Competency 6 & 7

Question 1

6a. Perform the evaluation of the glenohumeral joint for somatic dysfunction and document
appropriately.

Answer 1

Student contacts the olecranon while blocking linkage at the shoulder region.

Student evaluates passive flexion, noting normal to be 180 degrees.

Student evaluates passive extension, noting normal to be 60 degrees.

Student evaluates passive abduction, noting normal to be 180 degrees.

Student evaluates passive adduction, noting normal to be 40‐50 degrees.

Student evaluates passive internal & external rotation, noting normal to be 90 degrees for
both.

Student contacts proximal humerus to assess anterior/inferior glide and posterior/superior
glide passively

Student performs evaluation bilaterally in order to assess for asymmetries

Student names somatic dysfunction found in glenohumeral joint

Student states they would document a glenohumeral somatic dysfunction in the objective
portion of the SOAP note

Question 2

6b. Perform the evaluation of the acromioclavicular joint for somatic dysfunction and document
appropriately.

Answer 2

Student contacts over the AC joint and palpates for tenderness and tissue texture changes.

Student brings glenohumeral joint into 60° coronal abduction and 60° horizontal abduction
to maximize AC joint motion

While maintain the position, student assesses rotational aspect of AC joint by internally and
externally rotating the glenohumeral joint

Student performs evaluation bilaterally in order to assess for asymmetries

Student names an internal or external rotation dysfunction of the AC joint

Student states they would document an acromioclavicular joint somatic dysfunction in the
objective portion of the SOAP note

Question 3

6c. Perform the evaluation of the sternoclavicular joint for somatic dysfunction and document
appropriately.

Answer 3

Describes horizontal flexion and extension assessment as follows:

Have patient lie supine, place fingers bilaterally anteriorly on the clavicular head next to the
sternum to monitor motion

Have the patient flex shoulders to 90 then reach towards the ceiling, evaluating the motion
of both clavicles beneath your fingers

States proximal end of clavicle moves posterior as the patient reaches towards the ceiling
(horizontal flexion) as the distal clavicle moves anterior

As the patient returns shoulders back to neutral (horizontal extension), states proximal
clavicle moves anterior and distal clavicle moves posterior

Student states that by performing bilaterally, they can assess for asymmetries

Student states a horizontal extension dysfunction with restriction to horizontal flexion is
most common
Describes abduction and adduction assessment as follows:

Student now places the index fingers of both hands on the superior aspect of the head of
both clavicles, and has patient shrug their shoulders

States proximal end of clavicle moves inferiorly and distal end of clavicle move superiorly as
the patient shrugs shoulders superiorly (abduction)

As patient lowers shoulders to neutral (adduction), states proximal end of clavicle moves
superiorly and distal end of clavicle moves inferiorly

Student states that by performing bilaterally, they can assess for asymmetries

Student states an adduction dysfunction with restriction to abduction is most common

Student states they would document a sternoclavicular somatic dysfunction in the objective
portion of the SOAP note

Question 4

6d. Perform the evaluation of the scapulothoracic joint for somatic dysfunction and document
appropriately.

Answer 4

Patient in lateral recumbent position with student facing the patient’s anterior aspect
contacting the inferior angle of the scapula with their caudad hand the acromion with their
cephalad hand

Student performs scapular elevation (cephalad and parallel to spine) and states the upper
trapezius and levator scapulae are responsible for the motion

Student performs scapular depression (return from elevation) and states the lower
trapezius and lower rhomboids are responsible for motion

Student performs scapular protraction (away from/perpendicular to the spine) and states
the serratus anterior is responsible for the motion

Student performs scapular retraction (moving closer to the spine) and states the rhomboids
andmiddle trapezius are responsible for the motion

Student performs upward rotation (forward tilt) and states the serratus anterior and upper
trapezius muscles are responsible for the motion

Student performs downward rotation (Backward tilt) and states the levator scapulae,
rhomboid major and minor, and latissimus dorsi muscles are responsible for the motion

Student performs evaluation bilaterally in order to assess for asymmetries

Student names somatic dysfunction found in the scapulothoracic joint

Student states they would document a scapulothoracic somatic dysfunction in the objective
portion of the SOAP note

Question 5

6e. Perform the evaluation of Ulnar Abduction (valgus testing) coupled with wrist adduction for
elbow somatic dysfunction and document appropriately.

