GALS

GALS (standing for Gait, Arms, Legs, Spine) is a brief musculoskeletal screening test devised to detect neurological, musculoskeletal or functional deficits in patients.

It consists of an initial set of screening questions and a sequence of examination.

Questions

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

Can you dress yourself without any problem?

Can you walk up and down stairs without problem?

Examination

Gait

Ask the patient to walk a short distance, turn and then walk back.

Observation: looking for symmetry, smoothness of movement, normal stride length, pelvic tilt, arm swing, normal heel strike, stance, toe-off, swing through and ability to turn with ease. Note any antalgic, trendelenburg, hemiplegic or parkinsonian gait features.

Arms, legs and spine

From behind

Inspect for: a straight spine, normal paraspinal muscle bulk, symmetrical shoulder and gluteal muscle bulk, symmetry of iliac crests, absence of popliteal swellings, absence of foot or hindfoot swellings.

Palpate: over mid supraspinatus and roll the skin over the trapezius to test for signs of hyperalgesia or fibromyalgia.

From the side

Inspect for: normal cervical and lumbar lordosis, normal thoracic kyphosis and note any scoliosis. Whilst standing beside the patient place your index finger on one of the lumbar vertebral spinous processes, and your middle finger on the next one down and ask the patient to bend over and touch their toes, keeping their legs straight. Normally, as the patient bends, the spinous processes will move apart, so your fingers will move apart also. Note whether this is the case.

From the front

Inspect for: normal and symmetrical shoulder and quadriceps muscle bulk, no knee swellings, no deformity of mid or hind feet.

Now ask the patient to do the following noting any painful, restricted or asymmetrical movements:

"bend your left your left ear down towards your left shoulder and then the right ear on the right shoulder" to test for pain free cervical spine lateral flexion.

"open jaw and move it side to side" to test for pain free normal tempero-mandibular joint movement.

"put your hands behind your head with your elbows as far back as they can go" to test for normal sterno-clavicular, gleno-humeral and acromio-clavicular joint movement.

"put your hands by your sides with you elbows straight" looking for full elbow extension.

"put your hands out in front of you with your palms down and fingers out straight" looking for ability to extend fingers, and inspecting for any swelling or deformity of fingers or wrist.

"now turn your hands over" making sure that supination is normal (watch for external rotation of the shoulder to compensate for poor supination. Also inspect the palms for any signs or swellings.

"now make a fist with both hands around my fingers and squeeze tightly" test the grip for normal and symmetrical power.

"place the tip of each finger onto the thumb" to test for fine precision pinch. You may also do a metacapral squeeze at this point to test for metacarpal phalangeal tenderness.

Now sit the patient on the couch.

For both legs ask the patient to:

Compare true (ASIS to medial malleolus) and apparent (umbilicus to medial malleolus) leg length.

"put your heel onto your bottom" to test knee flexion. Place your hand over the knee and then the hip joints feeling for crepitus as the patient moves these joints.

now test internal rotation of the hip with the hip joint flexed to 90 degrees (moving the foot laterally with the hip flexed causes internal rotation of the hip joint - early OA causes pain and limitation of this movement).

Test for the balloon sign on the knees.

Inspect the soles of the feet for any calluses, or skin changes.

Squeeze the metatarsal joints to test for any tenderness.

References