Musculoskeletal screening examination: GALS video
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The GALS screening examination is designed for routine clerking of a patient. It is available in both video and CD format elsewhere. A brief revision form is presented here.
The screening examination includes three questions which should be incorporated into routine systemic enquiry. These include:
- “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 the stairs without any difficulty?”
The patient’s gait is assessed for symmetry and smoothness as well as the ability to turn quickly.
With the patient standing:
- From behind, observe the patient for normal shoulder muscle bulk, straight spine, level iliac crests, gluteal bulk and symmetry, any popliteal swelling, calf muscle bulk and any hindfoot abnormalities.
- Examine from the side, looking for normal cervical lordosis, thoracic kyphosis, lumbar lordosis and evidence of knee flexion or hyperextension.
- Asking the patient to touch their toes assesses both hip and lumbar flexion. Lumbar movement is assessed by placing two or three fingers on the lumbar spine.
- In the anatomical position, inspect for shoulder bulk, elbow extension, quadriceps bulk and symmetry, knee swelling and deformity, foot arches and any mid-foot or forefoot deformity.
- Lateral flexion of the cervical spine is performed, followed by assessment of the temporomandibular joints.
- Full shoulder abduction and external rotation is performed by asking the patient to place their hands behind their head.
- Inspect for swelling and deformity of wrists and hands.
- Inspect the palms of the hands for muscle bulk and other visual abnormality.
- Power grip assesses wrist and hand function; squeezing the examiner’s fingers assesses strength.
- Fine precision pinch tests hand joint movement, co-ordination and concentration.
- Gently squeezing the metacarpophalangeal joints screens for inflammatory joint disease.
With the patient on the examination couch:
- With the patient on the couch assess full knee flexion and internal rotation of the hip in flexion.
- A patellar tap should be performed to exclude knee effusions.
- The soles of the feet should be inspected for callus formation, and finally squeeze the metatarsophalangeal joints again to screen for inflammatory arthritis.
The results of the screening examination can be recorded in a table.