Answer 5

Student has patient in seated position with arms in anatomical position.

Student contacts the wrist with one hand and the lateral elbow with the other.

Student takes the elbow into extension and a valgus force is applied to the ulnohumeral
joint.

Student notes hard or soft end feel.

Student describes dysfunction as the ease of motion prefers abduction at the ulnohumeral
joint.

Student states they would document an ulnar abduction somatic dysfunction in the
objective portion of the SOAP note.

Question 6

6f. Perform the evaluation of Ulnar Adduction (varus testing) coupled with wrist abduction for
elbow somatic dysfunction and document appropriately.

Answer 6

Student has patient in seated position with arms in anatomical position.

Student contacts the wrist with one hand and the medial elbow with the other.

Student takes the elbow into extension and a varus force is applied to the ulnohumeral
joint.

Student notes hard or soft end feel.

Student describes dysfunction as the ease of motion prefers adduction at the ulnohumeral
joint.

Student states they would document an ulnar adduction somatic dysfunction in the
objective portion of the SOAP note.

Question 7

6g. Perform the evaluation of Radial Head Motion‐Posterior Glide coupled with pronation for
elbow somatic dysfunction and document appropriately.

Answer 7

Student has patient in seated position and faces them

Student contacts the wrist with one hand and the radial head with the other.

Student provides a posterior glide force to the radial head noting end feel

Student assesses forearm pronation and notes if there is ease of motion orrestriction to full
pronation

Student states a posterior radial head dysfunction will have ease of motion to posterior glide
and forearm pronation with restriction to anterior glide and forearm supination

Student states they would document a posterior radial head somatic dysfunction in the
objective portion of the SOAP note.

Question 8

6h. Perform the evaluation of Radial Head Motion‐Anterior Glide coupled with supination for
elbow somatic dysfunction and document appropriately.

Answer 8

Student has patient in seated position and faces them.

Student contacts the wrist with one hand and the radial head with the other.

Student provides an anterior glide force to the radial head noting end feel.

Student assesses forearm supination and notes if there is ease of motion or restriction to
full supination.

Student states an anterior radial head dysfunction will have ease of motion to anterior glide
and forearm supination with restriction to posterior glide and forearm pronation.

Student states they would document an anterior radial head somatic dysfunction in the
objective portion of the SOAP note.

Question 9

6i. Perform the evaluation of Wrist Flexion with coupled Dorsal/Posterior Carpal Glide for wrist
somatic dysfunction and document appropriately.

Answer 9

Student has patient in seated position and contacts the hand with one hand and the distal
radius/ulna with the other

Student places wrist into flexion and extension and notes freedom of motion is in flexion
with restriction to extension

Student states the carpal bones will have coupled freedom of motion in dorsal/posterior
glide with restriction to ventral/anterior glide

Student states they would document a wrist flexion/posterior carpal glide somatic
dysfunction in the objective portion of the SOAP note

Question 10

6j. Perform the evaluation of Wrist Extension with coupled Ventral/Anterior Carpal Glide for wrist
somatic dysfunction and document appropriately

Answer 10

Student has patient in seated position and contacts the hand with one hand and the distal
radius/ulna with the other

Student places wrist into flexion and extension and notes freedom of motion is in extension
with restriction to flexion

Student states the carpal bones will have coupled freedom of motion in ventral/anterior
glide with restriction to dorsal/posterior glide

Student states they would document wrist extension/anterior carpal glide somatic
dysfunction in the objective portion of the SOAP note.

Question 11

6k. Perform the evaluation of Abduction of the Wrist (deviation toward the radial side in the
anatomical position) for wrist somatic dysfunction and document appropriately.

Answer 11

Student has patient in seated position and contacts the hand with one hand and the distal
radius/ulna with the other.

Student places forearm in full supination.

