We prefer not to rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. Cortisone has temporary effects in regard to pain control whereas starMethod has permanent effects. She had such a good session Meg had asked whether she can come back for another session!!!! Meg just has a sprained neck (so much better now) but I think more importantly, the senior physiotherapist has impressed on her to strengthen her muscles in light of her loose joints. Extensor Tendinopathy (Tennis Elbow) Flexor Tendinopathy (Golfer's Elbow) Posterior Elbow Pain The radial nerve branches into a posterior The site is secure. The stability of the elbow joint due to its bony structure means that significant force is required to disrupt the joint. We will also assess to determine if it's other issues that's causing your elbow pain. Treatment: Posterior impingement syndrome of the elbow is often treatable with non-operative management. This muscle is essential in repeated movements such as a biceps curl, manual labor, or using a screwdriver. Medial epicondylitis pain can be sudden or gradual. utilized in order to make the diagnosis for posterior interosseous nerve Since the Anterior elbow dislocations occur when the elbow is flexed, and there is a direct blow on the posterior aspect of the elbow. Tennis elbow has similar symptoms. on the outside of the forearm a little below the elbow joint is known to be severity of your condition. Two of these are Wartenburg DEEP TISSUE RELEASE & SPORTS MASSAGE THERAPY. and needles), Electromyography (to determine Elbow Pain - Crosby Physiotherapy Elbow Pain Enquire Online Shoulder Pain Wrist & Hand Pain Most elbow conditions seen at the clinic tend to be located at the lateral, medial and posterior aspects of the elbow. An initial lateral radiograph (1a) and fat-suppressed proton density-weighted sagittal (2a-d) and T2-weighted coronal MRI (3a-c) images are made available for review. StatPearls Publishing, Treasure Island (FL). If pain, swelling, or immobility continues, however, it is important that a person consults a doctor. We appreciate you as our valued clients and want you to know that the # 1 way we grow as a clinic / brand is through word of mouth referrals from valued patients like yourself. Attention should be paid to normal radiocapitellar alignment in values to demonstrate adequate reduction. A person can usually treat it at home with rest and over-the-counter medication. They may also employ Addresses across the entire subnet were used to download content in bulk, in violation of the terms of the PMC Copyright Notice. Cartilage covers the bones to ease stress from compression and allow for fluid joint movement. interosseous nerve entrapment usually doesnt get better with time if the starting a treatment for this condition on your known. Chiropractic treatment for elbow pain with Dr. Winchell is a non-surgical, non-drug therapy that corrects the root cause of most elbow pain with . Synovial plicae of the elbow may be the cause of lateral elbow pain in patients with vague clinical symptoms. nerve. muscles from scar tissue micro-tears (and potential ruptures), and increases muscle NSAIDs. Gottlieb M, Schiebout J. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. Bethesda, MD 20894, Web Policies Accessibility syndrome and how you can prevent it from occurring? Surgical decompression is considered, which basically focuses on made. Access free multiple choice questions on this topic. The incidence is reported at 6 to 13 per 100,000 persons per year. The wrist is then graspedand the forearm placed in slight supination while gentle traction is applied. In particular, cross friction massage of the tendon, but only once, Golfers elbow exercises include both stretching and strengthening. can cause the pain to worsen. This anatomic structure is crucial for the stable anatomic reduction of a displaced extension type supracondylar . Your doctor will decide the best option based on the condition of . This could be a clean break, or the bone could break into many pieces. Treatment of Infection of Elbow Bursitis Treatment of infected bursitis requires repeated drainage of the fluid, antibiotic treatment, and sometimes a surgical procedure to remove the infected bursa. expert treatment for your pain as well as prescribing specific Elbow bursitis, also known as Students elbow or Olecranon bursitis, is the inflammation and swelling of the bursa at the back of the elbow. The only difference is the affected areas and the motions that cause it. Patients with septic. To treat tendinitis at home, R.I.C.E. 2004-2022 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. One potential cause of this is a partial or complete tear of the ulnar collateral ligament (UCL). There are many reasons that a person may experience pain in their elbow when lifting objects. Neurovascular complications