GALS examination – OSCE Guide

geekymedics.com/gals-assessment/

Lewis Potter 10/8/2010

GALS examination (Gait / Arms / Legs / Spine) , is often used as a quick screening tool to detect locomotor
abnormalities and functional disability in a patient. This GALS examination OSCE guide demonstrates how to
perform the assessment in a step by step manner, with an included video guide. Check out the GALS mark scheme
here.

Introduction
Wash hands

Introduce yourself

Confirm patient details – name / DOB

Explain examination

Gain consent

Expose patient’s chest, upper and lower body

Ask if the patient has any pain anywhere before you begin!

Screening questions
Do you have any pain in your muscles, joints or back?

Are you able to dress yourself completely without any difficulty?

Are you able to walk up and down the stairs without any difficulty?

Gait
Ask the patient to walk to the end of the room and back whilst you observe:

Inspect the symmetry of the patient’s gait

Inspect the smoothness of the patient’s gait – heel strike, toe off
When the patient reaches the end of the room, are they able to turn quickly without any issues?
Is each step of normal height? – increased stepping height is noted in foot drop
1/10
 Is there any evidence of pain ( antalgic gait) ?

Assess gait

Assess gait

1. 1
2. 2

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Inspection
Ask the patient to stand in the anatomical position whilst you inspect from the front, side and behind for any
abnormalities.

Front

Shoulders – assess shoulder bulk and symmetry

Elbow extension – assess carrying angle – normal is 5-15 degrees

Quadriceps – assess bulk and symmetry

Knees – swelling / deformity / asymmetry

Feet – note any midfoot or forefoot deformity / asymmetry ( e.g. hallux valgus)

2/10
 Inspect front of upper body

Inspect front of legs & feet

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2. 2

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Side

Cervical spine – inspect for hyperlordosis – spondylolisthesis

Thoracic spine:

Inspect degree of thoracic kyphosis (normal is 20-45º)

Hyperkyphosis – >45º (e.g. Scheuermann’s kyphosis)

Lumbar spine – assess degree of lordosis

Hyperlordosis – spondylolisthesis
Loss of lumbar lordosis ( flat back syndrome) – compression fractures / ankylosing spondylitis

Knee joints – note degree of flexion or hyperextension

Foot arches – inspect the patient’s foot arches

Low arch profile (pes planus / flat feet)

High arch profile (pes cavus) – e.g. Charcot-Marie-Tooth disease
3/10
Toe clawing – e.g. plantar fascial fibromatosis

Inspect upper body from side

Inspect lower body from side

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2. 2

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Behind

Shoulder muscles – wasting / asymmetry may suggest joint pathology

Spinal alignment – look for evidence of scoliosis (S-shaped spine)

Iliac crest alignment – pelvic tilt may suggest hip abductor weakness

Gluteal muscle bulk – wasting of gluteal muscles suggests reduced mobility

Popliteal swellings – Baker’s cyst / popliteal aneurysm (pulsatile)

Hind-foot abnormalities

4/10
 Inspect back

Inspect legs from behind

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2. 2

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Arms
Ask the patient to place their hands behind their head – assesses shoulder abduction and external rotation in
addition to elbow flexion.

Ask the patient to hold their hands out in front of them, with their palms facing down and fingers
outstretched:

Inspect the backs of the hands for asymmetry, joint swelling and deformity

Ask the patient to turn their hands over (pronation):

Inspect the muscle bulk of the palms (thenar / hypothenar eminences)

Note any other abnormalities

Ask the patient to make a fist whilst observing hand function.

Power grip – ask the patient to squeeze your fingers and assess grip strength (comparing between the hands)

Precision grip – ask the patient to touch each finger in turn to their thumb

5/10
Gently squeeze across the metacarpophalangeal (MCP) joints – observe for non-verbal signs of discomfort
– tenderness may indicate inflammatory arthropathy

Abduction & external rotation

Pronation

Supination

Thenar muscle bulk

6/10
 Assess power grip

Assess precision grip

MCP squeeze

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2. 2
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Legs
Position the patient lying down on the examination couch.

Assess passive full knee flexion and extension – feeling for crepitus

Assess passive hip flexion

Assess passive internal rotation of the hip joint (hip and knee joint should be flexed to 90º for assessment)
7/10
Patellar tap (can detect large effusions)

1. Empty the suprapatellar pouch by sliding your left hand down the thigh to the patella.

2. Keep your left hand in position and use your right hand to press downwards on the patella with your fingertips.

3. If fluid is present you will feel a distinct tap as the patella bumps against the femur.

Inspect the feet for swelling, callosities and deformity

Squeeze across metatarsophalangeal (MTP) joints – observe for non-verbal signs of discomfort – tenderness
may indicate inflammatory arthropathy

Hip flexion (passive)

Hip internal rotation (passive)

Patella tap

8/10
 MTJ squeeze

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2. 2
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Spine
Inspect the patient’s spine:

Looking from behind for evidence of scoliosis

Look from the side for abnormalities of lordosis or kyphosis

Lateral flexion of cervical spine – ask the patient to tilt their head to each side, moving their ear towards the
shoulder

Lumbar flexion:

1. Place 2 fingers on the lumbar vertebrae

2. Ask the patient to bend and touch their toes
3. Observe your fingers as they flex (they should move apart)
4. Observe your fingers and the patient extends their spine to return to a standing position (your fingers should
move back together)

Assess c-spine lateral flexion

9/10
 Assess TMJ joint

Assess lumbar flexion

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2. 2
3. 3

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To complete the examination

Thank patient

Wash hands

Summarise findings

Suggest further assessments and investigations

Perform a focused examination on joints with suspected pathology

Request further imaging of joints with suspected pathology (e.g. X-ray / CT / MRI)

10/10