The pectoralis major is retracted laterally, the conjoint tendon is retracted medially, and the previously cut biceps tendon is delivered into the wound. WebYou might need biceps tenodesis if: You have shoulder pain that hasnt been helped by rest, physical therapy or pain medication. The Yergason test requires the patient to place the arm at his or her side with the elbow flexed at 90 degrees, and supinate against resistance18 (Figure 2). A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The long head of the biceps (LHB) tendon may be affected by numerous pathologic processes that result in anterior shoulder pain, including tendinosis, partial The site is secure. 2019 Oct;11(5):857-863. doi: 10.1111/os.12536. Outcomes are often difficult to measure due to multitendon involvement and concomitant procedures. No superficial infections led to deep infections or other significant morbidity. Papp DF, Skelley NW, Sutter EG, Ji JH, Wierks CH, Belkoff SM, et al. Fang JH, Dai XS, Yu XN, Luo JY, Liu XN, Zhang MF, Zhu SN. In some instances, your surgeon relocates your biceps tendon to your upper arm bone (humerus). You might have some pain and discomfort after the surgery. WebPatients with biceps tendinitis or tendinosis usually complain of a deep, throbbing ache in the anterior shoulder. Epub 2019 Sep 18. You cant rotate your arm so that your palm is up. For patients with biceps tendinosis without a rotator cuff tear, LHB tenodesis at the groove is a possible solution. Management of Failed Proximal Biceps Surgery: Clinical Outcomes After Revision to Subpectoral Biceps Tenodesis. During the arthroscopic examination, the SGHL-CHL complex is the primary structure in evaluating biceps instability. Clinical and sonographic evaluation of subpectoral biceps tenodesis with a dual suture anchor technique demonstrates improved outcomes and a low failure rate at a minimum 2-year follow-up. Luckily, it had scared down right next to the previous attachment sight and he was able to put it back in the same hole and just tack in a new screw. Patient-reported outcomes including the functional score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons were obtained, and range of motion, strength, and complications were quantified. Biceps tenodesis is a procedure used to repair the bicep muscle after a full or partial tear from the shoulder. The tenodesis of the long head of the biceps tendon has been completed, thus preserving the length-tension relation of the tendon. (https://pubmed.ncbi.nlm.nih.gov/30723678/), Visitation, mask requirements and COVID-19 information. Biceps tenodesis is done by detaching your biceps tendon from your labrum and moving the tendon to your upper arm bone (humerus). A temperature that is higher than 101 F (38.3 C). The advantage of this approach is that the entire bad-quality tendon can be removed, Dr. Arce said. International Journal of Shoulder Surgery. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. A biceps tenodesis is more complicated than a tenotomy procedure, which uses needles to break up scar tissue. The anterior shoulder may be bruised, with a bulge visible above the elbow as the muscle retracts distally from the rupture point. eCollection 2022 May. It typically takes at least 4 to 6 weeks to recover from biceps tenodesis surgery. As a result, you might need to take off work or ask for help with everyday activities including driving. Epub 2017 Oct 18. official website and that any information you provide is encrypted We reported no deep infections, hematomas, peripheral nerve injuries, fractures, or ruptures utilizing this technique. Inject approximately 5 mL of lidocaine plus sodium bicarbonate around the biceps tendon sheath in a fan-like distribution after aspirating and checking to avoid blood vessels. Mazzocca AD, Rios CG, Romeo AA, Arciero RA. Outcomes may be difficult to measure because of multitendon involvement and concomitant procedures. This tendon is located at the top of your bicep muscle. Procedures on the biceps tendon were performed in cases of partial tears, subluxations, and complete dislocations. Full recovery typically takes four to six months. government site. All surgical cases from one surgeon (RZT) were reviewed from 12/2009 to 12/2012. Why Doesn't the U.S. Have at-Home Tests for the Flu? Receive small business resources and advice about entrepreneurial info, home based business, business franchises and startup opportunities for entrepreneurs. and transmitted securely. Careers. 