are rare from a simple, closed, posterior dislocation. The range of rehabilitation results vary from patients to patients, depending on a variety of factors and reasons such as severity of condition, genetics, gender and age. required to begin an early active range of movement. Dislocations that appear more unstable may require up to 3 weeks of splinting and a specific range of motion plan. Signs of infection include: Fevers, chills, and sweats Redness around the bursa His imaging is shown in Figure A. Rotate the tip of your elbow so that it is pointing toward your abdomen. assessment, helping them to select the most appropriate treatment to Tennis elbow is a repetitive strain injury in the forearm. Grab a tennis ball in the palm of your hand. Injury can occur to the tendon from overuse, or from a sudden impact such as a fall. Surgical treatment Surgery is carried out as a day case procedure usually either under local or general anaesthetic and takes about 15-30 minutes. identify the area of compression and assist in surgical planning). Mike is creator & CEO of Sportsinjuryclinic.net. Posterior elbow impingement. . She had such a good session Meg had asked whether she can come back for another session!!!! Particular attention should be paid to the distal radioulnar joint for tenderness which can indicate disruption of the intraosseous ligament, eponymously referred to as an Essex-Lopresti lesion. But opting out of some of these cookies may affect your browsing experience. is the acronym to remember rest, ice, compression and elevation. spontaneously, and it starts with the weakening of the muscles in the wrist and Unable to bend or straighten arm. government site. Patients who sustained injuries to their elbows, forearms, hands, wrists A qualified Sports Injury Therapist with a degree in Physical Education, Sports Science and Physics, and a Postgraduate Certificate in Education. The elbow is a complicated part of the body formed between three bones: A combination of cartilage, tendons, and ligaments surrounds these bones. (sprains and fractures) and fingers, usually will benefit / require Hand Therapy to, Commonly treated hand pain injuries includes, REFORMER CLINICAL PILATES & WELLNESS PILATES. Dr. Nady Hamid, MD is an Orthopedic Surgery Specialist in Charlotte, NC. These cookies do not store any personal information. this elbow condition, Tingling sensation (like pins The earlier a person can address the pain, the better, as it can worsen and become harder to treat. Conservative management Reduction of local inflammation and swelling around the nerve: [26] Wrist and/or elbow splints The arm can be put in an above-elbow cast for ten days with the elbow flexed at 90, the forearm supinated and the wrist in neutral position [27] Physical Therapists use a variety of treatment options, including: Laser. The part of the elbow and the severity of the pain that affects it both determine the type of treatment a person will receive. We avoid using tertiary references. innervation, the symptoms are known to be completely sensory, which means there Studies suggest that repetitive motions and excessive weights are common causes of strain in the upper limbs. The differential diagnosis of elbow joint pain is quite long (see Table). A solution created for athletes, by athletes. The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. The coronoid process must be distracted and disengaged from the olecranon fossa. usually involves rest, modification techniques, physical therapy, splinting and Along with forearm rotation, forceful elbow extension may produce pain (Ducic et al, 2012). Obvious bony deformities may distract both the patient and the practitioner from more serious traumatic injuries. Tomori Y, Nanno M, Takai S. Posteromedial elbow dislocation with lateral humeral condylar fracture in children: Three case reports and a literature review. The procedure is identical to the removal of loose bodies or spurs. interosseous nerve is known to occur more frequently in males as opposed to they can actively prevent it from happening again when you finally return to This condition occurs when the tendons surrounding the bone of the elbow tear or swell. Olecranon Fracture The stability of the elbow joint due to its bony structure means that significant force is required to disrupt the joint. Nonsurgical treatment, the mainstay of management, involves a myriad of. Of note, several patients did have decreased elbow exten-sion strength after this procedure likely related to the triceps fascia harvest [31]. Explain why careful planning and discussion among interprofessional team members involved in the management of patients with posterior elbow dislocation will improve outcomes. sport and exercise. Pain and pathology in a tendon, known as tendinopathy, is a common injury in athletes that can be difficult to manage. Inflammation of this triceps tendon onto the back of the elbow is commonly referred to as triceps tendonitis or posterior tennis elbow. forearm extensors. A splint is cut out into a 3- or 5-inch length, necessary to immobilize the affected part (usually radius and ulna). treated. Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility and breathing. Lim SM, Chua GG, Asrul F, Yazid M. Posterior Elbow Dislocation with Brachial Artery Thrombosis Treated Non-surgically: A Case Report. He developed acute worsening of pain and inability to throw. three years until the condition becomes clear and a definitive diagnosis is Pain in the elbow can also occur because of an acute injury. It's inner elbow pain that extends through your forearm to your wrists and hands, causing stiffness, numbness, tingling, and weakness. will keep your muscles healthy and fit with body/movement-confidence. Computerized tomography may be considered if there is a concern for a complex injury or to identify periarticular fractures not easily seen on plain radiographs. Elbow dislocations are fairly commonin clinical practice,however, they canbe associatedwith neurovascular compromise. When bursitis involves infection, treatment becomes more urgent. Diagnosis can be made clinically with positive posterior labral provocative tests and confirmed with MRI studies of the shoulder. All rights reserved. there are many ways the entrapment of the posterior interosseous nerve can be Hence, the primary care provider, nurse practitioner and emergency department physician should always refer these patients to the orthopedic surgeon. Mortimer AE, Nicholls A, Rawal A, Noor S, Oy H, Gollogly JG. PIN syndrome can occur in radial head fracture dislocations as well as Arthroscopic surgery of the elbow, or arthroscopic ulnohumeral arthroplasty, is often helpful for patients with painful elbow bone spurs caused by osteoarthritis, reports the medical information website eOrthopod 3. Normally, this sac has only a minimal amount of fluid in it and the bursa acts as a cushion for the tip of the elbow. FIGURE 1. The biceps muscle has two functions: bends the elbow and turns the wrist outwards. The Posterior elbow impingement is caused by repeated over extension or the arm, especially when the motion is forced. Aroojis A, Narula V, Sanghvi D. Pure Medial Elbow Dislocation without Concomitant Fracture in a 10-Year-Old Child. Specifically, varsity football and wrestling participants are particularlysusceptible to this injury. Arthroscopic management may provide a successful treatment option for such patients. Osteoarthritis affects the cartilage on the end of bones. flow to tired, tight and tense muscles toaccelerate recovery andshorten downtime / recovery period required. You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance. Olecranon bursitis is a common cause of posterior elbow pain and swelling. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. determine the severity of the condition. The less encountered anterior elbow dislocation requires much more force and concern for neurovascular compromise should be greater. This injury pattern is due to a particularlyforceful mechanism that disrupts the LCL and other soft tissues of the elbow joint. It boosts blood circulation in the targeted area. What is Posterior elbow impingement? A splint may be bisected lengthwise from the fingertips to the shoulder. My name is Nigel Chua, I'm the CEO and a principal hand therapist by training; my wife is Louise, she's the founder-COO and principal physiotherapist of Phoenix Rehab - and we're here to serve you. If you do need surgery, we will inform you and even refer to you the most suitable surgeon we professionallyknow. It is the most commonly dislocated joint in children, and the second most common in adults after the shoulder. A simple turning of the forearm where the palm is facing upward stages, we will take time to properly diagnose the condition Posterior interosseous nerve syndrome is basically a pathology that Some common causes of elbow pain when lifting include the following. + latter is known to cause forearm pain with the absence of motor weakness. These dislocations may also disrupt the posterior elbow compartment which contains the radial nerve and insertion of the triceps muscle. performance. For additional information, or to request that your IP address be unblocked, please send an email to PMC. are unmanageable and initial treatment doesnt prove to be satisfactory within Research suggests that risk factors for tennis elbow include repetitive elbow use and tobacco use. all that work airs from degeneration, irritation tears and pain . This injury frequently occurs during sporting activities when a person falls on an extended elbow. The triceps tendon at the back of the upper arm inserts into the elbow. You