GALS Examination OSCE Guide

1. Introduction
- Wash hands
- Introduce yourself
- Explain what youd like to examine
- Gain consent
- Expose patients chest, upper & lower body
- Ask if patient has any pain anywhere before you begin!
2. 3 Important questions to ask:
a. Do you have any pain in your muscles, joints or back?
b. Are you able to dress yourself completely without any difficulty?
c. Are you able to walk up and down the stairs without difficulty?
3. Gait
Is the patient demonstrating a normal heel strike / toe off gait?
Is each step of normal height? increased stepping height is noted in
foot drop
Is the gait smooth & symmetrical? Abnormalities antalgia
/waddling /festinant /broad based /high stepping?
4. Inspection:
a. Front
- Shoulder bulk- deltoids
- Elbow extension - assess carrying angle - 5-15 degrees
- Quadriceps bulk
- Knee swelling / deformity
- Foot arches - observe for evidence of flat feet (pes planus) or high -
arched feet (pes cavus)
- Mid-foot/ Forefoot deformity
b. Behind
- Shoulder muscle bulk wasting may suggest joint pathology
- Spinal alignment - S-shaped curvature noted in scoliosis
- Iliac crest alignment pelvic tilt may suggest hip abductor weakness /
paralysis
- Gluteal muscle bulk - wasting of gluteal muscles suggests reduced -
mobility (prolonged sitting)
- Popliteal swellings - bakers cyst / popliteal aneurysm(pulsatile)
- Hind-foot abnormalities.
c. Side
- Cervical lordosis assess for hyperlordosis spondylolisthesis /
osteoporosis / discitis
- Thoracic kyphosis - normal is 20-45 hyperkyphosis (>45) - vertebral
#/ Scheuermanns kyphosis
- Lumbar lordosis assess for hyperlordosis common causes include
obesity / tight lower back muscles
- Assess degree of knee flexion / hyperextension
5. Spine
- Lumbar flexion - place 2 fingers on lumbar spine as patient bends
fingers should move apart
- Lateral flexion of cervical spine touch your ear to your shoulder
- TMJ joint move your jaw side to side
6. Arms
- Ask patient to place hands behind head - abduction & external
rotation
- Pronation turn your palms downwards
- Swelling/deformity of wrists & hands - may suggest rheumatoid
arthritis
- Supination turn your palms up
- Palms assess muscle bulk of the thenar and hypothenar eminences
- Power grip grip my fingers tightly
- Precision grip touch each finger in turn to your thumb
- Squeeze MCP joints note any tenderness often present in
inflammatory arthropathy (e.g. RA)
7. Legs
- Hip passive flexion
- Hip passive internal rotation
- Patella tap if present indicates presence of a large effusion?
- Soles callus formation may suggest a gait abnormality
- Squeeze MTJs - tenderness may indicate inflammatory arthropathy
8. Complete the examination
Thank patient
Wash hands
Summarise findings

(from: http://geekymedics.com/2010/10/07/gals-assessment/)