Easy assessment of

musculoskeletal
system for GPs
Aspects of examining
the musculoskeletal
system

Revisiting the basics

GALS
Video
Some bits and pieces / a personal
view

History

Have you any pain or stiffness in

your muscles, joints or back?

Do you have any trouble getting up

or down stairs?

Do you have any difficulty getting

dressed?

Revisiting the basics

Inspection
Look
Palpation
Feel
Movement
Move
Stability
Function
Compare with opposite side

Inspection
Skin colour / rashes
Swelling
Deformity
Scars
Muscle wasting
Surrounding structures - bursae,
tendons

Palpation

Nature of swelling
bony
synovial
effusion

Warmth
Tenderness

Movement
Active and passive
Range of movement
Crepitus
Note pain
Instability

Stability

Subluxation or dislocation

MCP
Radioulnar
subtalar
MTP

Function
Lower limbs - gait
Hands
pincer grip
power grip

GALS

Doherty, Dacre, Dieppe and Snaith

(1992) The GALS locomotor screen,
Annals of Rheumatic diseases 51: 1165-9

GAIT
ARMS
LEGS
SPINE

GALS
provide a valuable screening test for
use in general practice
the procedure can be viewed as a
general functional (disability), as well as
a basic musculoskeletal assessment
..be useful in selective situations as a
rapid test of functional performance
and to screen out regional locomotor
abnormalities that merit closer
scrutiny

GALS recording

G
A
L
S

Bits and pieces

Hands
Wrists - CTS + de
Q
Shoulders
Backs
Hips
Feet biomechanics

Hypermobility
Fibromyalgia

Hand - RA

Early synovitis
PIP - skin discolouration and
tenderness
Clench fist - MCPs should be white
with no infilling
MCP squeeze to elicit tenderness
Inferior radio ulnar stress test
Bulge sign at knee
MTP squeeze test

Hand OA

Raynauds 1

Raynauds 2

Scleroderma early

Scleroderma

Sclerodactaly
(acrosclerosis)

Carpal Tunnel Syndrome

Phalens
Tinels

De Quervains
tenosynovitis
APL and EPB tendons
tender over radial styloid
sometimes nodule (thickened
sheath)
Finkelsteins test
Rest it
Inject it

Shoulders
Shoulder or not
Glenohumeral or not - external
rotation
Tenderness

bicipital groove
subacromial

Painful arc of abduction

Shoulder - abduction

Shoulder function related

to abduction

Backs

Lumbar flexion
Modified Schobers - or
use your fingers
Fingers to floor =
misleading

Lumbar extension
Lumbar lateral flexion
Sacroiliac restriction

Backs - neurology
Root Sensory loss Motor weakness

Reflex

L4

Medial calf and

ankle

Knee extension,
foot inversion

Knee

L5

Medial foot and

hallux

Dorsiflexion foot
and hallux

None

S1

Outer foot and

sole

Plantar flexion foot

Ankle

Hips

Internal rotation - can examine

sitting

Trochanteric bursitis

Trendelenburg - to distinguish lumbosacral

from hip pain

Trendelenburg test

Foot - biomechanics

Swing phase

Stance phase

Contact (27%)
Midstance (40%)
Propulsive (33%)

Biomechanics - stance
phase

Contact
outer border heel strikes then
PRONATION at subtalar joint shifts
centre gravity medially
causes tibia to internally rotate
purpose is shock absorption/adaption
uneven ground

Biomechanics - stance phase

(2)

Midstance

forefoot loaded
subtalar joint supinates
causes tibia to externally rotate
foot is converted to rigid lever ready
for propulsion
ends with heel lift

Biomechanics - stance phase

(3)

Propulsion
app 25% bodyweight on metatarsals
and toes (esp 1st)
ends with toes off

Abnormal pronation and

supination

Over pronation

Subtalar
pronation
unchecked
longitudinal arch
stretches and
flattens
excess rotation of
tibia

Hallux valgus
Plantar fasciitis
Achilles tendonitis
Post tibial
tendonitis
stress# navicular
anterior knee pain
low back pain

Hypermobility

1
2
3
4
5

Dorsiflexion of 5th MCP to 90 degrees

Apposition of thumb to volar aspect of forearm
Hyperextension of elbow by 10 degrees
Hyperextension of knee by 10 degrees
Hands flat on floor with knees extended

Fibromyalgia

The End