Medically Fit For Exams
Medically Fit For Exams

GALS (Gait, arms, legs + spine) assessment

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent



  1. Do you have pain or stiffness in any joints, muscles or in your back?
  2. Can you dress yourself without any difficulty?
  3. Can you walk up and down the stairs without any difficulty?



  • Ask the patient to walk away from you, turn around briskly and walk back
  • Assess their gait for:
    • Smoothness
    • Symmetry
    • Ability to turn quickly
  • Pay attention for:
    • Antalgic gait: altered to reduce pain – minimal time spent weight bearing on affected side
    • Leg length discrepancy compensation: walk on tiptoe on shorter side, hip and/or knee flexion on longer side
    • Trendelenburg gait/poor abductor function on side opposite to dropping side – one hip drops when walking
    • Foot drop/lifting knee high to compensate – occurs in common peroneal nerve palsy
    • Increased tone (stroke, cerebral palsy) – may present differently depending on the lesion, often ‘fixed’ leg extension in stroke, or ‘crouched’ position with hips and knees always flexed in cerebral palsy
    • Parkinsonian – stooped, shuffling, lack of arm swinging, difficulty turning, instability
    • Spastic paraparesis – stiff ‘scissor’ gait, result of spinal cord lesions
    • Central ataxia – wide based, appears drunk, result of cerebellar disease
  • Ask the patient to stand still
  • Inspect from the front, behind and side for:
    • Shoulder, quadriceps, gluteal, calf bulk and symmetry
    • Forefoot and hindfoot abnormalities
    • Spinal alignment
    • Popliteal swelling



  • Ask the patient to put their arms behind their head, which requires good:
    • Shoulder abduction, external rotation and elbow flexion
  • Ask the patient to hold their arms out with the palms down and fingers outstretched
  • Assess back of the hands for swelling and deformity
  • Ask the patient to turn their hands palm up
  • Assess for muscle bulk and symmetry
  • Ask patient to resist you trying to close their outstretched fingers
  • Ask the patient to make a fist
  • Ask the patient to squeeze your fingers to assess grip strength
  • Ask the patient to touch each finger to the thumb to assess fine precision pinch
  • Ask permission first, and gently squeeze across metacarpophalangeal joints, this may be painful



  • Ask the patient to lie on the couch
  • Assess passive flexion and extension of both knees, feeling for crepitus with one hand
  • Assess internal rotation of both hips: knees and hips flexed to 90 degrees, move foot laterally, likely to be painful in osteoarthritis of the hip
  • Patellar tap to assess for effusion: milk fluid from suprapatellar pouch towards the patella. Occlude the pouch and tap the patella. If a tap is heard, this suggests an effusion
  • Inspect feet for swelling and deformities
  • Ask permission first, and then gently squeeze metatarsophalangeal joints



  • Ask the patient to stand, assess from behind for scoliosis
  • (Press down the length of the spine assessing for tenderness)
  • Ask the patient to tilt their head from side to side, ear to shoulder on each side – assessing cervical lateral flexion
  • Ask the patient attempt to bend forwards to touch their toes
  • Place two fingers on lumbar vertebrae and ask the patient to flex forwards. Your fingers should move apart on flexion and back together on extension
  • Ask the patient to open their mouth and move their jaw from side to side – assessing temporo-mandibular joint


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