Shoulder

Shoulder Impingement vs. Rotator Cuff Injury: What’s the Difference?

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Shoulder Impingement vs. Rotator Cuff Injury: What’s the Difference?

Whenever patients suffering from shoulder injuries talk about issues related to rotator cuff or impingement, most of the athletes and other sportsmen relates to the pain, quickly. The reason? It is very prevalent in their community as well as to the general public. However, they are almost similar to shoulder impingement, another usual occurrence, and this leads to confusion between the two. It is generally one of the mentioned reasons for a shoulder injury, or sometimes- it is the combination of the two. But when one is left untreated, it affects the overall movements and postures, causing the other to occur, eventually increasing the pain.

Know How: Rotator Cuff

Before diving into the symptoms and treatments, you should know the basic anatomy of the rotator cuff. This will give you a holistic idea and clarify your self-doubts about your shoulder pain or any of your family members and friends.

Let us take a deep insight into the rotator cuff mechanism now. You should know that it comprises of the muscles and tissues/tendons that guards the shoulder joint, and position the head of your major arm bone, inside the aperture of your shoulder blade.

It’s a no brainer how vital the rotator cuff is in the overall shoulder architecture. It comes with the tissues and muscles that binds the shoulder joint, and position the upper bone of your arm, right in the required position of your shoulder blade. It has four muscles that facilitate its overall function-

  • Infraspinatus muscle – particularly involved in shoulder extension and rotation
  • Subscapularis muscle – helps in the internal rotation of arms
  • Supraspinatus muscle – positions the humerus at the correct angle and helps you to lift your arm
  • Teres minor – helps in shoulder rotation

All about Rotator Cuff Wound

A patient’s overall lifestyle deteriorate by rotator cuff wound because of the limited movement conditions. A rotator cuff injury poses to be alarming when the relative tissues in the shoulder no longer offers their flexibility to carry out regular movements. The most common reasons for this injury are generally due to-

  • Aging of tissue, leading to wear and tear
  • An injury due to a collision or a fall- common in sports like football or hockey
  • Recurring activities that involve the rotator cuff, like baseball, swimming, and tennis

If conservative remedies like rest, medication, and physical therapy do not improve symptoms, shoulder surgery may be recommended by the respective patient care. In either scenario, you should seek an experienced orthopaedic surgeon a.k.a rotator cuff injury specialist from a reliable platform like ours at shoulderandkneeclinic.com.

Diagnosis involved in a rotator cuff injury– To properly diagnose a torn rotator cuff, we generally perform-

  • A physical test of your shoulder- This will allow our experienced orthopedic surgeon to understand the exact status/level of the injury.
  • MRI Scan- this report showcases the form of rotator cuff injury
  • An X-ray- this ensures that no other similar formats of injury make things more confusing.  This has reference to issues like bone spurs or arthritis.
  • Ultrasound- the perfect way to identify any sign of tears in the tissues.

Classifications of Rotator Cuff Injuries-

In case of incomplete rip up, the orthopaedics has defined them as a case where only a certain segment of the tissues has been affected. While, there happens to be conditions where the patient is suffering from shoulder pain cause by the complete thickness tear-which defines that the total relative tissue has been separated from the bone. 

Symptoms of a Rotator Cuff Tear- Symptoms of a rotator cuff injury generally include pain and weakness as mentioned earlier, but it may be coupled with restricted access to movements of your hands behind your back. Given below is a detailed explanation, that might help you gauge/identify-

  • Sensation of Pain in the Shoulder Area- In most cases, the pain gradually increases with vehement movements of the arm or extending behind the back or towards the overhead during showering, combing, or dressing.
  • Uneasiness or pain while sleeping on the affected shoulder- The intensity of pain may be less during the day, but it may drastically rise in the night making you wake up from your sleep.
  • Shoulder weakness- You may experience uneasiness or lack of potential while trying to lift objects lying in front of you, like grabbing a litre of milk from your refrigerator, etc.