will not have noticed a precise incident or time when your injury occurred. underlying osteoporosis - [ # in 56% of women , 29% of men > 60yrs] risk factors are: age > 50; past history of ca; unexplained weight loss >4.5 kg, pain non-responsive to treatment > 1month- stronger viewed as negative predictors. General of injury (depending on how severe it is). PIN syndrome, Common treatment options for The injury more often occurs in adolescent male athletes. This is serious and requires immediate medical attention. Elbow fractures are the most common fracture in the pediatric population. Olecranon bursitis is the most common superficial bursitis and is a common cause of posterior elbow pain and swelling. Anterior dislocations are often associated with olecranon fractures. After the patient has been cleared of other significant injuries, attention can be turned to the affected extremity. The elbow joint is considered relatively stable; however, elbow dislocations are a fairly common occurrence. A . Symptoms of posterior interosseous nerve syndrome include weakness of the wrist and fingers. The most common symptom of brachioradialis pain is extreme tightness of the muscles in your forearm. All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB). Recurrent elbow dislocations suggest chronic joint instability and may require operative fixation. It is usually fractured from a direct impact or fall onto a bent elbow. This pain with resisted wrist extension. Treatment for posterior elbow impingement includes both surgical as well as non-surgical options. Sudden intense pain at the back of the elbow will be felt at the time of injury. However, we will do our best to deliver the best evidence-based-practice therapy that we can deliver (we try our best to only engage the most experienced and specialist therapists - which makes a big difference in clinical outcomes). and electrotherapy, as well as activity modification. Post-surgery rehabilitation You can go home soon after the operation. This book is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, a link is provided to the Creative Commons license, and any changes made are indicated. Treatment includes ice, rest, and medication for inflammation. Rheumatoid arthritis is an autoimmune condition affecting the joints that causes inflammation, swelling, and pain. In most instances, the semilunar notch of the ulna is dislocated posteriorly from the distal humerus. The information available on this site is for educational purposes only, if you need a full professional advise on physiotherapy, hand therapy, TCM, podiatry, BodyTalk, CranioSacral Therapy, SomatoEmotional Release etc, please schedule an appointment with us by contacting us. Patients may exhibit signs of numbness, The pain intensifies when you use your forearm . parts, theyre considered different diagnoses that are associated with the same The LCL is often disrupted when an elbow dislocation occurs; the MCL is the last soft tissue structure injured as the ulna is displaced. Elbow bursitis occurs in the olecranon bursa, a thin, fluid-filled sac that is located at the boney tip of the elbow (the olecranon). Waymack JR, An J. Posterior Elbow Dislocation. Specifically sudden onset (acute) elbow injuries, as well as pain on the outside, inside, and back. Massage and stretching can improve the mobility of the tissue. Since this sensory nerve doesnt have any motor Before Pressure from surrounding tissue in the elbow can cause trapped nerves. syndrome generally has a history of fracture or trauma around that region. Bruising and swelling of the elbow within the first few minutes to hours from internal bleeding. Rahman M, Cil A, Stylianou AP. Posterior elbow pain is a pain in the back of the elbow. entrapment of the posterior interosseous nerve occurs when the deep branch of You can opt-out if you wish. supinator arch, it can lead to the entrapment of the posterior interosseous Its characterized by motor weakness Germain Sim is a hand therapist practicing hand therapy, splinting, assessing and treating finger, hand and elbow pains in Phoenix Rehab, Adele is a registered physiotherapist with over 25 years of experience including treating national athletes as well as recreational athletes having worked in Singapore Sports Council and Singapore Spo, Achilles tendon pain is very common among recreational and elite sportspeople. The range of elbow motion was full in all patients postoperatively. activities that may worsen the symptoms and result in further entrapment. Noticeable deformity or irregular appearance to the elbow joint. The loss of cartilage causes the bones to rub against one another. Moreover, its expected that the that can occur as the nerve passes under the supinator muscle (Arcade of Fohse) Red Flag Conditions. passionate about what we do (I've been practicing since 2005; and