Expansion
Gait, Arms, Legs, Spine
Expansion
Three screening questions first
- 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?
GALS
- G - Gait: watch the patient walk, turn and return. Assess smoothness, symmetry, stride length, arm swing and turning
- A - Arms: hands out with palms down then up; make a fist; precision pinch; squeeze the metacarpophalangeal joints; hands behind head (abduction and external rotation)
- L - Legs: with the patient lying, assess knee flexion and hip rotation, feel for effusion (patellar tap or bulge sign), squeeze the metatarsophalangeal joints, inspect the soles
- S - Spine: inspect from behind for scoliosis and muscle bulk, from the side for lordosis and kyphosis; lateral flexion; lumbar flexion with fingers on the lumbar spine to feel separation
Recording is by a simple grid of appearance and movement for each of A, L and S, with gait recorded as normal or abnormal.
Any abnormality found on screening then prompts a regional examination using look, feel, move followed by special tests and assessment of the joint above and below.