There are some significant treatments (other than surgery) that help in reducing the pain or inflammation-

  • Cortisone Injection can minimize the pain and inflammation, but it’s not a solution for long-term
  • Plasma injection rich with platelets- infused with the patient’s blood itself, helps in speedy recovery
  • Injection into the bone marrow eases the movements of the shoulder tissues
  • NSAIDs like Aleve and Advil help in minimizing the inflammation, but will not heal the tear
  • An arm sling may be recommended by our doctors to immobilize the shoulder and position the arm in a comfortable position to heal.

In the end, whether any of the above will be appropriate for your cause or to go for surgery should be decided by an experienced orthopedic surgeon.

Now that you have a holistic idea about rotator cuff injury, let’s have a look at shoulder impingement syndrome to help you differentiate between the two.

All about Shoulder Impingement

This type of shoulder pain happens when the top exterior portion of your scapula (i.e. shoulder blade) pressurizes your rotator cuff under it. HCPs often entitle it as shoulder impingement syndrome. There are several types of impingement syndrome and all of them are mentioned as follows-

  • Rotator cuff tendinitis- As goes by its name, it is the condition where there is swelling of your tendon affecting your rotator cuffs.
  • Acromion deformity- The acromion is generally flat. If in any case, it is re-positioned in a bad manner, it can bother your rotator cuff, leading to the syndrome.
  • Shoulder bursitis- It is the condition where the bursa (a fluidic sack that cushions the space between rotator cuff tendons and acromion) has suffered inflammation, thus causing shoulder impingement.

Causes and Symptoms of Shoulder Impingement- It generally feels like originates from the front of your shoulder. The uneasiness and pain can spread from the front to the side of your arm. It may gradually increase at night and affect your sleep. Subsequently, it becomes worse when you try to extend your arm to reach for something.

Rotator cuff tendinitis symptoms include stiffness, skin discoloration, and swelling of the skin around your shoulder. Moreover, the patient might often hear an odd sound when they try to move their shoulder.

Most case studies of this kind of shoulder pain reveal that patients started to suffer because of intensive usage of the joint in a perpetual pattern over a prolonged period. This indicates that over time when a recurring motion puts too much pressure on the joint, it leads to this syndrome. Some people suffer through shoulder impingement without any obvious cause (impromptu). It is also possible for cases like trauma or extensive sports sessions.

Diagnosis involved with shoulder impingement symptoms- Our experienced orthopedic doctor at Shoulder and Knee Clinic will suggest some physical tests to get an understanding of the overall situation of your shoulder and eliminate any other reasons (rotator cuff tears, shoulder arthritis, and biceps tendon injuries) that might cause the pain. These include-

  • X-rays
  • Ultrasound and
  • MRI

Treatments towards easing the pain and inflammation due to shoulder impingements are many-

  • Complete rest- Taking a break from regular activity, especially recreational activities and sports
  • Physical therapy- An experienced physical therapist (yoga instructor) will give you customized exercises and stretches to heal your shoulder and improve its potential for motion.
  • Icing- Applying a cold pack can relieve you from the pain but you have to be careful from frost bites (avoid direct application on the skin).
  • Pain killers- NSAIDs gathered from over-the-counter can minimize inflammation and pain. However one should consult a shoulder impingement specialist if the situation persists beyond 10 days.
  • Lastly, it’s the injection of corticosteroids that might reduce the swelling.

If none of the above doesn’t suit your condition, your respective doctor will ask you to go through shoulder impingement surgery which is the ultimate solution and can relieve you of pain permanently. High chance that your surgeon will perform an arthroscopic shoulder decompression. This includes eliminating a portion of your acromion to allow more space for your rotator cuff.

Most patients tend to feel good after a few weeks of a proper shoulder impingement treatment. In the case of surgery, it takes around 6 to 8 weeks for a complete recovery. But in the end, it’s all about how severe your injury has been. If it’s in the jurisdiction of the hospital premises, then its fine, otherwise, you shouldn’t resume your daily activities or any kind of recreational activities/sports till you feel comfortable and advised by your doctor.

When you should see a healthcare provider?

You should book an appointment with your healthcare provider if you experience any sign of new pain, swelling, or stiffness in your shoulder- especially if the condition is getting worse making it harder to move your shoulder and eventually feeling completely numb.

Book an appointment with our most experienced (over 15 years) orthopedic surgeon in Mumbai, to know more about your shoulder pain and the best possible treatment that you can get that best suit your condition.

