MSK: GALS

Question 1

Step 1

Answer 1

Introduce yourself to the patient and obtain consent

Question 2

Step 2- screening questions

Answer 2

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

Question 3

step 3

Answer 3

hand hygiene

Question 4

step 4

Answer 4

Ask the patient to stand in the anatomical position

Question 5

step 5a: inspection (back)

Answer 5

1) Shoulder: muscle bulk and symmetry
2) Spine: deformities
3) Lower limbs: level iliac crests, gluteal bulk/ symmetry, popliteal swelling, calf muscle bulk/ symmetry, hindfoot abnormalities

Question 6

step 5b: inspection (side)

Answer 6

1) spine: normal curvature of cervical/ thoracic/ lumbar spine
2) lower limbs: knee flexion or hyperextension

Question 7

step 5c: inspection (front)

Answer 7

shoulder bulk/ symmetry, elbow extension, quadriceps bulk/ symmetry, knee swelling/ deformity, foot arches, mid- foot/ forefoot deformity.

Question 8

step 6: gait

Answer 8

• Ask patient to walk forwards and turn around

- Able to describe patient’s gait: smoothness, symmetry and ability to turn quickly

Question 9

step 7: cervical spine/ TMJ

Answer 9

• Lateral flexion of the cervical spine performed (ask the patient to tilt to one side, and bring the ear to each shoulder)
• Ask patient to open mouth and move jaw side to side to assess TMJ movement

Question 10

step 8: spine examination

Answer 10

• Patient is asked to touch his toes to assess both hip and lumbar flexion
• Lumbar movement is assessed by placing 2 or 3 fingers on the spinous processes of 2 adjacent lumbar vertebrae (expect fingers to separate)

Question 11

step 9: arm (shoulders)

Answer 11

flex elbow, straighten elbow, raise hands as high as can go

Question 12

step 10: arm (wrist. hands)

Answer 12

Ask patient to turn palm downwards and upwards to examine for swelling and deformity of wrists and hands.

Question 13

step 11: arm (hands)

Answer 13

1) ask patient to make a fist, observe any asymmetry and any difficulty in making a fist
2) power grip examiner’s fingers
3) precision grip test
4) gently squeeze MCP joints

Question 14

step 12: leg (hips/ knees)

Answer 14

flex knees and hips, internally rotate hips

Question 15

step 13: leg (knees)

Answer 15

patella tap

Question 16

step 14: legs (feet)

Answer 16

• inspection: soles for callus formation, swelling/ deformity
• squeeze MTP joints

Question 17

step 15

Answer 17

hand hygiene