GALS Examination

- Screening examination
- Examines Gait, Arms, Legs and Spine
... but we usually examine them in the order of Gait, Spine, Arms, Legs, for simplicity.
... however, 'GSAL' is less catchy.

WIPER

"Hi, my name is Anamika Basu, I'm a final year student.

- Is it alright if I do a quick examination of your joints and general movement?

- For this examination we need to have in your underwear, is that okay?

- And we'll need to have you standing up at the start of it."

GAIT

"Can you walk a few steps away from me, turn around and walk back to me?"

I'm observing the patient's gait for symmetry, smoothness and the ability to turn quickly.

"Can you stand like this (imitate anatomical position)?"

I'm looking from 

- behind, from the sides, and from the front,

all the time assessing for 

- the bulk and symmetry of the shoulder, gluteal, quadriceps and calf muscles,

- limb alignment,

- alignment of the spine,

- level of iliac crests,

- ability to extend elbows and knees,

- any popliteal swelling,

- and any abnormalities of feet.

SPINE

As the patient is standing, I am also inspecting the spine

- behind for scoliosis

- and from the side to observe any lordosis or kyphosis

"Can you tilt you head to each side, with the ear towards the shoulder?"

I'm assessing the lateral flexion of the neck

"Can you bend down to touch your toes, as much as you can?"

I'm assessing functional movement

"Okay, now I'm just placing two fingers on your back. Can you straighten up for me?"

I placed my fingers on the lumbar vertebrae to see if they move apart on flexion and back together on extension. This also helps to distinguish the patient's movement from compensatory hip flexion.

ARMS

"Would you like to sit on the couch?

- Can you put you hands behind your head?"

I'm assessing

- shoulder abduction,

- external rotation

- and elbow flexion

"Okay, relax, now can you put you hands out like this, with the palm face down, and fingers outstretched?"

I'm looking for any 

- joint swelling

- or deformity

"Can you turn your hands over?"

I'm assessing the palms for

- muscle bulk

- and any abnormalities

"Can you make a fist for me?"

I'm assessing

- power grip,

- hand and wrist function

- and range of movement in fingers

"Can you squeeze my fingers for me?"

I'm assessing grip strength

"Can you bring each finger in turn to meet the thumb?"

I'm assessing fine precision pinch, which has functional importance

"Do you have any pain in your hands?"

I'm gently squeezing across the MCP joints to check for tenderness, which might suggest inflammatory joint disease, remembering to look at the patient's face for discomfort.

LEGS

"Can you lie down on the couch for me? Are you comfortable? Do you have any pain in your legs? I'm just going to have a feel of your knee joints."

I'm assessing for 

- full flexion and extension of the knees

- and feeling for ant crepitus 

- x2

I'm flexing the hip and knee to 90 degrees, holding the knee and ankle. This is to assess the

- internal rotation of each hip in flexion

- x2

"I'm going to tap on your knee."

I'm performing a patella tap on each knee to check for patellar effusion

This involves me sliding down my hand down the thigh and push over the suprapatellar pouch, forcing any effusion behind the patella. Keeping the pressure on that hand, I use the first two fingers of my other hand to push the patella down gently. If the patellar bounces and 'taps' this is positive for the present of an effusion.
- x2

I'm inspecting the feet for

- swelling,

- deformity

- and calloses on the soles

"Is there any pain in your toes?"

I am squeezing across the MTP joints to check for tenderness

GALS is written down a column with two additional columns headed appearance and movement.

A tick is given for normal findings, and a cross for abnormal ones, with extra notes noting the details.