GALS screening

GALS is a rapid screening method for musculoskeletal and neurological problems.

1. Screening Questions
   1. Do you have any pain/stiffness in any of your joints, muscles or back?
   2. Do you have any difficulty (un)dressing yourself?
   3. Do you have any difficulty walking up/down stairs?
   4. Do you have any difficulty brushing your hair / reaching up to get things?
2. Gait
   1. With the patient suitably exposed, ask the patient to walk a few yards, turn round and walk back.
      1. Observe smoothness and symmetry. (NB Here are some great videos of normal and abnormal gaits: http://www.youtube.com/user/onlinemedicalvideo/videos?query=gait )
3. Arms
   1. Inspect
      1. Inspect the arms for any muscle wasting, deformity or scars.
   2. Palpate
      1. Standing in front of the patient, palpate along the top of the shoulder for tenderness in the supraspinatus muscle.
   3. Move
      1. Ask the patient to put their hands behind their head (elbows out), testing abduction and external rotation of the shoulder.
      2. Ask the patient to keep their elbow flexed at 90°, and ask them to turn their hands up and then down.  This tests pronation and supination of the forearm.
      3. Ask the patient to flex their elbows as much as possible to touch their shoulders.  This tests flexion of the elbow.
      4. Ask the patient to make a prayer sign and then an inverse prayer sign, testing flexion and extension of the wrist.
      5. Ask the patient to extend their arms right out, testing elbow extension.
      6. Ask the patient to clench fists and open their hands, to test finger flexion and extension (and wrist function).
      7. Ask the patient to squeeze your first two fingers, testing grip
      8. Ask the patient to touch each finger to thumb, testing precision grip and coordination.
      9. Gently squeeze the metacarpal heads to check for tenderness.
4. Legs
   1. With the patient lying supine, carry out Thomas’ Test for fixed flexion deformity.
   2. Passively flex the patient’s leg with one hand on the knee, feeling for crepitus on movement, but also for warmth and swelling.
   3. Test passive external and internal rotation of the hip by flexing the hip and knee at 90° and moving the foot medially and laterally, respectively (i.e. pushing the foot towards the midline testsexternalrotation of the hip).
   4. Inspect the patient’s foot for any deformity/abnormality.
   5. Gently squeeze the metatarsal heads to check for tenderness.
5. Spine
   1. With the patient standing, inspect the back and posture.  Look for the normal lordosis and kyphosis, and also for symmetry of the legs and trunk.  Look for any deformity of the back and legs.
   2. Ask the patient to try and touch their toes, testing flexion and highlighting any abnormal spinal curvature or limited hip extension.
   3. With you supporting the hips static and stable, ask the patient to turn from side to side, testing thoracocolumnar rotation.
   4. Ask the patient to slide one hand as far down the side of their leg as can go, testing lateral lumbar flexion.
   5. Ask the patient to touch ear to shoulder, testing lateral cervical flexion.
   6. Ask the patient to look down at the floor and up to the ceiling, testing cervical flexion/extension.
   7. Ask the patient to drop their jaw and move it from side to side, testing the TMJs.

Recording the results