How Shoulder Replacement Can Improve Your Quality of Life

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Shoulder Replacement Surgery - Shoulder and Knee Clinic

Shoulder happens to be a vital part of our body, especially the mechanism with which it facilitates our hands on a day-to-day basis. And thus, shoulder pain can seriously disrupt our daily life, affecting almost everything like- basic grocery shopping to having fun at recreational activities. So, if you are one of those individuals who is suffering from severe shoulder pain due to fractures, arthritis, or rotator cuff injuries, a shoulder replacement surgery can significantly provide instant relief and a direction towards a healthy lifestyle. With access to advanced treatments in metro cities, for e.g., PSI in shoulder replacement surgery Mumbai, you can take the leap of faith as they offer more customized and effective treatment, rather than the old traditional surgery methodologies.

Let us now delve into the knowhow of a new age shoulder replacement surgery and how it can give patients like you, a new hope for a better tomorrow.

Shoulder Replacement Surgery: Know-How

First, you should know how a shoulder replacement surgery works and what it entails. It basically involves substitution of the shoulder joint with artificial implants. It is a ball and socket joint, and replacement surgeries prioritize on crafting these structures to reinstate mobility and relieve pain. The surgical methodology is generally recommended for-

  • Bad Fractures: Comminuted breaks in the shoulder bones that cannot be healed with home remedies (or other treatments).
  • Chronic rotator cuff tears: where the muscle around the joint are severely damaged, making it nearly impossible to lift your arm because of pain / weakness.
  • Severe Arthritis: Specifically, Osteoarthritis (the wear and tear that happens with age), where the cushions between the bones of your shoulder joint wears away, causing stiffness and pain.
  • Patients suffering from Rheumatoid Arthritis suffers from an autoimmune condition where their respective immune system attacks the joints, causing inflammation and ache.
  • Avascular necrosis: where the patient is suffering since his or her bone tissue continues to expire with time, due to reduced blood flow.
  • Previous Failed Surgery Attempt:

Types of Shoulder Replacement Surgeries:

There are different forms of shoulder replacement surgeries. Any experienced shoulder replacement surgeon in Mumbai would suggest the one that best suits your condition. Let us go through them so that you have a comprehensive understanding beforehand-

  • Total Shoulder Replacement – In this case, both the socket (glenoid) and the ball (top of the upper arm bone) are changed. This surgical procedure is mostly recommended for patients suffering from chronic arthritis or extensive impairment to both portions of the shoulder joint.
  • Partial Shoulder Replacement – Also known as hemiarthroplasty, is a procedure where only the ball end of the shoulder joint is substituted. This will be the apt surgery for patients who have damaged ball portion but a rather healthy socket like in some fractures.
  • Reverse Shoulder Replacement – In the case of reverse shoulder replacement, the positions of the ball and socket joint are interchanged. The socket is affixed to the shoulder blade, while the ball is positioned on the upper arm bone.

If you visit to a renowned hospital in a metro city like Mumbai, the best shoulder replacement doctors will ensure that you get the most suited surgery according to your shoulder condition. You can also find one at one from our platform at shoulderandkneeclinic.com.

Steps Involved in the Complete Surgical Procedure

Since a complete and successful shoulder replacement surgery improves your overall wellbeing, let go through the step-by-step methodology-

  • Pre-surgery consultation: Prior taking you to the operation theatre, the doctors will take X-rays and conduct other tests like MRI scans and CT scans to evaluate bone structure, joint mobility and critical tissues. This will give them the data to identify the overall damage happened to your shoulder. High chances that they will also have a conversation with you about your medical history and any medications that you are already following.
  • Anesthesia: Like any other pre-surgery routine, you will be undergoing through anesthesia. This will help you to sleep, ensuring that you won’t be feeling any pain during the actual surgery commences.
  • Proceeding with Incision: The shoulder replacement surgeon will proceed with the cut from the front or back end of your shoulder to access the affected joint.
  • Eliminating Damaged Portions: The worn-out portions of the joint will be removed by the surgeon. This completely depends on the type of shoulder replacement operation.
  • Positioning Artificial Parts: The removed parts are substituted with artificial components made of high-end plastic/ ceramic and metal that substitute natural bones and ligaments. These new portions blend together to form a seamless and functioning joint.
  • Closing the Incision: In the end, the shoulder replacement surgeon will stitch back the incision or use staples and cover it with bandages, till the area heals by itself.

