The GALS screen (Gait, Arms, Legs, Spine) is a rapid, systematic screening tool used to detect significant abnormalities in the musculoskeletal system.
It is the standard starting point for any orthopaedic or rheumatological assessment.
Before beginning the screen, perform the standard introduction and screening questions:
W – Wash: Clean your hands thoroughly.
I – Introduce: State your name and role.
P – Permission & Pain: Obtain consent. Crucial: Ask three screening questions:
“Do you have any pain or stiffness in your muscles, joints, or back?”
“Can you dress yourself completely without any difficulty?”
“Can you walk up and down stairs without any difficulty?”
E – Exposure: The patient should be in their underwear to allow for full visualization of the joints and muscle bulk.
R – (Re)position: The examination begins with the patient standing.
Ask the patient to walk to the end of the room, turn, and walk back.
Observe: Look for smoothness, symmetry, and the ability to turn quickly.
Abnormalities: Note any antalgic gait (limping due to pain), broad-based gait (instability), or foot drop.
Observe the patient from the behind, the side, and the front.
Inspection
Behind: Look for scoliosis (lateral curvature) or muscle wasting.
Side: Observe for normal cervical and lumbar lordosis, and thoracic kyphosis.
Front: Check for symmetrical shoulder and hip height.
Movements
Cervical Spine: Ask the patient to touch their ear to their shoulder on both sides (lateral flexion).
Lumbar Spine: Ask the patient to touch their toes. Place two fingers on the lumbar spine; they should move apart as the patient bends (Schober’s test principle).
The goal is to assess the function and range of motion of the upper limbs.
Inspection & Movement
Shoulders: Ask the patient to place their hands behind their head (external rotation/abduction) and then reach behind their back (internal rotation).
Elbows: Check for full extension and any nodules or psoriatic plaques.
Hands/Wrists:
Inspection: Look for joint swelling (MCPs/PIPs), redness, or deformity (e.g., ulnar deviation).
Grip: Ask the patient to “squeeze my fingers” (power grip).
Precision: Ask the patient to touch each fingertip with their thumb (pincer grip).
Squeeze Test: Gently squeeze the MCP joints; pain indicates active inflammatory arthritis.
The patient should now lie supine on the examination couch.
Inspection
Look for knee swelling (effusions), hallux valgus (bunions), or flattening of the arches in the feet.
Movement
Hip & Knee: Passively flex the hip and knee. Perform internal rotation of the hip (often the first movement lost in osteoarthritis).
Knee Stability: Check for a “patellar tap” if an effusion is suspected.
Feet: Squeeze the MTP joints (the “squeeze test” of the foot).
To finish your OSCE GALS screen, state you would:
Perform a Focused Exam: If an abnormality was found (e.g., a “Regional Orthopaedic Exam” of the knee or shoulder).
Neurovascular Status: Check pulses and sensation in the affected limb.
Review Imaging: State you would request X-rays or MRI of the symptomatic joints.
| Sign | Potential Pathology |
| Squeeze Test Pain | Inflammatory Arthritis (Rheumatoid) |
| Loss of Lumbar Lordosis | Ankylosing Spondylitis |
| Joint Swelling & Warmth | Septic Arthritis or Crystal Arthropathy (Gout) |
| Trendelenburg Gait | Hip Abductor Weakness |
For a visual guide to the GALS screening sequence:
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