Lesson 5.6: Musculoskeletal Examination
GALS Screening
GALS (Gait, Arms, Legs, Spine) is a rapid MSK screen, perform it as the opening assessment in any MSK station before targeted regional examination.
| Component | What to Do and Observe |
|---|
| Gait | Walk to end of room and back. Symmetry, arm swing, fluency, stride length. |
| Arms | Hands behind head (shoulder ER). Hands behind back (IR/extension). Squeeze MCPs. Grip. Pinch. Supinate/pronate. |
| Legs | Lie flat. Roll leg to assess hip rotation. Flex knee (patellar tap for effusion). Inspect soles. |
| Spine | Look from behind (scoliosis, muscle bulk). Side flexion. Lumbar forward flexion (Schober test). Cervical lateral flexion. |
Knee Examination Checklist
- Inspect — swelling, deformity, quadriceps wasting, scars, valgus/varus alignment
- Gait — antalgic, valgus/varus
- Warmth, bony tenderness — joint line, tibial tuberosity, patella
- Patellar tap — small to moderate effusion
- Sweep test (bulge sign) — small effusion
- Range of movement — flexion (0–135°), full extension (0°)
- Anterior drawer / Lachman test — ACL integrity (Lachman more sensitive)
- Posterior drawer — PCL integrity
- Valgus stress — MCL. Varus stress — LCL
- McMurray test — medial/lateral meniscus
- Offer: weight-bearing X-ray; MRI if soft tissue injury suspected
Shoulder Examination Checklist
- Inspect — Wasting, asymmetry, deformity, scars/skin changes
- Palpate — AC joint, glenohumeral joint line, bicipital groove
- Active ROM — flexion (0–180°), abduction (0–180°), ER and IR
- Passive ROM — compare; restricted passive = joint pathology
- Painful arc — pain between 60–120° abduction = rotator cuff impingement
- Empty can test — supraspinatus strength
- Hawkins-Kennedy test — impingement
- Speed's test — biceps tendon
- Neurovascular check — sensation over deltoid (axillary nerve), distal pulses
- Offer: X-ray shoulder; MRI if rotator cuff tear suspected
Hand Examination — RA vs OA Pattern
| Feature | Rheumatoid Arthritis | Osteoarthritis |
|---|
| DIP joints | Spared | Heberden nodes (bony, hard) |
| PIP joints | Boutonniere / swan neck deformity | Bouchard nodes |
| MCP joints | Subluxation, ulnar deviation, Z-thumb | Minimal or spared |
| Distribution | Bilateral and symmetrical | Asymmetrical, use-related joints |
| Joint feel | Warm, boggy (active synovitis) | Bony hard, cool |