A Pathway towards Recovery, post-Surgery

Whether you have gone through a shoulder replacement surgery in Mumbai, or any other part of the world, the post-recovery process takes time for any patient who have undergone through it. Here’s what you can expect-

  • Hospital Period: Most of the patients who undergoes through this surgery stays admitted in the hospital for a day or two, where the respective doctor monitors the patient condition on a periodic basis. You might get the same treatment schedule.
  • Physical Therapy: This is the second stage and this step is a very crucial one as a first step towards holistic recovery. The involvement of a physical therapist is a much needed one in this stage, where the expert will teach you resistance training towards a better shoulder movement by the day.
  • Coping with Pain: shoulder replacement per se is not very painful procedure. There may be some amount of pain in the first day of the surgery, but typically from the second day, people are very comfortable.
  • Periodic visits and follow-ups: Periodic check-ups with your shoulder replacement surgeon are necessary to monitor the condition of your shoulder. At Shoulder and knee clinic, you will be reminded about your follow-up doctor’s appointment till you recover to the fully. This eliminates unnecessary gaps in your treatment and thereby complications.

Benefits of Shoulder Replacement Surgery:

Now comes the better half of the process. To be very brief, after your shoulder replacement surgery and your rehab phase, you will definitely feel a deep sense of positive energy and overall improved quality of your life. Given below are some of the top benefits that every patient gets after their successful shoulder replacement surgery-

  • Relief from pain – Of course, this is the most obvious part towards going through with the surgery. Most of the patients who undergoes through a successful surgery experiences an exponential decline in feeling uneasiness or pain, allowing their prompt return to a normal daily schedule with regular tasks on their calendar. As mentioned earlier, the artificial parts that generally replaces the original structures are crafted to mimic the natural motion of the shoulder joint, minimizing the discomfort caused by the worn-out tissues.
  • Enhanced Range of Motion – Suppose a patient have gone through the complete cycle of shoulder replacement surgery in Mumbai or in any other metro city. Post that they will experience a substantial development in the range of motion. For patient who have been suffering from arthritis or fracture, the surgery can restore the joint’s operations back to normal. Boosted mobility enables patients to perform everyday chores and can involve themselves in recreational activities.
  • Experience a better quality of life – With reinstated mobility and seamless shoulder function, patients often lead a healthy and enhanced quality of life. Activities that was barred from their life (like- grocery shopping, lifting books and household appliances) once, became a piece of cake for them. This not only helps them physically but mental too, where they felt seen and included in their community.
  • Long-term durability – New age shoulder replacement surgeries have levelled up the game and lasts for a long time. Advances in medical technology has brought Patient-Specific Instrumentation (PSI) where the surgical tools and components will rightly suit your personalized surgery catering to the exact anatomical measurements of your joints. This custom shoulder replacement methodology has proven its benefits over the years which sums up to-
  • Surgeons felt more comfortable executing the surgery with highest precision, leading to more success rates.
  • The above condition, leading to reduced surgery time.
  • Patients have reported faster recovery phase as compared to their traditional surgery counterparts. With proper physical therapy and rehab practices, patients can completely heal within a few months.

By now you might have got a gist how a successful shoulder replacement surgery reaps many benefits along with enhancing the quality of life. And if you are among those who are suffering from shoulder joint pains, this procedure might help you get back to your old lifestyle in no time.

You can also opt for the best shoulder replacement doctor in Mumbai from shoulderandkneeclinic.com to consult- whether you actually need to consider surgery or not. And even if you do, what kind of surgery should you need or is it only PSI procedure that will only suit you. Clarify these doubts at the earliest to get the best results.

Frozen Shoulder: What is it and How Can It Be Treated?

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Frozen Shoulder - Shoulder and Knee Clinic

Know-how: Frozen Shoulder

People also call this disease as adhesive capsulitis, which is usually the feeling of uneasiness and pain in the shoulder joint. This makes the shoulder joint painful. Proper physical therapy from a reliable physician should ease the issues within 3 years.

