GALS Exam:

 Gals stands for gate arms, legs, and spine

 The gals screen is a rapid muscular skeletal, neurological, and functional assessment

ARMS :
 Ask about pain or stiffness in a muscle, join or back, whether they can dress
themselves without difficulty and if they can walk up and down stairs without
difficulty
( lakukan tanya anamnesis mengenai naik tngga dan lain lain)
 If all these answers are ok, there’s unlikely to be a significant problem.
 Ask the patient to undress and stand in front of you
o Can you walk towards me? Ask the patient to walk ahead in a straight line for
several steps, turn around and walk back.
o Could you do that again please ?
 Watch from both I front and behind and looking for smoothness and
symmetry of the gate
 Normal, ga ada pincang, gate nya juga bagus)
 Apakah ada varus ? vagus??? Normal?

o Could I have a look at your back?

 Lakukan palpate for hyperalgesia in the blly of the supraspinatus
mucles ( dari kanan sampai kiri )
 Tanyakan is that sore?
o Hyperalgesia here is a typical finding for fibromyalgia ( Ketika
di pegang sakit biasanya pada fibromyalgia )
 When asking a patient to exhibit movements, its often simpler to
demonstrate actions rather than only telling them what to do

o Please copy the movement I make with my arms

 This position with the hands behind the head and the elbows going
back test Abduction and external rotation of the glenohumeral joint
 With the elbows at the side of the body, bend then at 90 degree, and
o Waktu dia itu harus nempel sama ketiaknya ga bole ada
bantuan lain
 ask to do pronation and supination-> bringing the hands to touch the
shoulders requires elbow flexion opposing the fingers and palm’s in a
prayer sign extends wrists, wallen sign…
 Put the backs of the hands together similarly to demonstrate wrist
flexion, put their arms straight out in front of to demonstrate elbow
extension
 Ask the patient to make a fist and open the hand flat, testing the hand
and wrist, look for complete extension of all the finger joints
o Please relax yout arms
 Ask the patient to squeenze your index and middle fingers testing
their power grip
o Saya coba Tarik tangan saya, bapak tahannya
 o Please make a pincer grip, and don’t let me break it
 Test the ability and strength of the thumb and index finger opposition
o Please touch each finger to your thumb ( kiri kanan)
 This demonstrats precision, grip coordination and concentration
 Gently squeeze the patients metacarpal heads-> tenderness suggest
inflammation involving the metacarpophalangeal and proximal
interphalangeal joints caused for example by rheumatoid arthritis
 Is this sore ?

LEGS :
1. Ask the patint to lie supine on the couch and adjust it as necessary
a. REMEMBER : that some parts of lower limb examination may risk dislocation
of a total hip replacement, so examine with care
b. Start wiwth thomasis test ( pemeriksaan kaki dan tulang belakang . ada luka
ga di iliopsoas) for fixed flexion deformity of the hip ( testing hip extension if
you like )
c. With the patient lying supine, you can see that he cant extend his hips any
futher because of the count supporting is knees and ankles
d. When performing thomasis test we flex the lumar spine and pelvis so the hip
hyper extension is required to put the lower limb flat on the couch
e. Your left hand in the small of the patients back will detect when the lumbar
lordosis is straightened
2. Im going to bend your knees
a. Flex both hips as far as they’ll go feeling the lumbar spine flattening against
your left hand
3. Could you straighten your left leg ?
a. Putting the left lower limb flat on the couch with the lumbar spine still flexed
show a few degrees of hyper extension of the left hip in fixed flexion
deformity, the limb will remain elevated or curvature will return to the spine
4. Could you bend your knee for me ?
a. Examine the range of flexion in the hip and knee with your hand on the
patients knee-> this allows you to feel for crepitus ( bisa jadi ada patah ) in
the patella femoral joint
5. Could you bend this knee for me ( both kanan dan kiri )
a. The normal limit of flexion is 120 degrees at the hip and 140 degrees at the
knee ( kiri )
b. Could you bend this knee for me ( kanan )
i. Flex the patients knee and hip to 90 degrees and passively rotate each
hip internally and externally,
ii. Think about the anterior of the thigh when working out which
direction is which
c. Could you bend your left knee ? becarefull to do this test gently, it maybe
uncomfortable for the patient ( note any pain of restriction of movement )
i. Normal range is 45 degrees in each direction
6. Palpate each knee for warm and sweeling -> these are features of inflammation
 a. Check fo the patellar tap caused by knee joint effusion : with your left hand,
gather the contents of the suprapatellar pouch into the joint
b. Bisa aja ada abnormal di kaki nya itu karena pakai sepatu yang kurang baik,
makanya ada weight.
7. Look at the feet for any abnormality, examine sore for calluses or ulcers indicative of
abnormal load bearing
a. Remebr to look at the back of the heels, which are sight of sores in bedbound
patients
b. Look at the alignment of the toes and gently squeeze the metatarsal heads
together
i. Tanya : Is this sore ? to see if there is tenderness from inflammatory
artritis ( kanan dan kiri )