Student places wrist into abduction (radial deviation) and adduction (ulnar deviation) and
notes freedom of motion is in abduction (radial deviation) with restriction to adduction
(ulnar deviation)

Student states they would doc

Question 12

6l. Perform the evaluation of Adduction of the Wrist (deviation toward the ulnar side in the
anatomical position) for wrist somatic dysfunction and document appropriately.

Answer 12

Student has patient in seated position and contacts the hand with one hand and the distal
radius/ulna with the other.

Student places forearm in full supination.

Student places wrist into adduction (ulnar deviation) and abduction (radial deviation) notes
freedom of motion is in adduction (ulnar deviation) with restriction to abduction (radial
deviation)

Student states they would document wrist adduction somatic dysfunction in the objective
portion of the SOAP note.

Question 13

6m. Perform the evaluation of Finger Abduction (index, long, ring and little fingers) for finger
somatic dysfunction and document appropriately.

Answer 13

Student has patient in seated position and contacts the distal metacarpal with one hand and
the proximal phalanx of the metacarpal joint in question with the other.

Student has hand/wrist in full supination for anatomical position.

Student provides a force to move the jointaway from the midline and towards midline.

Student states the ease of motion is into abduction and restriction is to adduction.

Student states they would document the specifically named joint plus abduction somatic
dysfunction (e.g. right 3rd metacarpal abduction somatic dysfunction) in the objective
portion of the SOAP note

Question 14

6n. Perform the evaluation of Finger Adduction (index, long, ring and little fingers) for finger
somatic dysfunction and document appropriately.

Answer 14

Student has patient in seated position and contacts the distal metacarpal with one hand and
the proximal phalanx of the metacarpal joint in question with the other.

Student has hand/wrist in full supination for anatomical position.

Student provides a force to move the joint toward the midline and away from midline.

Student states the ease of motion is into adduction and restriction is to abduction.

Student states they would document the specifically named joint plus adduction somatic
dysfunction (e.g. right 3rd metacarpal adduction somatic dysfunction) in the objective
portion of the SOAP note

Question 15

6o. Perform the evaluation of Abduction of Thumb for finger somatic dysfunction and document
appropriately.

Answer 15

Student has patient in seated position and contacts the distal first metacarpal with one hand
and the proximal phalanx of the thumb with the other.

Student has hand/wrist in full supination for anatomical position.

Student provides a force to move the joint in an anterior direction.

Student states the ease of motion is to abduction of the joint and restricted to adduction.

Student states they would document thumb abduction somatic dysfunction in the objective
portion of the SOAP note.

Question 16

6p. Perform the evaluation of Finger Flexion (index, long, ring and little fingers) for finger somatic
dysfunction and document appropriately.

Answer 16

Student has patient in seated position and contacts the distal metacarpal with one hand and
the proximal phalanx of the joint in question with the other.

Student provides a force to move the joint into flexion.

Student states the ease of motion is to flexion of the joint and restricted to extension.

Student states they would document finger flexion dysfunction of the joint name in question
(e.g. third MCP flexion dysfunction) in the objective portion of the SOAP note.

Question 17

6q. Perform the evaluation of Finger Extension (index, long, ring and little fingers) for finger
somatic dysfunction and document appropriately.

Answer 17

Student has patient in seated position and contacts the distal metacarpal with one hand and
the proximal phalanx of the joint in question with the other.

Student provides a force to move the joint into extension.

Student states the ease of motion is to extension of the joint and restricted to flexion.

Student states they would document finger extension dysfunction of the joint name in
question (e.g. third MCP extension dysfunction) in the objective portion of the SOAP note.

Question 18

7a. Perform the flexion/extension evaluation of the hip joint for somatic dysfunction (prone and
supine) and document appropriately.

Answer 18

Student is standing at side of table facing patient and places patient in a supine position.

Student assesses passive flexion of the hip joint by blocking linkage and noting 90 degrees
expected

Student assesses bilaterally.

Student places patient in prone position and assesses passive extension of the hip joint by
blocking linkage and noting 15‐30 degrees expected

Student assess bilaterally

Student states flexion dysfunction has ease of motion to flexion and restriction to extension

Student states extension dysfunction has ease of motion to extension and restriction to
flexion.