5. The purpose of this paper is to review the management of long head biceps tendon pathology, with a particular emphasis on a prior failed biceps tenotomy or tenodesis. AAOS 2023 Advance Registration ends Jan. 27. Popeye sign: Tenodesis vs. self-locking "T" tenotomy of the long head of the biceps. There are bruises or swelling from your upper arm to your elbow. A patient may also report pain relief if there is instability or subluxation of the biceps tendon. Search for Similar Articles [5] One potential reason for the absence of clinically evident early failures in our series compared to previously reported series using interference screws may be the lack of a sharp transition in stress at the site of fixation with the suture anchor construct compared with the tenodesis screw. Koh et al. When necessary, biceps tenodesis was performed with one of the anterior suture anchors above the rotator cuff. You can drive if you arent taking medication that affects your ability to drive and once your shoulder doesnt hurt when you control the wheel. 1995-2022 by the American Academy of Orthopaedic Surgeons. The long head of the biceps Mazzocca AD, Bicos J, Santangelo S, Romeo AA, Arciero RA. While both procedures treat the symptoms your torn biceps causes, people who have biceps tenotomy are more likely to develop unusually large bulges in their biceps. Mazzocca AD, Cote MP, Arciero CL, Romeo AA, Arciero RA. Open subpectoral biceps tenodesis has been associated with a low frequency of more significant complications, such as neurovascular injury, deep wound infection, as well as hardware failure, and minimizes the chance of postoperative groove pain. Keywords Biceps tenodesis Complications Patient outcomes Infection Hardware failure You may find sleeping in a reclined position more comfortable than lying flat on your back. Savin DD, Waterman BR, Sumner S, Richardson C, Newgren J, Gowd AK, Romeo AA. Biceps tendon tears may happen quickly from a traumatic injury or develop over time from repetitive motions of the shoulder. a sudden, sharp pain in the upper arm, sometimes accompanied by a popping or snapping sound What are the risk factors? Read our editorial policy. You may search for similar articles that contain these same keywords or you may An alternative technique is to combine the lidocaine with sodium bicarbonate and corticosteroid solution in the same syringe to avoid changing syringes. The procedure also treats SLAP tears tears in your labrum (cartilage that lines the inner part of your shoulder joint.) Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis. Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini-open Tenodesis? Biomechanical evaluation of subpectoral biceps tenodesis: dual suture anchor versus interference screw fixation. There were 72 male and 31 female shoulders. Would you like email updates of new search results? Advertising on our site helps support our mission. Try not to get frustrated and give in to the temptation to do more because you might end up doing too much too soon. Inflammation of the biceps tendon within the intertubercular (bicipital) groove is called primary biceps tendinitis, which occurs in 5 percent of patients with biceps tendinitis.1 The 95 percent of patients without primary biceps tendinitis usually have an accompanying rotator cuff tear or a tear of the superior labrum anterior to posterior, known as a SLAP lesion. The average age was 44.4 14.3 years, and the surgical indications included failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and patient dissatisfaction after tenotomy (8%). As a result, you might need to take off work or ask for help with everyday activities. Arthroscopic assessment, particularly of the SGHL-CHL complex, is key in diagnosing and treating biceps instability. Lesions at the long head of the bicep tendons often lead to fractures of the humerus bone. Upgrade to Patient Pro Medical Professional? There were 2 temporary nerve palsies (2%) resulting from an interscalene block. 2018 Jan;138(1):63-72. doi: 10.1007/s00402-017-2810-z. A patient with an unstable biceps may experience pain and locking sensations when the arm is moved from abduction and external rotation to adduction and internal Millett PJ, Sanders B, Gobezie R, Braun S, Warner JJ. Failed biceps tenodesis is usually recognized with persistent pain in the area of the bicipital groove, often caused by either the mechanical failure of the tenodesis or associated shoulder pathology that is not addressed at the time of the primary surgery. External rotation of the arm and humeral head places the tender bicipital groove in a posterolateral position. You will receive local or general anesthesia. Biceps tenodesis surgery treats injuries that happen when you tear or damage the tendon that connects your biceps muscle to your shoulder. Luckily its a workplace injury so there's an MRI scheduled for next week (usually takes a year in this part of Canada. Patzer T, Santo G, Olender GD, Wellmann M, Hurschler C, Schofer MD. The injection requires a 21-or 22-gauge 1.5-inch needle, 8 mL of 1% lidocaine (Xylocaine), 1 mL of 8.4% sodium bicarbonate to decrease the sting of the injection, one 10-mL syringe, one 1- or 3-mL syringe, corticosteroid solution (. not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Nevertheless, he continued, we have