An example of a perfect GALS examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination following the MSK "look-feel-move" principle.
GALS
Examination
W.I.P.E.E 4. Arm movements
- Lying down 1) Hands out, fingers straight
- Exposure = shorts & bra/sports bra 2) Make a fist – test grip strength
3) Turn hands over
4) Put both hands behind head, then in small of back
5) Touch thumb to all fingers (opposition)
1. Initial questions
6) Squeeze all finger joints – ask if any
1) Do you have any pain or stiffness in your muscles, joints
or back?
pain/inflammation
2) Can you dress yourself in the morning?
3) Can you walk up and down the stairs without difficulty
or assistance? 5. Leg movements (lying down)
1) Extension and flexion of knee (feel for crepitus)
2) Rotate the hip with the knee flexed
2. Gait 3) Patellar tap
Ask patient to walk normally, and turn to walk back 4) Check soles of feet for calluses
5) Squeeze metatarsals together – pain?
1) Trendelenburg – one-sided hip drop
2) Parkinsonian – shuffle, slow turning, small steps
3) Ataxic – wide base stance
4) Scissor gait – stiff legs, knock-kneed, on toes
5) Hemiplegic – one leg swings around hip 6. Spine movements
6) High-stepping gait - marching 1) Open jaw and move side to side – pain?
2) Bend your ear to touch your shoulder
3) Touch your chin to your chest
3. Observe from 3 angles – standing 4) Look up at the ceiling
From behind: 5) Turn your shoulders as far to the left/right as you
can (stabilise hips)
- Shoulder muscle bulk & symmetry 6) Bend over to touch toes
- Spinal alignment 7) Bend backwards
- Gluteal muscle bulk & symmetry
- Popliteal swelling/abnormalities
- Calf muscle bulk & symmetry
- Hindfoot abnormality
From front:
- Full elbow extension
- Quadriceps bulk & symmetry
- Forefoot abnormality
put two fingers on 2 lumbar vertebrae, ask patient to bend over –
want fingers to separate = normal
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