BACK ( SPINE )
1. Im want to check your back, and im just going to lower the couch
2. We need the patient standing again lower the couch to a height that is safe for them
to climb off
3. Let me give u and hand up
4. Could you stand here for me please, with you legs slightly apart
a. Standing behind the patient assess the straightness of the spine
b. Look at the symmetry and muscle bulk in the neck, upper limbs, trunk, and
lower limbs
c. Look for asymmetry in the level of the ilac crests which may be due to leg
shortening ( look for the sweeling or the other abnormalities of the gluteal
hamstring and calf muscle and the achilles tendons and hindfoot regions for
swelling or deformity
5. Could you try and touch your toes ( stand beside the patient while they try to bend
down as well as spinal flexion -> look for exacerbation of scoliosis or limitation of the
hip flexion )
6. Stand behind and hold the pelvis to stop it moving
Tanya : could you turn from side to side?
 This test rotation movement happening mostly in the thoracic spine
7. Could you slide your right hand? Down the outside of your right thigh towards your
knee and the same of your left side?
a. Testing lateral flexion which occurs mostly in the lumbar spine
b. Could you turn to face me ?
c. Can you try and put your right ear to your right shoulder
i. Lateral cervical flexion and the same of yout left
d. Look up at the ceiling cervical extension and down to your chest and flexion
e. Please look straight ahead
f. Can tou opern your mouth and move your jaw from side to side testing
function in the temperomandiluar joint
BASED ON DOCTOR :
1. Konsepnya dibagi menjadi 3 : asking screening questions berkaitan dengan
anamnesis dan berkaitan dengan skeletal, disini juga akan berkaitan dengan postur,
pergerakan sakit )
2. GARMS ( cara jalan,arms, back legs )
3. Rems -> lebih ke bis aga abduksi dan aduksi
4. Screening question for MS disorders?
a. Bapa aapkaha ada nyeri pada kaki ?
b. Apakah ada nyeri di pinggang ?
c. Apakah bisa menggunakan baju sendiri ?
 Ketika seseorang sulit menggunakan baju sendiri, makanya jadi susah juga
untuk bisa melakukn aktivitas lain
d. Bisa naik . turun tangga gak ? kalau misalkan ada gangguan juga pada ini
maka bisa ada masalah serius bisa jg berkaitan dengan neurollogi.
5. Interpretasi :
a. Pada pasien DM ada masalah Pundak maka akan dilanjutkan dengan history
taking dari sakit Pundak tersebut, apakah ada DM??
b. Pada abnormal finding lain jg bisa diperiksa tangan dua duanya.
c. Kalau misalkan pasein ga ada keluhaan apapun dia tas, maka biasnaya ga ada
maslaha apapun yang signifikan.
6. Screening exam hanya 1-2 menit, dan akan langsung kelihatnan Ketika dia ada
masalah yang signifikan, swelling, dan devormitas lainnya
7. Gait :
a. Diperiksa cara jalan ( cari apa aja, kayak jalan di seret)
b. Minta di lepas wanita, dan mint dia berdiri apakah ada miring? Pasien
diminta untuk bisa berjalan kea rah kita. Kita juga liat dari samping juga
8. Arms :
a. Minta tangannya diangakat, dan dilipat di atas kepala dan lihat apakah bisa
lakukan aduksi dan kontra aduksi ( jadi kelihatan nanti otot tangannya )
b. Step:
i. Tangan ke depan untuk melihat aduksi dan abduksi
ii. Terus di puter-puterin tangannya..
iii. Fleksi
iv. Iasanya juga dilihat di pergelenagan tangan, liat ada deformitas atau
ga
v. Semuanya sama ( LFM -> Look feels move )
vi. Minta pasien untuk menggengam dan menjaba tangan /
bersalamanan dan ini akan berkaitan dengan neurologi
vii. Pinch
viii. Metacarpalnya di pencet
9. Legs
a. Sama di cek juga, abduksi, aduksi, ini dalam posisi tidur
 b. Pasiennya tiduran 30 derajat, terus di tekuk dan dilurusin ke atas, ini dilihat
apakah ada low backpaint
c. Patella nya di ketok
d. Inspeksi feet
10. Spine
a. Lihat ada lordosis, skolirosis
b. Minta dia ke aknan dan kekiri
c. Spine simetris

Tambahan :
1. Kalau ada callus maka akan menyebabkan adanya miring
 Perkenalan
Kesadaran, head to toe mata dll -> ada rakun ga? Ada pendarahan hidung ga? Ada
sianosis sentral ga

Supraklavikula
Abdomen liat diskolarisasi dll

Anamnesis

MSK -> Look feel move-> di arm gimana, rasain, gerakin

Inspeksi -> struktur tubuhnya normal ga? Ada vagus ga? O? atau X-> liat dari depan,
samping belakang.

Apakah ada bekas masa? Diskolarisasi, pendarahan? Ataxic gait?