Student notes a hip flexion or extension dysfunction would be noted in the objective portion
of the chart noting side of laterality

Question 19

7b. Perform the internal rotation/external rotation evaluation of the hip joint for somatic
dysfunction (prone and supine) and document appropriately.

Answer 19

Student is standing at side of table facing patient and places patient in a supine position
with hip and knee at 90 degrees.

Student places patient in supine or prone position and assesses passive internal rotation of
the hip joint by blocking linkage and noting 30‐40 degrees expected

Student places patient in supine or prone position and assesses passive external rotation of
the hip joint by blocking linkage and noting 40‐60 degrees expected

Student states internal rotation dysfunction has ease of motion to internal rotation and
restriction to external rotation.

Student states external rotation dysfunction has ease of motion to external rotation and
restriction to internal rotation.

Student notes a hip internal or external rotation dysfunction would be noted in the
objective portion of the chart noting side of laterality.

Question 20

7c. Perform the adduction/abduction evaluation of the hip joint for somatic dysfunction (supine)
and document appropriately.

Answer 20

Student is standing at foot of table facing patient and places patient in a supine position
with knee extended

Student assesses passive abduction of the hip joint by blocking linkage and noting 45‐50
degrees expected

Student assesses passive adduction of the hip joint by blocking linkage by lifting the
contralateral lower extremity and sweeping the ipsilateral leg into adduction, noting 20‐30
degrees expected

Student states abduction dysfunction has ease of motion to abduction and restriction to
adduction.

Student states adduction dysfunction has ease of motion to adduction and restriction to
abduction.

Student notes a hip adduction or abduction dysfunction would be documented in the
objective portion of the chart noting side of laterality.

Question 21

7d. Perform the internal rotation/external rotation evaluation of the tibia/knee joint for somatic
dysfunction and document appropriately.

Answer 21

Student is standing at side of table facing patient and places patient in a supine position
with hip and knee flexed to 90 degrees or prone with knee flexed to 90 degrees.

Student assesses passive internal rotation of the tibia by blocking linkage proximally and
noting 10 degrees expected range of motion.

Student assesses passive external rotation of the tibia by blocking linkage proximally and
noting 10 degrees expected range of motion.

Student states internal rotation dysfunction has ease of motion to internal rotation and
restriction to external rotation.

Student states external rotation dysfunction has ease of motion to external rotation and
restriction to internal rotation.

Student notes a tibia/knee internal rotation or external rotation dysfunction would be
documented in the objective portion of the chart noting side of laterality.

Question 22

7e. Perform the abduction/adduction evaluation of the knee joint for somatic dysfunction and
document appropriately.

Answer 22

Doctor standing at side of table with patient in a supine position.

Doctor contacts the lateral aspect of the knee with one hand and the medial ankle with the
other.

Doctor applies a valgus force to assess for adduction ease or restriction of motion

Doctor reverses hand to medial knee and lateral ankle and applies a varus force to assess for
abduction ease or restriction of motion.

Doctor notes this is evaluating for a functional change not a structural change in the tissues.

Doctor states that an adduction somatic dysfunction will have ease of motion with valgus
force.

Doctor states that an abduction somatic dysfunction will have ease of motion with varus
force.

An adduction or abduction dysfunction will be documented in the objective portion of the
chart with the side of laterality noted.

Question 23

7f. Perform the proximal fibula evaluation of the knee joint for somatic dysfunction and document
appropriately.

Answer 23

Doctor standing at side of table and patient supine with knee flexed and foot flat on table.
(Can also do supine with knee fully extended)

Doctor contacts the head of the fibula with the thumb and index finger of one hand

Doctor slowly applies an anterior then posterior force to assess for gliding motion of the
fibular head with the tibia.

Doctor notes if there is asymmetry between anterior and posterior glide.

Doctor notes an ease of anterior glide with posterior glide restriction defines an anterior
fibular head somatic dysfunction

Doctor notes an ease of posterior glide with anterior glide restriction defines an posterior
fibular head somatic dysfunction

Doctor notes an anterior or posterior fibular head somatic dysfunction will be documented
in the objective portion of the chart with the side of laterality noted.

