Determining the underlying aetiology of locomotor disease requires a directed history and examination, but an overall screening system is crucial to ensure that no feature is overlooked. In addition the locomotor history can be employed in the systems review of any general medical or surgical situation.

This chapter will focus on a validated screening tool for the locomotor system, the GALS locomotor screen (Doherty et al., 1992, Annals Rheum. Dis. 51:1165–9). Detailed and regional history and examination is covered in subsequent chapters.

‘GALS (gait, arms, legs, spine)’ locomotor screen

Screening questions

If the answer to the following questions is ‘Yes’, there is unlikely to be major locomotor pathology.

‘Are you free of pain or stiffness in your muscles, joints or back?’
‘Can you dress yourself completely without any difficulty?’
‘Can you walk up and down stairs without any difficulty?’

Screening examination

The examination is broken down into gait, arms, legs and spine, and any abnormality in appearance or movement is documented and a regional, directed history and examination undertaken. It should be performed with the patient in light underwear, allowing close inspection of each area following a few simple commands.