Louise since 2006), and here in Phoenix Rehab - we have cherry-picked the best and most experienced team of principal-gradephysiotherapists, hand therapists, TCM If a person is experiencing pain when they lift objects, they may have tennis elbow. These tight muscles overstretch and inflame the elbow tendons, leading to pain in the elbow during exercises like bench press, push-ups, pull-ups, triceps extension, skull crushers and biceps curls. and determine the severity of the symptoms. Conservative treatment of isolated UCL injury consists of short immobilisation in a long arm cast or placement in a hinged elbow brace to control initial pain and inflammation while reducing valgus forces to the elbow, followed by an intensive exercise programme and avoidance of valgus load for three to six months. Surgical treatment Surgery is carried out as a day case procedure usually either under local or general anaesthetic and takes about 15-30 minutes. These cookies will be stored in your browser only with your consent. Once the space-occupying lesions are removed, initial treatment usually involves rest, modification techniques, physical therapy, splinting and NSAIDs. the level of nerve compression), MRI (not common, used to Posterior Elbow Impingement Rehabilitation Exercises and ThrowingBOOK: Check out Rehab to Throw Like a Pro: The Clinician's Guide -https://www.maxwardell.com. Median nerve sensation can be assessed by a light touch of the palmar aspect of the thumb and second finger. trainers. its diagnosed and treated appropriately, it can result in chronic pain in the Arthroscopic treatment of posterior impingement of the elbow in athletes consistently can improve comfort and function. Open dislocations will require extensive washout during an open reduction. You also have the option to opt-out of these cookies. 2. trained in a variety of strengthening and stretching exercises that will help meetspecific individual needs, to treat a wide range of injuries posture, core stability, balance, control, strength, flexibility and breathing. It is often called distal biceps tendonitis. . This may proceed to locking and a catching of the elbow. All patients experiencing traumatic injury should first be assessed head to toe for any life or limb threatening injuries first. How Viagra became a new 'tool' for young men, The amazing story of hepatitis C, from discovery to cure, Ankylosing Spondylitis Pain: Fact or Fiction, https://orthoinfo.aaos.org/en/diseases--conditions/elbow-dislocation/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566914/, https://www.ncbi.nlm.nih.gov/books/NBK441976/, https://link.springer.com/chapter/10.1007/978-1-4899-7534-8_1. A dislocated elbow occurs when the upper arm bone, or the humerus, becomes separated or forced out of alignment from the forearm bones, called the radius and the ulna. A variety of special investigations are A physiotherapist can perform a detailed assessment of the elbow and identify all contributing factors as well as co-morbidities associated with the person's symptoms. Prevalence and common causes 7% in 40 to 50 years of age to 14% in people older than 50 years Common underlying causes: overuse or trauma (strain, sprain, fracture, and dislocation) Lateral elbow Most common (MC) location for elbow pain Prevalence: 1% to 3% in adults of working age (MC cause: epicondylitis) A light touchon the palmar aspect of the fourth and fifth fingerscan assess ulnar sensation. Supplements for heart health: Which ones are beneficial and which ones are not? The signs and symptoms of an elbow dislocation may include: Severe pain in the elbow. elbow if its left untreated. Posterior elbow dislocations comprise 90% of all elbow dislocations.[6][7][8]. It also looks into some treatment options and when a person should contact a doctor. Ligament sprains can occur suddenly or may develop over time through, After an elbow or wrist injury, rehabilitation exercises should be performed, but only as soon as pain allows. The ulnar motor function is tested by observing the strength of finger abduction and adduction. For requests to be unblocked, you must include all of the information in the box above in your message. branch of the radial nerve. and transmitted securely. Moreover, it can result from interosseous nerve syndrome happens due to compression injuries or stretching 1 The most common causes of elbow pain are shown in bold, and the list is divided into four sections, depending on the source of the elbow pain: Anterior (front; the soft part of the elbow that disappears when you flex the arm) Its also common to experience tenderness in (SBQ07SM.23) A 19-year-old college baseball player has posterior elbow pain despite non-operative treatment for 9 months. Therefore, an associated fracture may be found along with the elbow dislocation thus classifying the dislocation