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- Gait, Arms, Legs, Spine
- A brief musculoskeletal screening test devised to
detect neurological, musculoskeletal or functional
deficits in patients.
- It consists of an initial set of screening questions and
a sequence of examination.

I. Questions
Do you have any stiffness or pain in your back,
or any muscles or joints?
Can you dress yourself without any problem?
problem with upper extremities
Can you walk up and down stairs without
problem with lower extremities

II. Examination

A. Gait
Ask the patient to walk a short distance, turn and
then walk back.
o Observation: looking for
- Symmetry,
- Smoothness of movement,
- normal stride length,
- pelvic tilt,
- arm swing,
- normal heel strike, stance, toe-off, swing
- Ability to turn with ease.
o Note any antalgic, trendelenburg, hemiplegic
or parkinsonian gait features.

B. Arms, legs and spine
From behind
o Inspect for:
- straight spine,
- normal paraspinal muscle bulk,
- symmetrical shoulder and gluteal muscle
- symmetry of iliac crests,
- absence of popliteal swellings,
- absence of foot or hindfoot swellings.
o Palpate: over mid supraspinatus and roll the
skin over the trapezius to test for signs of
hyperalgesia or fibromyalgia.

From the side
o Inspect for:
- normal cervical and lumbar lordosis,
- normal thoracic kyphosis and
- note any scoliosis.
- Evidence of knee flexion or hyperextension
o Schobers test:
1. Whilst standing beside the patient, look for
the point in the patients back that is in
between the 2 ASIS
2. Note the vertebra body (vertebra A) and
the one on top of it (vertebra B).
3. Place your middle finger on vertebra B and
your index finger on vertebra A.
4. Ask the patient to bend over and touch
their toes, keeping their legs straight.

5. Normally, as the patient bends, the
spinous processes will move apart, so your
fingers will move apart also. Note whether
this is the case.
* The point in between your two fingers should
migrate by 5 cm.

1. (same)
2. Mark that point with a finger.
3. Measure 10cm up from that point and
mark with another finger.
4. Ask the patient to touch his toes.
5. Normally, the 10cm distance between your
two fingers should increase to 15 cm.

From the front
o Inspect for:
- normal and symmetrical shoulder and
quadriceps muscle bulk,
- no knee swellings,
- note foot arches
- no deformity of mid or hind feet
o Now ask the patient to do the following noting
any painful, restricted or asymmetrical
- "Bend your left your left ear down towards
your left shoulder and then the right ear on
the right shoulder" to test for pain free
cervical spine lateral flexion.
- "Open jaw and move it side to side" to
test for pain free normal tempero-
mandibular joint movement.
- "Put your hands behind your head with
your elbows as far back as they can go"
to test for normal sterno-clavicular, gleno-
humeral and acromio-clavicular joint
movement. <elbow external rotation>
- "Put your hands by your sides with you
elbows straight" looking for full elbow
- Pinch/apply pressure on shoulders check
for pain by looking at patients facial
- Squeeze the condyles of the humerus
(elbow area) to check for pain or
- "put your hands out in front of you with
your palms down and fingers out straight"
looking for ability to extend fingers,
noting muscle bulk and inspecting for any
swelling or deformity of fingers or wrist.
- "Now turn your hands over" making sure
that supination is normal (watch for
external rotation of the shoulder to
compensate for poor supination. Also
inspect the palms for any signs or
- "Now make a fist with both hands around
my fingers and squeeze tightly" power
grip; test the grip for normal and
symmetrical power. Assesses the wrist and
hand function.
- Squeezing examiners fingers assesses
- "Place the tip of each finger onto the
thumb" to test for fine precision pinch.
Also test hand-joint movement,
coordination and concentration.
- You may also do a metacapral squeeze at
this point to test for metacarpal phalangeal
tenderness (inflammatory joint disease).

Patient lies down on the couch.
o For both legs ask the patient to:
* Compare true (ASIS to medial malleolus)
and apparent (umbilicus to medial malleolus) leg
- Passive full knee flexion. Place your hand
over the knee and then the hip joints
feeling for crepitus as the patient moves
these joints.
- Now test internal rotation of the hip with
the hip joint flexed to 90 degrees (moving
the foot laterally with the hip flexed causes
internal rotation of the hip joint early OA
<oseteoarthritis> causes pain and
limitation of this movement).

o Test for the balloon sign on the knees
1. Rest the thumb and index finger of your
right hand on each side of the patella
nd , with your left hand, compress the
suprapatellar pouch back against the
2. With your right thumb and finger, feel for
fluid entering (ballooning into) the
spaces next to the patella.
Normally none is felt.
But when the knee joint and suprapatellar
pouch contains large effusion, suprapatellar
compression ejects fluid into the spaces next
to the patella <BALLOON SIGN>

o Milking test or the bulge sign
1. With the ball of your hand, milk the medial
fluid aspect of the knee firmly upward two or
three times to displace any fluid.
2. Then press or tap the knee just behind the
lateral margin of the patella
3. A bulge of returning fluid in the hollow
medial of the patella indicates an effusion
within the knee joint. Normally none is seen.
* A bulge sign is useful in detecting small
effusions. It may be absent in large

o Run back of hand along joint line or lateral side
of leg feel for temperature change of the
knee joints
o Inspect the soles of the feet for any calluses,
or skin changes.
o Squeeze the metatarsal joints to test for any
o Squeeze the big toe joint checking for

III. Record results

Appearance Movement
Gait /
Arms / /
Legs / /
Spine / /