rotator cuff problems (the group of tendons that hold the shoulder in its socket) or adhesive capsulitis (a stiff, painful "frozen" shoulder). The other arm instructions look at the elbows, the forearms and the hands, so each one tests something different and none of them screens the shoulder in this way.

GALS: stands for Gait, Arms, Legs and Spine, a screening examination.
Instruction: place both hands behind the head with the elbows pointing out.
Movements screened: shoulder abduction and external rotation, with elbow flexion.

Why the other options are incorrect

A. Ask the patient to bend both elbows fully and then place the hands on the top of the shoulders: Bending the elbows and placing the hands on the shoulders tests elbow flexion and some shoulder adduction, not shoulder abduction and external rotation with the elbows out. It does not screen the movement combination asked about.
B. Ask the patient to raise both arms out to the sides until they are horizontal, keeping the elbows straight: Raising the arms out to the sides with the elbows straight tests shoulder abduction alone, without external rotation or elbow flexion. It is therefore incomplete for the combination in the stem.
D. Ask the patient to place both hands behind the small of the back with the elbows pointing backwards: Placing the hands behind the small of the back tests shoulder extension and internal rotation with elbow flexion, not shoulder abduction and external rotation. It therefore does not screen the combination of movements asked about.
E. Ask the patient to place both hands behind the head with the elbows pointing forwards: Placing the hands behind the head with the elbows pointing forwards does not put the shoulders into the externally rotated, abducted position needed for the GALS shoulder screen. It therefore misses the shoulder external rotation component asked about.

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What you will practise

More questions from this set. Start the quiz to answer them and see each explanation.

1
A woman has symmetrical knuckle pain and morning stiffness without obvious hand deformity. During GALS, which finding most directly supports inflammation of the metacarpophalangeal joints in suspected early rheumatoid arthritis?
2
After the screening movements of a GALS examination, which action is the most appropriate way to finish?

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