A GALS screen is an examination used by doctors

Physician

A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 and other healthcare professionals to detect locomotor abnormalities and functional disability relating to gait

Gait

Gait is the pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate. Most animals use a variety of gaits, selecting gait based on speed, terrain, the need to maneuver, and energetic efficiency...

, arm

Arm

In human anatomy, the arm is the part of the upper limb between the shoulder and the elbow joints. In other animals, the term arm can also be used for analogous structures, such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods...

s, legs

Human leg

The human leg is the entire lower extremity or limb of the human body, including the foot, thigh and even the hip or gluteal region; however, the precise definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle.Legs are used for standing,...

 and the spine

Vertebral column

In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...

.

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

Antalgic gait

Antalgic gait is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase. It can be a good indication of pain with weight-bearing.-Conditions associated with an antalgic gait:* Coxalgia...

, trendelenburg

Trendelenburg gait

The Trendelenburg gait pattern is an abnormal gait caused by weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus. People with a lesion of superior gluteal nerve have weakness of abducting the thigh at the hip...

, hemiplegic or parkinsonian gait features.

Arms, legs and spine

From behind

Inspect for: a straight spine (note any scoliosis

Scoliosis

Scoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line...

), 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

Lordosis

Lordosis is a medical term used to describe an inward curvature of a portion of the lumbar and cervical vertebral column. Two segments of the vertebral column, namely cervical and lumbar, are normally lordotic, that is, they are set in a curve that has its convexity anteriorly and concavity...

 and normal thoracic kyphosis

Kyphosis

Kyphosis , also called roundback or Kelso's hunchback, is a condition of over-curvature of the thoracic vertebrae...

. 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:

Test rotation of the thoracic and lumbar spine. Gently hold the patient's hips still and ask them to: "Turn your shoulders round as far as you can to the left, then do the same to the right."

Test lateral flexion of the thoracic and lumbar spine: "Stand up straight and then slide the palm of your right hand down your thigh towards your knee, bending your shoulder down to the side."
"Now do the same with your left hand down your left leg."

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

Now test for stiffness or pain flexing or extending the cervical spine: "bend your neck forwards to try to touch your chin against your chest."
"bend your neck back to lift your chin."

"open your jaw and move it from 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. Now try to touch the small of your back" to test for normal sterno-clavicular, gleno-humeral and acromio-clavicular joint movement.

"put your hands by your sides with your 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 the fingers or wrists.

"now turn your hands over" making sure that supination is normal (watch for external rotation of the shoulder to compensate for poor supination). 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 lay the patient down.

For both legs compare true (ASIS

Anterior superior iliac spine

The anterior superior iliac spine is an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis, which provides attachment for the inguinal ligament, and the sartorius muscle...

to medial malleolus) and apparent (umbilicus to medial malleolus) leg length.

Ask the patient to:

"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 knee joint flexed to 90 degrees (moving the foot laterally with the knee 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.

pGALS

The paediatric assessment of the musculoskeletal system includes all the components of the adult version with several minor additions:

Gait

Ask the child to walk on their tip toes and also upon their heels

From the front

Ask the child to put their hands together (as if praying) and also put their hands back to back. Also have them reach up their arms towards the sky.

Additionally, when assessing the spine ask the child to open their mouth and insert three of their own fingers into their mouth.