successful surgical techniques. The average age at time of tenodesis was 45.5 years. Clipboard, Search History, and several other advanced features are temporarily unavailable. You feel cramps in your upper arm, especially when youve been carrying or lifting heavy objects. Betamethasone acetate, betamethasone sodium phosphate (Celestone Soluspan), Arthrography (used with MRI or CT to visualize the joint capsule and glenoid labrum), CT arthrography shows biceps tendon subluxations, ruptures, dislocations, and SLAP lesions, Shows the width and medial wall angle of the bicipital groove, spurs in the groove, and supertubercular bone spur or ridge, Does not show possible intra-articular disorders of the labrum (soft tissue injuries), Excellent evaluation of the superior labral complex and biceps tendon, Partial tears of the biceps tendon are more difficult to detect than complete ruptures, Radiography (anteroposterior views of the shoulder and acromioclavicular joint, lateral axilla, outlet view, and ALVIS view), Rules out shoulder fracture and strains or dislocations of the acromioclavicular joint and arthritis of the glenohumeral and acromioclavicular joint, Shows only bony origins of impingement syndrome and not soft tissue. The purpose of the study is to determine the early complication rate after subpectoral biceps tenodesis utilizing a dual suture anchor technique. are the only authors who have reported the results of subpectoral tenodesis utilizing a suture anchor technique. Patients with unsatisfactory [14] Scheibel et al. have recommended the use of an interference screw instead of suture anchors for subpectoral tenodesis fixation. Your biceps tendon wears out over time and so tears more easily. may email you for journal alerts and information, but is committed Biceps tenodesis surgery is divided into two categories: soft tissue procedures and bone procedures with hardware fixation. Clinical Outcomes of Revision Biceps Tenodesis for Failed Long Head of Biceps Surgery: A Systematic Review. I should also point out that at no point did I have any pain throughout the slight flexion. In this way, small changes in the normal anatomy can be identified and the biceps instability diagnosis can be easily addressed.. A positive test is pain radiating to the bicipital groove. 2 Arthroscopic view of grove dbridement. Treatment of biceps tendon lesions in the setting of rotator cuff tears: Prospective cohort study of tenotomy versus tenodesis. Biceps tendinitis is inflammation of the tendon around the long head of the biceps muscle. Inflam-mation of the biceps tendon in the bicipital groove, which is known as primary biceps tendinitis, occurs in 5 percent of patients with biceps tendinitis. This injury is called a, Avoid food or drink for eight hours before you go to the hospital. You may be trying to access this site from a secured browser on the server. Ice packs, pain medication and wearing a sling should help relieve both. Keywords: HHS Vulnerability Disclosure, Help All infections were treated with oral antibiotics alone or superficial debridement and oral antibiotics. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox. Accessibility Sears BW, Spencer EE, Getz CL. LHB tenodesis at the groove is a possible solution to this problem and is the most common technique for patients who have biceps tendinosis without a rotator cuff tear (Fig. Biceps, complications, subpectoral, tenodesis. (https://pubmed.ncbi.nlm.nih.gov/27599831/). Snyder SJ, Banas MP, Karzel RP. LCHL = lateral coracohumeral ligament; MCHL = medial coracohumeral ligament; SGHL = superior glenohumeral ligament; Subs = supscapularis tendon. biceps , tenodesis , tenotomy , revision , tendinitis , rupture. January 2020. 4 users are following. HHS Vulnerability Disclosure, Help For information on cookies and how you can disable them visit our Privacy and Cookie Policy. so seven months post op, and it sounds like he's going to have to go back in to repair. Preoperative imaging included shoulder radiographs (AP, true AP, scapular Y and axillary views) and a shoulder magnetic resonance imaging (MRI) of every patient undergoing a biceps tenodesis. Conservative management of biceps tendinitis consists of rest, ice, oral analgesics, physical therapy, or corticosteroid injections into the biceps tendon sheath. Confirm the diagnosis by performing the Yergason test. Several techniques have been described for LHB tenodesis including arthroscopic and open techniques in both the suprapectoral and subpectoral regions. PMC about navigating our updated article layout. In this sub-group of patients with longer follow-up, there was only a single complication (superficial wound infection treated with oral antibiotics). Bleeding that soaks through your dressing and doesn't stop when you place pressure over the area. Patients being treated with concomitant rotator cuff repair or capsular release were