Question 1

What is the difference between the GALS screen and REMS?

Accepted Answer

The gait, arms, legs and spine screen is a rapid 1 to 2 minute assessment that detects whether a musculoskeletal problem is present, but not what it is. The regional examination of the musculoskeletal system is the detailed, joint-by-joint examination of a region flagged by the screen or the history, using the same look, feel, move and function structure.

Question 2

Why examine both active and passive movement?

Accepted Answer

Comparing them helps localise the problem. Reduced active movement with relatively preserved passive movement suggests weakness, tendon injury, neurological impairment or pain inhibition, rather than proving the joint is normal. When both are equally restricted, an intra-articular or capsular cause such as an effusion, contracture or mechanical block becomes more likely.

Question 3

How reliable are special tests in the musculoskeletal examination?

Accepted Answer

Each has useful but imperfect sensitivity and specificity, and most load several tissues rather than isolating one structure, so a single result rarely confirms or excludes a diagnosis. A validated combination of findings can shift probability more usefully, but counting positive tests does not create a valid cluster. Interpret them with the history and basic examination.

Question 4

What features should a sports history always screen for?

Accepted Answer

Features that suggest a cause other than a simple musculoskeletal one: unremitting pain unrelieved by position change, fever, unexplained weight loss and progressive neurological deficit. For suspected cauda equina syndrome, new urinary retention or altered urinary sensation or flow, saddle or perineal sensory change and bilateral deficit matter most. These features are context-dependent rather than automatic markers of serious disease.

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