{
  "resourceType": "ActivityDefinition",
  "id": "thumb-adduction-key-pinch",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/thumb-adduction-key-pinch",
  "version": "1",
  "name": "ThumbAdductionKeyPinch",
  "title": "Thumb Adduction / Key Pinch Exercise",
  "status": "draft",
  "experimental": true,
  "description": "Strengthening the adductor pollicis through key pinch (lateral pinch) tasks. Adductor pollicis shows nearly equal activation to FPL during pinch, with activity increasing proportionally with force. 79% MVC increase demonstrated after training at 50% MVC.",
  "useContext": [
    {
      "code": {
        "system": "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code": "user"
      },
      "valueCodeableConcept": {
        "text": "difficulty: beginner"
      }
    }
  ],
  "topic": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "thumb-adduction-key-pinch",
          "display": "Thumb Adduction / Key Pinch Exercise"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "hand",
          "display": "Hand"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "782474003",
          "display": "Structure of ligament of first carpometacarpal joint"
        }
      ],
      "text": "Hand"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "3×10 reps key pinch holds (5 seconds each), 3x/week. Train at 50% MVC for strength gains [Lyle 1998]"
    }
  ],
  "usage": "Evidence: moderate. Adductor pollicis nearly equal to FPL during pinch [Cooney 1985]. 79% MVC increase after training at 50% MVC [Lyle 1998]",
  "note": [
    {
      "text": "Quiet wrist — adductor pollicis pulls the thumb toward the palm",
      "authorString": "focus:internal"
    },
    {
      "text": "Pinch a key edge between the thumb pad and the index side",
      "authorString": "focus:external"
    },
    {
      "text": "Hold the squeeze for five steady seconds",
      "authorString": "focus:external"
    },
    {
      "text": "Free hand on the first web space to feel the contraction",
      "authorString": "focus:tactile"
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "label": "kisner-therapeutic-2017",
      "citation": "Kisner C, Colby LA, Borstad J. (2017). Therapeutic Exercise: Foundations and Techniques"
    },
    {
      "type": "citation",
      "label": "acsm-guidelines-2021",
      "citation": "American College of Sports Medicine. (2021). ACSM's Guidelines for Exercise Testing and Prescription",
      "document": {
        "url": "https://doi.org/10.4135/9781412994149.n165"
      }
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Adductor Pollicis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "60114005"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Pollicis Longus"
        },
        {
          "url": "role",
          "valueCode": "secondary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "82465007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Pollicis Brevis"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "20588008"
          }
        }
      ]
    }
  ]
}