GALS Screen
The Gait Arms Legs Spine exam is a screening test for rheumatological disease.
It is advisable to do it in the order: Questions, Gait, Arms, Spine,
Legs. The first three can be performed with the patient standing, and
examination of the legs whilst the patient is on the couch.
Note that there are different versions of the GALS
screen, it is worth finding out which version your medical school
recommends.
The Routine
Questions
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"Pain or stiffness in your muscles joints or back?"
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"Dress yourself completely without any difficulty?"
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"Walk up & down stairs without any difficulty?”
Gait
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Symmetry, smooth movement, arm swing, no pelvic tilt, normal stride length, ability to turn quickly
Arms
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Raise arms out sideways & up above your head: 180 degree elevation through abduction without wincing.
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Touch the small of your back: Touches above T10 with both hands.
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Straighten your elbows right out: Elbows extend to 0 degrees or slightly beyond (females) symmetrically.
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Place hands together as if to pray, with elbows right out: 90 degrees wrist
extension & straight fingers. The same with hands back to back: 90 degrees
wrist flexion.
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Place both hands out in front, palms down, fingers out
straight: No wrist/finger swelling/deformity, 90 degrees pronation MCP cross
compression: No tenderness.
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Turn hands over: 90 degrees of supination. No palmar swellings, wasting or erythema.
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Make a fist & hide your nails: Can hide fingernails.
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Pinch index, middle finger & thumb together: Can do.
Spine
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Inspection: No scoliosis, symmetrical paraspinals, normal
shoulder & gluteal muscle bulk & symmetry, level iliac crests,
normal cervical & lumbar lordosis
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Movement
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Bend forward & touch toes: Finger to floor distance less than 15cm, lumbar expansion.
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Place your ear on your shoulder: Ear touches acromion
Legs
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Standing:
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Inspect front & back: No knee deformity, anterior or
popliteal swelling, no muscle wasting, no hindfoot swelling or deformity
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Lying:
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Flex hip & knee, holding knee: No bony crepitus, 140 degrees knee flexion.
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Passively rotate hips: 90 degrees total pain free rotation.
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Bulge test/patellar tap: No detectable fluid.Palpate popliteal fossa: No swelling.
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Inspect feet: No deforminty, callosities or forefoot widening (daylight sign).
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Test subtalar & ankle movement: Pain free calcaneal
mobility at STJ, dorsiflexion beyond plantigrade & 30 degrees
plantarflexion