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GALS - Gait , Arms , Legs and Spine - screening examination for musculoskeletal disorders

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Screening examination for musculoskeletal disorders (GALS) - screening examination is known by the acronym 'GALS', which stands for Gait, Arms, Legs and Spine

  • sequence in which these four elements are assessed can be varied -in practice, it is usually more convenient to complete the elements for which the patient is weightbearing before asking the patient to climb onto the couch


  • observe gait
    • ask the patient to walk a few steps, turn and walk back
      • observe the patient's gait for symmetry, smoothness and the ability to turn quickly

  • observe patient in anatomical position
    • ask the patient to stand in the anatomical position
      • observe from behind, from the side, and from in front for:
        • bulk and symmetry of the shoulder, gluteal, quadriceps and calf muscles;
        • limb alignment; alignment of the spine;
        • equal level of the iliac crests;
        • ability to fully extend the elbows and knees;
        • popliteal swelling;
        • abnormalities in the feet such as an excessively high or low arch profile, clawing/ retraction of the toes and/or presence of hallux valgus


  • observe movement - hands behind head
    • assess shoulder abduction and external rotation, and elbow flexion (these are often the first movements to be affected by shoulder problems)

  • observe backs of hands and wrists
    • patient's hands held out, palms down, fingers outstretched
    • inspect the backs of the hands for joint swelling and deformity

  • observe palms
    • inspect the palms for muscle bulk and for any visual signs of abnormality

  • assess power grip and grip strength
    • assess power grip, hand and wrist function, and range of movement in the fingers

  • assess fine precision pinch
    • ask the patient to squeeze your fingers. Assess grip strength

  • squeeze MCPJs
    • gently squeeze across the metacarpophalangeal (MCP) joints to check for tenderness suggesting inflammatory joint disease - watch the patient's face for non-verbal signs of discomfort


  • assess full flexion and extension
    • patient lying on the couch, assess full flexion and extension of both knees, feeling for crepitus

  • assess internal rotation of hips
    • position patient so that hip and knee flexed to 90 degrees
      • holding the knee and ankle to guide the movement, assess internal rotation of each hip in flexion (this is often the first movement affected by hip problems)

  • perform patellar tap
    • to check for a knee effusion
      • slide your hand down the thigh, pushing down over the suprapatellar pouch so that any effusion is forced behind the patella.
      • when you reach the upper pole of the patella, keep your hand there and maintain pressure
      • use two or three fingers of the other hand to push the patella down gently - is there a consequent bounce and 'tap'? - if so then indicates the presence of an effusion

  • inspect feet
    • from the end of the couch
      • for swelling, deformity, and callosities on the soles

  • squeeze MTPJs
    • to check for tenderness suggesting inflammatory joint disease - watch the patient's face for signs of discomfort


  • inspect spine
    • whilst the patient is standing
      • inspect the spine from behind for evidence of scoliosis, and from the side for abnormal lordosis or kyphosis

  • assess lateral flexion of neck
    • assess lateral flexion of the neck (this is sensitive in the detection of early neck problems).
    • ask the patient to tilt their head to each side, bringing the ear towards the shoulder

  • assess lumbar spine movement
    • ask the patient to bend to touch their toes
      • this movement is important functionally (for dressing) but can be achieved relying on good hip flexion, so it is important to palpate for normal movement of the vertebrae
        • assess lumbar spine flexion by placing two or three fingers on the lumbar vertebrae. Your fingers should move apart on flexion and back together on extension


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