GALS Screening Examination

Question 1

What are the 3 initial GALS questions?

Answer 1

Do you have any pain or stiffness in your muscles, joints or back?
• Are you able to completely dress and undress yourself without any difficulty?
• Are you able to climb up and down stairs without any difficulty?

Question 2

What are the areas of the screening?

Answer 2

Initial Questions
Inspection
Gait
Spine
Arms: shoulders, wrists, and hands
Legs
Feet

Question 3

What is involved in the inspection stage of GALS?

Answer 3

• From the front: Observe abnormalities in the shoulders, elbows, wrists, hands, chest,
hips, thighs, knees and feet.
• From the side: Check for the presence of the normal spinal curvatures: Cervical
lordosis, thoracic kyphosis and lumbar lordosis. Identify any hip and knee flexion
deformity, or knee hyperextension.
• From the back: Observe any abnormalities in the shoulders, spine and paraspinal
muscles, the level of the iliac crests, the gluteal regions, popliteal fossae, calves,
Achilles tendons and hind-feet.

Question 4

What is involved in the gait stage of GALS?

Answer 4

Ask the patient to walk a few steps, turn, and walk back. Comment on arm swing, pelvic tilt,
stride length, ability to turn quickly and any antalgic (painful) gait on walking. Ask whether
walking is painful/painless.

Question 5

What is involved in the spine stage of GALS?

Answer 5

• Assess flexion of the lumbar spine. Place your fingers on two adjacent lumbar
vertebrae. Ask the patient to bend forward to touch their toes. Observe your fingers
moving apart as the patient bends forward, and then coming together as the patient
bends back.
• Assess lateral flexion of the neck. Ask the patient to tilt their head sideways so that
their ear touches their shoulder. Comment on the ROM on both sides and ask if it is
painful.

Question 6

What is involved in the arms stage of GALS?

Answer 6

Shoulders
• Ask the patient to put their hands behind their head and push their elbows back.
Observe abnormalities in the ROM of shoulder abduction and external rotation & elbow
flexion. You must ensure that the shoulders are pushed back as far as possible.

Wrists and Hands
• Look: Ask the patient to put their hands out in front of them, palms down. Then ask
them to turn their hands over, palm up. Observe any joint swelling, deformity, loss of
contours, muscle wasting, skin/nail changes and nodules in the wrists and hands.
Observe their ability to supinate and pronate at the elbow as they turn their hands over.
Observe their ability to fully straighten their elbow.
• Feel: Assess for tenderness by performing a lateral squeeze of the
metacarpophalangeal joints (MCP’s). You should apply enough pressure so that your
own fingernails start to blanch, not the patients!
• Move:
o Check the patient’s ability to make a full fist covering the nails.
o Ask the patient to squeeze your fingers to assess grip strength
o Ask the patient to bring each finger in turn to meet the thumb (test fine
precision)

Question 7

What is involved in the legs stage of GALS?

Answer 7

Ask the patient to lie on the couch with their legs out in front of them.

Hips and Knees
• Ask the patient to fully flex and extend their knee. Place your hand over their knee to assess for crepitus as they do so.
• Bend the knee and hip both to 900
. Hold the knee and use the ankle to move the leg
so that you assess internal and external rotation of the hip. (‘Internal rotation in flexion’ is usually the first movement to be lost in any hip pathology).
• Perform a patellar tap: slide one of your hands down from mid-thigh so that any fluid in the suprapatellar pouch is pushed into the knee joint. When your hand reaches the upper pole of the patella, leave it there and maintain pressure. With your other hand, use 2 or 3 fingers to push down firmly on the patella. If the patella bounces and makes a “tap” sound, it indicates the presence of a joint effusion.
• An alternative test is the bulge test (slide your hand up the medial side of the joint, then down the lateral side. Any fluid present will cause a visible bulge in the medial suprapatellar fossa when you slide your hand down over the lateral joint margin)

Question 8

What is involved in the feet stage of GALS?

Answer 8

• From the end of the couch, inspect the soles of the feet for swelling, deformity,
callosities
• Squeeze across the MTP joints to check for tenderness (suggests inflammatory joint
disease). Watch the patient’s face for signs of discomfort.

Question 9

How do you complete GALS?

Answer 9

Thank the patient
• Request them to redress
• Wash your hands