Evaluation of gals and modified gals in patients without prior musculoskeletal symptoms

Musculoskeletal (MSK) symptoms are the most common health disorders requiring medical attention, and accounting to 20% of both primary care and emergency-room visits. MSK symptoms do not receive proper teaching attention. Over the past two decades, rheumatologists from around the world have not only championed the musculoskeletal system examination but also modified the undergraduate teaching curriculum. This has led to the development and adoption of the gait, arms, legs and spine (GALS) screening along with regional examination techniques. This study was designed to evaluate the ability of the GALS examination to detect abnormalities in patients without musculoskeletal symptoms and to study whether particular modifications in the GALS can improve the sensitivity. Clinical case-series collection. The study has been conducted at the rheumatology clinic of Ibn-Sina teaching hospital, on one hundred adult males after taking their consent to participate in this study, their ages ranged between 30 - 50 years and they were not suffering from MSK complain after asking them the three questions which are the following: • ‘Do you have any 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?’. Then doing screening examination of gait, arm, leg and spine. The GALS examination was performed as previously described……… The modified GALS adopted the following modifications: 1. Using neck extension instead of lateral bending. 2. Using shoulder internal rotation instead of external rotation. 3. MCP extension was added to squeezing test. 4. Adding toe and heel walking to gait examination. 5. Adding jaw movement ( tempromandibular joint ). The presence of locomotor abnormalities were found in 22 out of 100 adults by using GALS screen, gait abnormalities was 0%, while 9% showed arm abnormalities, 3% showed leg abnormalities, 10% showed spine abnormalities. When examining the same adults by using modified GALS (MGALS) screen, the locomotor abnormalities were found in 27%, gait 10%, arm 11%, leg 3% and spine 18%. The MGALS is significantly more sensitive than GALS in detecting abnormalities in gait and cervical spine (P-value 0.001, 0.04 respectively). In MGALS there is a significant positive correlation between abnormalities as following: cervical extension and shoulder internal rotation (r-value 0.613) , lumber movement and heel walking ( r-value 0.696), knee abnormalities and toe walking ( r-value 0.660 ), increasing age correlated positively with abnormalities in both cervical extension and shoulder internal rotation ( r-value 0.503, 0.387 respectively). In GALS there is a positive correlation between cervical lateral bending and shoulder external rotation (r-value 0.241). Increasing age correlated with abnormalities in both cervical lateral bending and shoulder external rotation (r-value 0.299, 0.336 respectively). 1-GALS or its modification can detect abnormalities in asymptomatic patients. 2-GALS modification improves its detection of abnormalities. Clinical musculoskeletal evaluation needs major under- and post- graduate improvements.