Clinical Examination Guide

GALS Examination
Introduction
The GALS (Gait, Arms, Legs, Spine) examination screens for common musculoskeletal and functional disability
• Introduce yourself, confirm patient ID
• Explain examination and need to expose their back and legs, gain consent, and ask patient to stand
• Ask
- “Do you have any pain or stiffness in your muscles, joints or back?”
- “Can you dress yourself completely without difficulty?”
- “Can you walk up and down stairs without difficulty?”
• Gel hands

General Inspection - standing

Front Side Behind
• Quadricep bulk and • Normal cervical and lumbar • Shoulder muscle bulk /
symmetry lordosis symmetry
• Knee swelling, varus or • Normal thoracic kyphosis • Spinal alignment - no
valgus • Full elbow extension scoliosis, symmetrical
• Forefoot/midfoot • Quadricep bulk and paraspinal muscles
abnormalities symmetry • Level iliac crests
• Foot arches • Knee swelling, flexion / • Gluteal muscle bulk /
hyperextension symmetry
• Forefoot / mid foot • Popliteal swellings
abnormalities, normal foot • Calf muscle bulk /
arches symmetry
• Hind foot / Achilles
abnormalities

Gait
Walking & Turning
With patient walking and turning, look for:

• symmetry, smoothness and normal stride length

• normal stance phase (heel strike, foot flat and toe off) and swing phase.
• ability to turn quickly
[Problems with walking may indicate lumbar spine and lower limb problems]

Document Owner: Clinical Skills – LK/ST

Last Updated: April 2018
Arms
Hyperalgesia Abduction & external Shoulder Rotation,
rotation Pronation & Suppination
“Please bring your With arms held out, palms down, fingers
hands up to your spread, look for
ears, elbows back” • Wrist or finger swelling/deformity
• Full finger extension
• Nail signs [Pitting in psoriasis]
Press on midpoint of each [Abduction and external rotation are
supraspinatous and note if often first movements affected by With palms facing up, look for:
causes pain shoulder pathology]
• Normal supination [supination assesses
the radio-ulnar joint, commonly
affected in RA]
• Skin/muscle/joint deformity
[Heberden’s nodes over the DIPs in OA]

Fist Pincer MCPs

Ask patient to make fist around your Ask patient to bring each fingertip to Squeeze across the MCP joints in both
fingers and squeeze. For both hands, the thumb and pinch them together in hands, note any tenderness
assess: turn. For both hands, assess: [RA or other inflammatory joint
• Dexterity disease]
• Finger flexion • Pincer grip
• Grip • Precision
[Fine movements important
for function, limited in in
RA]

Legs
Knee
Holding patient’s knee, flex their knee
and hip. Assess for:
• Full hip and knee flexion
• Knee crepitus
Ankle movement
Ask patient to:
• dorsiflex and plantarflex
the foot [OA affects tibio-
talar joint]
• Invert and evert the foot
at the ankle [RA affects
mid tarsal and subtalar
joints]
Hip Internal Rotation
• With knee and hip flexed to 900
assess for pain on internal
rotation.
• Use the knee passively rotate the
hip. The foot moves in opposite
direction to hip rotation [internal
rotation affected early in OA]
Abnormal weightbearing
Look for deformities and
callouses on the foot
[suggestive of abnormal
weight bearing]
Patella
• Press on the patella
and assess for
tenderness
[patellofemoral disease]
• Empty suprapatellar pouch of fluid
by stroking it downwards a few
times from 15cm above the patella,
then tap on patella. [“Bounce and
tap” = effusion of inflammatory
process]
MTPs
Squeeze across the MTP
joints, note tenderness
[inflammatory joint disease]

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Spine
Lateral Cervical Flexion Cervical Flexion and Extension Temperomandibular Joint
“Keeping the shoulders still, “Keeping the shoulders still, look up… “Open your mouth wide, close it, and
move your ear down then look down” move our jaw from side to side”
towards your
shoulder…and then to the
other side”

[Lateral cervical flexion

affected early in OA and RA]
[TM joint often affected in RA]
Lumbar Flexion Thoracic & Lumbar Rotation
• Place two fingers on the lumbar • Stabilise the pelvis with your hands
vertebrae. • Ask the patient to rotate their upper body from side
• Ask patient to bend down to touch to side without moving their feet.
toes
• Your fingers will move apart as the
patient bends
• Increase in distance between you
fingers is due to lumbar flexion (normal
range 6-7cm increase)

Conclusion
• Thank the patient, ask them to get dressed, report/record findings
• Consider more detailed musculoskeletal or neurovascular examination

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