Question 24

7g. Perform the anterior/posterior lateral malleolus (distal fibula) evaluation of the ankle joint for
somatic dysfunction and document appropriately.

Answer 24

Doctor standing at side of table and patient supine with knee flexed and foot flat on table.

Doctor contacts the lateral malleolus (distal fibula) with the thumb and index finger of one
hand

Doctor slowly applies an anterior then posterior force to assess for gliding motion of the
lateral malleolus (distal fibula) with the tibia.

Doctor notes if there is asymmetry between anterior and posterior glide.

Doctor notes an ease of anterior glide with posterior glide restriction defines an anterior
lateral malleolus (distal fibular) somatic dysfunction

Doctor notes an ease of posterior glide with anterior glide restriction defines a posterior
lateral malleolus (distal fibular) somatic dysfunction

Doctor notes an anterior or posterior lateral malleolus (distal fibular) somatic dysfunction
will be documented in the objective portion of the chart with the side of laterality noted.

Question 25

7h. Perform the talus evaluation of the foot joint for somatic dysfunction and document
appropriately.

Answer 25

Doctor is standing at the foot of the table with the patient in a supine position.

Doctor contacts the foot and applies a passive force to place the ankle into dorsiflexion and
states 15‐20 degrees expected range of motion.

Doctor contacts the foot and applies a passive force to place the ankle into plantar flexion
and states 50‐65 degrees expected range of motion.

Doctor states the motion is occurring between the talus and the tibia/fibula.

Doctor states a talus plantar flexion dysfunction is defined as ease of motion to plantar
flexion and restriction to dorsiflexion.

Doctor states a talus dorsiflexion dysfunction is defined as ease of motion to dorsiflexion
and restriction to plantar flexion.

Doctor states a talus dorsiflexion or plantar flexion somatic dysfunction would be
documented in the objective portion of the chart with the side of laterality noted.

Question 26

7i. Perform the calcaneus evaluation of the foot joint for somatic dysfunction and document
appropriately.

Answer 26

With the patient in a supine position, the doctor is standing at the foot of the table placing
the ankle in a standing posture position (dorsiflexion, 90 degree angle between tibia and
foot) to avoid excess laxity in the subtalar joint.

Doctor contacts the calcaneus and applies a passive force to place the calcaneus into
inversion, noting 35 degrees expected.

Doctor contacts the calcaneus and applies a passive force to place the ankle into eversion,
noting 20 degrees expected.

Doctor states the motion is occurring between the talus and the calcaneus (subtalar joint).

Doctor states a calcaneus inversion dysfunction is defined as ease of motion to inversion
and restriction to eversion.

Doctor states a calcaneus eversion dysfunction is defined as ease of motion to eversion and
restriction to inversion.

Doctor states a calcaneus inversion or eversion somatic dysfunction would be documented
in the objective portion of the chart with the side of laterality noted.

Question 27

7j. Perform the navicular evaluation of the foot joint for somatic dysfunction and document
appropriately.

Answer 27

With the patient in a supine position, the doctor is standing at the foot of the table

Doctor contacts the navicular bone with the thumb and index finger.

Doctor applies a passive force to place the navicular into dorsal and ventral gliding motion.

Doctor states the motion should demonstrate symmetry in the glide range of motion

Doctor states a dorsal navicular dysfunction is defined as ease of motion to dorsal glide and
restriction to plantar glide.

Doctor states a plantar navicular dysfunction is defined as ease of motion to plantar glide
and restriction to dorsal glide.

Doctor notes more common to have a plantar glide dysfunction.

Doctor states a navicular dorsal or plantar glide somatic dysfunction would be documented
in the objective portion of the chart with the side of laterality noted.

Question 28

7k. Perform the cuboid evaluation of the foot joint for somatic dysfunction and document
appropriately

Answer 28

With the patient in a supine position, the doctor is standing at the foot of the table

Doctor contacts the cuboid bone with the thumb and index finger.