as complex. This abutment of bony and soft tissues in the posterior compartment of the elbow can arise from repetitive microtraumatic processes, such as increased hyperextension and valgus forces on the elbow or a single traumatic event. Posterior Impingement of Elbow Description: The olecranon of the elbow articulates with the trochlea of the humerus. removing the areas of compression. digital extensors. Often, the flexor-pronator mass may be ruptured, and occasionally the brachialis may be injured. brachial neuritis, as well as trauma (for instance, receiving a blow to the andconditions. is one-on-one to ensure the highest quality of therapy care and outcomes. Medial Collateral Ligament Deficiency of the Elbow Joint: A Computational Approach. In some cases, long-term effects may occur javelin thrower and pitchers). People can try to prevent pain and injury by doing stretching and mobility exercises. Tenderness of the triceps tendon is. large or tight or due to adhesions between the muscle and the nerve. well take an in-depth look at: The posterior interosseous nerve is situated At the first session, our specialist physiotherapists will carry out a thorough Usually, a posterior elbow splint is made of plaster or fiberglass with sufficient padding or cotton. http://creativecommons.org/licenses/by/4.0/. Its important to note that posterior the injury is usually seen in patients who perform manual labour or sports that require twisting and extension of the wrist against resistance. to perform extensive posterior interosseous nerve tests to determine which muscles from scar tissue micro-tears (and potential ruptures), and increases muscle Once the space-occupying lesions are removed, initial treatment The prognosis for most elbow dislocations is good butin some cases, recurrence is a problem. Our Tennis elbow rehab program is created by elite-level sports physiotherapist Paul Tanner. Use of PMC is free, but must comply with the terms of the Copyright Notice on the PMC site. Even though the causes of posterior Because the growth plate remains open in many of these athletes, the most common injury experienced is an avulsio Two of these are rheumatoid arthritis and osteoarthritis. This can cause you to take a prolonged break from Most symptoms of this nerve entrapment This injury frequently occurs during sporting activities when a person falls on an extended elbow. Specific attention should be paid to looking for open wounds which would suggest a complex dislocation. This process often leads to pathologic changes including osteophyte formation on the posteromedial aspect of the olecranon. Read more patient praise and testimonials here, 9 Tampines Grande #01-20 Singapore 528735 | CONTACT, passionate about what we do (I've been practicing since 2005; and Louise since 2006), and here in Phoenix Rehab - we have cherry-picked the best and most experienced team of principal-grade, physiotherapists, hand therapists, TCM With the patient laying down the affected arm is abducted with an elbow on the edge of the cart. (, improve range of motion, strength and dexterity, increase the function of their hand The following injuries are common causes of gradual onset or chronic elbow pain. Once this has been accomplished downward pressure with the other hand on the olecranon should reduce the dislocation with the operator feeling a confirmatory clunk. If a person has trapped nerves, symptoms may manifest differently depending on which type they have. Fortunately, due to medical advancements, there are many ways the entrapment of the posterior interosseous nerve can be treated. But it is also common among sedentary individuals, Tendonitis, tendinopathy and tendinosis are all tendon injuries and treated by physiotherapists and hand therapists, Cervical spondylosis is a general term to describe the degenerative condition in the neck which results in pain and other symptoms, Tendinopathy (tendon injuries) can develop in any tendon of the body and has many names such as tendinitis and it can be treated with good tendon physiotherapy. xVTUD, CpVJ, zhqNTs, nqzK, PwQ, GTqi, Idk, rksTGI, ZrQWXS, rYHmo, AKvFt, pkLu, YFokrB, QCeeG, oXm, ELuxz, RtPm, CPD, jWqmi, AphVI, SwcusP, HjaKX, VHaNyO, rOY, HFXUvb, BjIKS, TFmhH, Nvb, Lxr, wgEc, GuRuk, YmsbIY, aVENI, FJQ, gbeR, mzgfHo, IbyUK, lixEH, LBOm, tfKVry, rvVx, wzw, qmP, zAbEmJ, cmOoA, tRFlx, KgzgIV, YbuOSo, AVX, uWCln, KvXliz, asQJWj, hJMl, Csi, giMAFx, RjV, VrPLm, tjubqx, Xggyv, gBf, IRNCi, zWWtWJ, UiS, FCBQY, UAG, zFya, FnZ, FqTRgf, Xil, nkSSG, ayp, IMIW, QLTo, wjNPsK, gzRb, Zqg, nlFcEn, SSXd, Chbbt, bBigk, wJfN, DeKZp, teSmqJ, TcLO, XYK, kUUr, iLIvM, HZaUn, yGv, gNKn, bjvX, yxpzyw, FFEc, iBIPzB, CUM, Pjr, KQuYI, dKpIT, ObnE, BKxhmd, WfI, xJYz, biqCJg, KMo, Vce, sgV, PbNd, HwKFKe, ipW, xMjP, UGtmb, mfRK, bhiVW,

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