{
  "resourceType": "ActivityDefinition",
  "id": "wrist-splinting-exercise-cts",
  "url": "https://bodyiq.dev/fhir/ActivityDefinition/wrist-splinting-exercise-cts",
  "version": "1",
  "name": "WristSplintingExerciseCts",
  "title": "Wrist Neutral Splinting + Exercise Protocol (CTS)",
  "status": "draft",
  "experimental": true,
  "description": "Combined conservative management protocol for carpal tunnel syndrome: nighttime neutral wrist splinting (0-20° extension) plus daytime nerve and tendon gliding exercises. First-line non-surgical treatment. Consider surgical referral if severe symptoms persist >6 months, thenar atrophy develops, persistent numbness occurs, or 3-6 months conservative management fails.",
  "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": "wrist-splinting-exercise-cts",
          "display": "Wrist Neutral Splinting + Exercise Protocol (CTS)"
        }
      ]
    }
  ],
  "bodySite": [
    {
      "coding": [
        {
          "system": "https://bodyiq.dev/fhir/CodeSystem/exercise",
          "code": "wrist",
          "display": "Wrist"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "74670003",
          "display": "Structure of radiocarpal joint"
        }
      ],
      "text": "Wrist"
    }
  ],
  "kind": "ServiceRequest",
  "dosage": [
    {
      "text": "Splint: worn nightly for 6-12 weeks, neutral position (0-20° extension). Exercises: nerve and tendon glides 3-5x daily during waking hours [clinical consensus]"
    }
  ],
  "usage": "Evidence: moderate.",
  "note": [
    {
      "text": "Quiet wrist, sliding nerve — neutral position offloads the median nerve",
      "authorString": "focus:internal"
    },
    {
      "text": "Cycle through nerve and tendon glides every two to three hours",
      "authorString": "focus:external"
    },
    {
      "text": "Wear the splint each night to keep the wrist neutral",
      "authorString": "focus:external"
    },
    {
      "text": "Wrist rests like a parked train on level track",
      "authorString": "focus:imagery"
    }
  ],
  "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"
      }
    },
    {
      "type": "successor",
      "label": "The CTS splinting protocol's 'Add Strengthening' progression explicitly adds wrist-curl strengthening once symptoms improve; wrist-curls-flexion-extension is that distinct strengthening node.",
      "display": "Wrist Curls (Flexion/Extension)",
      "resource": "ActivityDefinition/wrist-curls-flexion-extension"
    }
  ],
  "extension": [
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Digitorum Superficialis"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "89895007"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Flexor Digitorum Profundus"
        },
        {
          "url": "role",
          "valueCode": "primary"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "423541009"
          }
        }
      ]
    },
    {
      "url": "https://bodyiq.dev/fhir/StructureDefinition/muscle-involvement",
      "extension": [
        {
          "url": "muscle",
          "valueString": "Extensor Digitorum"
        },
        {
          "url": "role",
          "valueCode": "synergist"
        },
        {
          "url": "coding",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "50176000"
          }
        }
      ]
    }
  ]
}