It has a complex anatomy which comprises of a ball and socket joint, including parts-

  • Humerus (Upper arm bone)
  • Clavicle (Collarbone)
  • Scapula (Shoulder blade)

Generally, people (especially women) who are prone to frozen shoulder are in the 40 – 60 age bracket. There can be multiple reasons behind the cause, but if it persists for a prolonged period, a medical consultation (from shoulder specialist) at the earliest is recommended.

Symptoms

Pain occurring from a frozen shoulder generally identifies itself as-

  • Generally aching or dullness
  • Gradually worsens in its initial days, especially when you try to move your shoulder
  • Normally affects the outer shoulder area and occasionally in the upper arm

So generally, it has three stages (in chronological order)-

  • Freezing – Where significant limitation to your shoulder movement happens with excruciating pain. Typically lasts from 7 weeks to 9 months.
  • Frozen – Pain increases and lasts up to 6 months. You will be barred from daily activities.
  • Thawing – Condition improves with time. Anywhere between 6 months – 2 years.

Causes

The sad news is- there is no clear statement as to the cause of a frozen shoulder. But you can prevent it by mitigating the trigger factors like-

  • Diabetes: Diabetic patients tend to catch frozen shoulder disease more than normal people. The suffering tenure is much more before it hits the “thawing” stage.
  • Some other groups are at risk such as those suffering from hyperthyroidism, cardiac diseases, etc
  • Sometimes after an injury, people tend to keep the shoulders immobile leading to a frozen shoulder. So, it is recommended to those patients- to work those shoulders as much as possible.

Home Care

You can tackle your frozen shoulder at home by-

  • Implementation of cold compresses or warm ones alternatively. For heat application try to utilize a damp towel from a microwave or a heating pad. Apply at most 20 mins, three times a day.

Try to avoid direct ice in terms of cold treatment. The frequency remains the same as the hot one.

  • Stretching helps a lot! Seek a professional physician who can guide you to do certain kinds of stretching at home. Sometimes this includes a rubber stretching band too and will discuss this in the later section of this blog.

Various forms of Shoulder Treatments

Earlier, some non-surgical shoulder treatments have already been discussed in the home care section. Apart from that there are a few injections-

  • Steroid: Some medics prescribe cortisone (anti-inflammatory medicine)
  • Hydrodilatation- where a sterile fluid is injected into the shoulder joint to stretch the shoulder joint capsule. 

In terms of surgical treatments, you should first consider consulting with an experienced arthroscopic surgeon from reliable platforms like- shoulderandkneeclinic.com. And it normally commences during the second stage i.e. “frozen”. Anesthetic measures are taken where the goal of the shoulder surgeon is to ease the stiffened joint capsule.

Stretches that are specific to frozen shoulder

  • One way to mitigate the pain is to stretch by leaning forward while keeping your arms at your respective sides. As you lean, you can keep one arm at a table for support and move the other in a circle around five times in one direction and five times in the other rotation.
  • With your hurt arm, try to lift the weight of your good hand, up to your chest level and hold it for around 10 seconds. Repeat at least 10 times a day.
  • You can go for a towel stretch and inward or outward rotations, but you should consult an experienced physician before going for these shoulder treatments.

Shoulder Pain – Symptoms, Causes, Home Care, and Treatment

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Shoulder Pain - Shoulder and Knee Clinic

Know-how: Shoulder Pain

It is a condition where your shoulder hurt when you try to move them. There might be several reasons behind your shoulder problems as they are made up of a complex ball and socket joint structure. Sometimes it is caused due to a condition called arthritis or can even generate from other portions of your body.

Complex Mechanics:

Your shoulder comprises of

(a) Humerus – upper arm bone

(b) Scapula (shoulder blade)

(c) Clavicle (collarbone)

So, it calls for a professional diagnostic and treatment, if home care fails in the long run.

Shoulder Injury Symptoms

To identify shoulder injury symptoms, run yourself through some queries like-

  • Are you able to do normal stuff (lifting/moving standard weights) with that shoulder?
  • Does that shoulder joint feel loosely placed?

