GALS examination

Question 1

screening questions

Answer 1

Do you have any pain or stiffness in your muscles, joints, or back?
Can you dress yourself completely without any difficulty? Can you walk up and down stairs without any difficulty?

Question 2

look

Answer 2

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 spine, equal level of iliac crests
- Inspect the spine from behind for evidence of scoliosis, and from the side for abnormal lordosis or kyphosis
- Ability to fully extend the elbows and knees, popliteal swelling
- Abnormalities in the feet such as an excessively high or low arch, clawing of the toes, and hallux valgus.

Question 3

arms: shoulders

Answer 3

Ask the patient to put their hands behind their head. Assess shoulder abduction and external rotation, and
elbow flexion.

Question 4

arms: hands

Answer 4

With the patient’s hands held out, palms down, fingers outstretched: observe the backs of the hands for joint swelling and deformity.

Question 5

arms: fingers

Answer 5

look at the palms for muscle bulk and for any visual signs of abnormality. Ask the patient to make a fist: visually assess power grip, hand and wrist function, and range of movement in the fingers.
Ask the patient to squeeze your fingers: grip strength. Ask the patient to bring each finger in turn to meet the thumb: assess fine precision pinch (important functionally).
Gently squeeze across the MCP joints to check for tenderness suggesting inflammatory joint disease (watch patient’s face for signs of discomfort).

Question 6

legs

Answer 6

With the patient lying on the couch, assess full flexion and extension of both knees, feeling for crepitus.
With the 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).
Test for knee effusion.
From the end of the bed, inspect the feet for swelling, deformity, and callosities on the soles.
Squeeze across ther MTP joints to check for tenderness suggesting inflammatory joint disease (watch patient’s face for signs of discomfort).

Question 7

spine

Answer 7

With the patient standing, ask the patient to tilt their head to each side, bringing the ear towards the shoulder. Assess lateral flexion of the neck (this is sensitive in the detection of early neck problems).
Ask the patient to bend forward to touch their toes. Assess lumbar spine flexion by placing two or three fingers on the lumbar vertebrae – your fingers should move apart upon flexion and back together upon extension.