Doctor applies a passive force to place the cuboid into dorsal and ventral gliding motion.

Doctor states the motion should demonstrate symmetry in the glide range of motion

Doctor states a dorsal cuboid dysfunction is defined as ease of motion to dorsal glide and
restriction to plantar glide.

Doctor states a plantar cuboid dysfunction is defined as ease of motion to plantar glide and
restriction to dorsal glide.

Doctor notes more common to have a plantar glide dysfunction.

Doctor states a cuboid dorsal or plantar glide somatic dysfunction would be documented in
the objective portion of the chart with the side of laterality noted.

Question 29

7l. Perform the cuneiform evaluation of the foot joint for somatic dysfunction and document
appropriately.

Answer 29

With the patient in a supine position, the doctor is standing at the foot of the table

Doctor contacts the cuneiform bone with the thumb and index finger.

Doctor applies a passive force to place the cuneiform into dorsal and ventral gliding motion.

Doctor states the motion should demonstrate symmetry in the glide range of motion

Doctor states a dorsal cuneiform dysfunction is defined as ease of motion to dorsal glide and
restriction to plantar glide.

Doctor states a plantar cuneiform dysfunction is defined as ease of motion to plantar glide
and restriction to dorsal glide.

Doctor notes more common to have a plantar glide dysfunction.

Doctor states a cuneiform dorsal or plantar glide somatic dysfunction would be documented
in the objective portion of the chart with the side of laterality noted and numbered 1‐3.

Question 30

7m. Perform the metatarsal evaluation of the foot joint for somatic dysfunction and document
appropriately.

Answer 30

With the patient in a supine position, the doctor is standing at the foot of the table

Doctor contacts the distal aspect of the metatarsal bone with the thumb and index finger.

Doctor blocks linkage at the neighboring metatarsals with opposite thumb and index finger
while inducing a dorsal and ventral glide motion.

Doctor applies a passive force to place the metatarsal into dorsal and ventral gliding motion.

Doctor states the motion should demonstrate symmetry in the glide range of motion

Doctor states a dorsal metatarsal dysfunction is defined as ease of motion to dorsal glide
and restriction to plantar glide.

Doctor states a plantar metatarsal dysfunction is defined as ease of motion to plantar glide
and restriction to dorsal glide.

Doctor notes more common to have a plantar glide dysfunction.

Doctor states a metatarsal dorsal or plantar glide somatic dysfunction would be
documented in the objective portion of the chart with the side of laterality noted and
numbered 1‐5.

Question 31

7n. Perform the metatarso‐phalangeal evaluation of the foot joint for somatic dysfunction and
document appropriately.

Answer 31

With the patient in a supine position, the doctor is standing at the foot of the table

Doctor contacts the metatarsal‐phalangeal joint with the thumb and index finger.

Doctor blocks linkage at the associated metatarsal head with opposite thumb and index
finger while inducing motion.

Doctor applies a passive force to place the joint into dorsiflexion/plantar flexion,
adduction/abduction, internal/external rotation motions.

Doctor states the motions should demonstrate symmetry in the range of motion

Doctor states a dorsiflexion metatarsal‐phalangeal dysfunction is defined as ease of motion
to dorsiflexion glide and restriction to plantar flexion.

Doctor states a plantar flexion metatarsal‐phalangeal dysfunction is defined as ease of
motion to plantar flexion and restriction to dorsiflexion.

Doctor states an adduction metatarsal‐phalangeal dysfunction is defined as ease of motion
to adduction and restriction to abduction.

Doctor states an abduction metatarsal‐phalangeal dysfunction is defined as ease of motion
to abduction and restriction to adduction.

Doctor states an external rotation metatarsal‐phalangeal dysfunction is defined as ease of
motion to external rotation and restriction to internal rotation.

Doctor states an internal rotation metatarsal‐phalangeal dysfunction is defined as ease of
motion to internal rotation and restriction to external rotation.

Doctor states a metatarsal‐phalangeal dorsiflexion/plantar flexion, adduction/abduction,
internal/external rotation somatic dysfunction would be documented in the objective
portion of the chart with the side of laterality noted and numbered 1‐5.