Most shoulder injuries can be treated at home with crepe bandages and cold treatment (ice) for a few days. But some of them need professional interference. You should seek shoulder treatment from a shoulder specialist if-

  • You can’t move your shoulder at all.
  • The joint looks deformed.
  • The pain persists (2 -4 weeks) and increases by the day.
  • The pain couples with swelling, fever, or redness/discoloration.

Types of shoulder problems

The different types of shoulder problems are-

  • Posterior Instability: It is a condition in which the head of the humerus (upper arm bone) dislocates or subluxes posteriorly from the glenoid (socket portion of the shoulder) as a result of significant trauma.
  • Frozen Shoulder/Stiff Shoulder: It is a common condition in which the articular shoulder capsule (a sack of ligaments surrounding the joint) swells and stiffens, restricting its mobility. It typically affects only one shoulder, but one in five cases affect both.
  • SLAP (Superior Labrum Anterior To Posterior) Tears: It is a tear in the top part of the glenoid labrum in the shoulder that extends from the front to the back of the labrum.
  • Bicep Tendon Disorders: It is a condition that occurs when you have inflammation in your upper biceps tendon.
  • Fractures Around The Shoulder: It involves at least one of three bones in the shoulder: the scapula (shoulder blade), clavicle (collarbone), or humerus (upper arm bone).
  • Recurrent Dislocation Of The Shoulder: a condition where the shoulder dislocates multiple times, even after a previous dislocation or surgical repair.
  • Massive Rotator Cuff Tears And Superior Capsular Reconstruction: a full thickness tear of at least two of the four rotator cuff tendons, a full thickness tear greater than 5 centimetres in diameter, or both.
  • Acromioclavicular Joint Injuries/ Shoulder Separation: a damage to the ligaments that connect the collarbone to the shoulder blade.
  • Rotator Cuff Tears And Rotator Cuff Repair: a tear in the muscles and tendons of the shoulder that can cause pain, weakness, and limited range of motion:

Sometimes your shoulder may be a victim of referred pain- caused due to another issue in your body such as lungs or neck.

Home Care

For your shoulder treatment at your place of stay, you can-

  • Apply ice treatment on the shoulder area for around 10 mins and keep it off for the same timing. Continue doing this for around 4 days with a frequency of 3 times per day. Remember-never apply direct ice on your skin.
  • Try to return to regular activities, post treatment.
  • Medication to be taken in consultation with a doctor/physician.

In case of rotator cuff issues, your shoulder treatment at home should include proper stretching (yoga) with the help of an expert physician.

When to Seek a Professional Help?

Unexpected left shoulder pain might also be a cause of mild heart related issues. You must call an ambulance to your nearest hospital if the pain originates from your chest to the left jaw, neck, or arm followed by shortness of breath, sweating, or dizziness.

You must report to a hospital’s emergency ward if your shoulder shows signs of swelling, bleeding, or redness of the skin around the shoulder area even after self-treatment.

Shoulder Pain Treatments

The treatments depend on your type of shoulder injury-

  • For a dislocated shoulder, a closed reduction or manipulation is necessary by a doctor to put it in the socket properly.
  • For a separated shoulder- a sling treatment works best.
  • For shoulder fractures, a sling will help with surgery if needed.
  • In the case of rotator cuff tears- can be cured with a sling but sometimes doctors recommend NSAIDs and physical therapy.

So, your takeaway is that- in case of mild shoulder problems you can treat is at home but for prolonged issues you should consult a doctor from a reliable one in a metro city. A quick tip would be- you can try out shoulderandkneeclinic.com to get the most experienced Arthroscopic surgeons in Mumbai.

About Dr Aditya Sai

Dr. Aditya Sai is a consultant in Orthopaedics specializing in Shoulder Surgery, Knee and Hip arthroscopy & Joint preservation Dr. Aditya has been trained in the best of the institutes in India as well as globally, with his MBBS from the Madras Medical College and MS in Orthopedics from Seth GS Medical College & KEM hospital, both amongst the top institutes in the country.

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Contact Us

Dr. Aditya Sai – Sports Injury & Arthroscopy Specialist In Mumbai – Shoulder & Knee Clinic

Dr. LH Hiranandani Hospital, Hillside Rd, Hiranandani Gardens, Mumbai, Maharashtra 400076

Phone: 096534 15034

E-mail: consult.ortho@gmail.com.

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