The musculoskeletal examination: GALS

GALS exam:  Gait / Arms/ Legs / Spine*

The GALS Screening Questions
Do you have any pain or stiffness in your muscles, joints or back? Can you dress yourself completely without difficulty? Can you walk up and down stairs without difficulty?

A GALS screen involves a rapid assessment of the musculoskeletal system: if you see abnormalities in any area you move to the REMS (see later)


Instruct patient:

Walk/turn/inspect at the end in the anatomical position (palms forward)


  • Inspect from the front and the back
  • You can see muscle groups (quads/upper limbs)
  • Levels of the Iliac crests (Trendelenberg sign)

Clearly any significant arthritis of the upper or lower limbs may be evident here. Remember things like the arm swing, heal toe strike, ranges of movements, symmetry etc.


Instruct patient:

Hands behind headàpalms down hands out straightà palms upà make a fistàthen check grip strengthà MCP Squeezeàopposition


  • Hands behind your head: abduction / external rotation of the shoulder [infraspinatus], elbow flexion
  • Hands behind your back: internal rotation: [subscapularis]
  • Palms down: inspect synovitis? Symmetrical disease (RA) other?
  • Palms up: this checks supination
  • Remember the focus on functional status


Instruct patient:

Knee flexionàhip flexion internal external rotationàknee effusionàfeetàMTP squeeze test


  • Lie them down flat then inspect. Flex the knees fully both knees to check for limitations of movement
  • Then flex hip to 90 degrees and knee to 90 degrees. In this position check internal rotation (knee turning inwards foot outwards) and external rotation (knee turning outwards hip inwards).
  • Now: Patellar tap [fluid from suprapatellar pouch, milk it downwards using the ‘v’ your thumb and index finger]: bouncing the patella off the femur]àgo for the feet (inspect) and MTP squeeze test [synovitis]


Instruct patient:


  • Inspect: (cervical thoracic lumbar) àNeck movementsà touch your toes (check lumbar expansion by putting fingers on their back.
  • Remember: scoliosis (forward flexion),  kyphosis (dorsiflexion), lordosis (lateral flexion)

REMS = Regional Examination of the Musculoskeletal System


*Based on the Clinical Assessment of the Musculoskeletal System, ARC, 2005