Examinations
CPSA · Clinical examination · Musculoskeletal
GALS screen (Gait, Arms, Legs, Spine)
A rapid MSK screen to detect abnormality and decide which regional exam to do next. Three screening questions + look at Gait, Arms, Legs and Spine.
Practise it out loudPosition: Patient standing (in underwear), then on the couch.
The routine
Screening questions
- 1Any pain or stiffness in muscles, joints or back?
- 2Can you dress yourself completely without difficulty?
- 3Can you walk up and down stairs without difficulty?
Gait
- 1Observe walking: symmetry, stride, arm swing, turning; smoothness of the phases of gait
Arms
- 1Hands out (palms down then up), make a fist, pincer grip, squeeze MCPs; hands behind head (shoulder) and behind back
Legs
- 1Inspect; passive knee flexion (feel for crepitus), patellar tap; internally rotate the hip; squeeze the MTPs; inspect the feet/soles
Spine
- 1Inspect from behind (scoliosis) and the side (kyphosis/lordosis); lateral neck flexion (ear to shoulder); “touch your toes” (lumbar flexion)
Signs & what they mean
Abnormal screen in a regionPrompts the relevant regional look/feel/move exam
Antalgic or Trendelenburg gaitLower-limb joint or abductor pathology
Loss of lumbar flexion / “schober” restrictionInflammatory back disease (e.g. ankylosing spondylitis)
To complete, I would…
- Perform the appropriate regional examination for any abnormality
- Take a full MSK history
OSCE tips
- GALS is a screen — its job is to flag which regional exam to do, not to diagnose.
- Record findings as a grid (appearance / movement per region).
- The three questions have high sensitivity for significant MSK disease.