this study will be conducted to investigate the effect of instrument assisted soft tissue mobilization on hand post surgical scars in primary flexor tendons repair in zone v
Both sex will be included in this research
Hand scar in zone v
Age varying from 20 to 40
Hand scar formed post primary flexor tendons repair
Vascular injuries requiring arterial repair
Soft tissue loss
Fractures
Tendon in-juries of other zones
Parallel
Instrument Assisted Soft Tissue Mobilization
Other interventionthe treatment will start by disinfect the instrument between patients to avoid transfer of infections. It is recommended to disinfect the instrument with intermediate-level disinfectants (e.g. isopropyl alcohol), then wash it with soap and water to remove any residuals of the chemical disinfectant off the instrument. If the tools contacts blood, bodily fluids, mucous membranes, or non-intact skin then disinfecting it with high-level disinfectant should be done .IASTM will be done at 30-60 degrees angle for 40-120 seconds+ radiational therapy
traditional therapy
Other interventionthe patients will receive traditional therapy in the form of ultrasound, scar massage, and stretching exercises.
scar assessment
Patient and Observer Scar Assessment Scale (POSAS) will be used to assess scar.It consists of two distinct scales: the OSAS and the PSAS. The PSAS consists of six items: scar-related pain, itchiness, colour, stiffness, thickness and irregularity. Each POSAS item has a 10-point scoring system, with 1 representing normal skin and 10 the worst imaginable scar or sensation; these items are summed to obtain a total score ranging from 6 to 60 for each scale. In addition to the POSAS score, both observer and patient give their own overall opinion on the appearance of the scar using a 10-point scale.
range of motion
the range of motion (wrist, metacarpophalangeal, proximal and disatal interphalangeal joint)will be assessed by kinovea software.Kinovea provides a tool to manually draw lines and measure angles to assess ROM as the following:Pause the video at the point where maximum movement occurs (e.g., maximum wrist flexion).Use the angle tool to draw two lines corresponding to the bones of the joint. The software will calculate the angle between the lines, giving you a measure of the ROM.
handgrip strength
The hand dynamometer will be used to assess hand grip strength.The subject grips the dynamometer with their maximum force for a few seconds (typically 3 to 5 seconds).Avoid jerky movements or changes in posture during the measurement.
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