Introduction
This topic covers the screening examination of the joints and vertebral column (GALS) and the specific tests for the spine and each major joint.
GALS screening
GALS = Gait, Arms, Legs, Spine. Ask three questions:
- Any pain or stiffness in your muscles, joints or back?
- Can you dress yourself completely without any difficulty?
- Can you walk up and down the stairs without any difficulty?
Also observe the gait.
Vertebral column
Thoracic spine: sign of Ott
- Locate C7 and measure 30 cm inferiorly; mark it.
- Ask the patient to bend forward without bending the knees and measure the marked 30 cm again.
- If the increase is less than 5 cm: problem with the thoracic spine.
Lumbar spine: Schober (Schubert) sign
- Measure 10 cm superiorly from the iliac spine (midline); mark it.
- Ask the patient to bend and note the new distance.
- Normal: increase of 5 cm or more; anything less means a problem in the lumbar part.
Cervical spine: no measurement (Forestier's sign)
- The patient stands with heels, buttocks and back close to the wall.
- Ask the patient to touch the wall by tilting the head back.
- Ankylosing spondylitis: cannot touch the wall = Forestier's sign positive. If the patient can touch it, it is negative.