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Table 1 GALS screening examination

From: Teaching musculoskeletal examination skills to UK medical students: A comparative survey of Rheumatology and Orthopaedic education practice

Position/Activity

Observation

Gait

Symmetry, smoothness of movement (legs, arm swing, pelvic tilting)

Normal stride length

Normal heel strike, stance, toe off, swing through

Ability to turn quickly

Spine

 

Inspection from behind

Straight spine (no scoliosis)

Normal, symmetrical paraspinal muscles

Normal shoulder and gluteal muscle bulk/symmetry

Level iliac crests

No popliteal swelling

No hindfoot swelling/deformity

Inspection from the side

Normal cervical and lumbar lordosis

Normal (mild) thoracic kyphosis

Inspection from in front

 

‘Head on shoulders’

Normal cervical lateral flexion

‘Touch toes’

Normal lumbar spine (and hip) flexion

Palpation from behind

 

Press over the midpoint of each supraspinatus

Note any tenderness

Arms

 

‘Arms behind head’

Normal glenohumeral, sternoclavicular, and acromioclavicular joint movement

‘Arms straight’

Full elbow extension

‘Hands in front’

No wrist/finger swelling or deformity

Ability to fully extend fingers

‘Turn hands over’

Normal supination/pronation (superior and inferior radioulnar joints)

Normal palms (no swelling, muscle wasting, erythema)

‘Make a fist’

Normal power grip

‘Fingers on thumb’

Normal fine precision pinch/dexterity

Squeeze across second to fifth metacarpals

Note any tenderness

Legs

Normal quadriceps bulk/symmetry

No knee swelling or deformity (varus/valgus)

No forefoot/midfoot deformity

Normal arches

Flex each hip and knee while holding the knee

Confirm full knee flexion with no crepitus

Passively internally rotate each hip in flexion

No pain or restriction

Press on each patella

Note tenderness or effusion

Squeeze across the metatarsals

Note tenderness

Inspect the soles

Note any callosities, reflecting abnormal weight bearing