excluded. The end of the tendon is rolled into a ball, then stitched together. Your surgeons close the tiny cuts in your shoulder. Could this just be caused by wearing the sling for over a week and not allowed to do any passive ROM exercises? Try our Symptom Checker Got any other symptoms? Golish SR, Caldwell PE, Miller MD, Singanamala N, Ranawat AS, Treme G, et al. [11] A glenohumeral arthroscopy was initially performed on all patients at which time the biceps tendon was evaluated as well as the labrum, glenohumeral cartilage, and rotator cuff. The active compression test: A new and effective test for diagnosing labral tears and acromiooclavicular joint abnormality. Suspected accompanying anatomic lesions may be seen with magnetic resonance imaging (MRI).3,5,14,3341 Many surgeons prefer obtaining MRI arthrography or computed tomography arthrography before surgery to visualize the intraarticular tendon and related pathology. For successful treatment of both biceps instability and biceps tendinosis, a complete arthroscopic assessment is a key factor. Epub 2020 Jun 24. The goal of stretching is to regain a balanced range of motion without stiffness or pain in any position. Patients should be counseled on the high complication rate (48%), with persistent pain being the most common complaint. Biceps tenodesis treats biceps tendon tears caused by injury or overuse. Complications associated with subpectoral biceps tenodesis: Low rates of incidence following surgery. For more information, please refer to our Privacy Policy. Stitching is then threaded through the needles and repeated to create a locking pattern. Failure of biceps tenodesis with interference screw fixation. Older patients (i.e., athletes older than 35 years or nonathletes older than 65 years) may have acute biceps tendinitis caused by sudden overuse, or biceps tendinosis caused by use over time.4 Primary impingement syndrome is considered the most common cause of biceps tendinosis or tenosynovitis (i.e., inflammation of the tendon sheath).4 Primary impingement is a mechanical impingement under the coracoacromial arch caused by bone spur formation of the acromion, an unfused acromial apophyses, or thickening of the coracoacromial ligament. Finally, Sears et al. Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients. Please enable it to take advantage of the complete set of features! These include failure or rerupture of the tendon, hematoma, infection, persistent pain, reaction to a fixation device, nerve injury, cosmetic deformity, and fracture. Talk to your healthcare provider about your concerns. Confirm this is the biceps tendon by externally rotating the arm and placing the elbow in 90 degrees of flexion. Maybe a little more time is needed you doing any ROM yet? There were a total of 7 complications (7%) in the entire group. The ramp test may be used to evaluate stability and tissue quality of the biceps tendon, Dr. Arce said. Insert the 10-mL syringe of 1% lidocaine plus sodium bicarbonate with the 21- or 22-gauge 1.5-inch needle subcutaneously parallel to the bicipital groove. Medscape: "Complete Ruptures of the Achilles Tendon. Clipboard, Search History, and several other advanced features are temporarily unavailable. Twenty-two (88%) patients reported high satisfaction and stated they would have this revision surgery again. Having had a bicep tenotomy as part of a more complex shoulder surgery in early October its my understanding that a tenodesis is performed as an alternative to a tenotomy specifically to ensure full strength can be achieved after healing and therapy. 2018 Feb;104(1):23-26. doi: 10.1016/j.otsr.2017.09.016. WebAlthough the primary complication of biceps tenotomy has been considered to be a cosmetic deformity of the arm (Popeye deformity), rates of persistent biceps pain and Am J Sports Med. Accessibility Not sure if irritation is the right word more like I could feel it was there and it felt odd. Epub 2015 Sep 28. You should call your healthcare provider if you have: Biceps tenodesis is the first step toward healing your biceps tendon so you can resume favorite activities like sports. Consequently, it is likely that most traumatic failures would occur within the first 6 months as has been shown in other series. The bulges are sometimes called Popeye syndrome. Hey Dave902 - No passive ROM yet. as being in breach of those terms. Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. All rights reserved. Tenodesis of the long head of the biceps tendon can be performed through arthroscopic and open techniques with various fixation methods and at different locations on the humerus. Biceps tendinitis may also refer to tendinosis, which is a syndrome of overuse and degeneration. Coming to a Cleveland Clinic location?Cole Eye entrance closingVisitation, mask requirements and COVID-19 information. [6] Based upon this biomechanical data, Golish et al. With an open hole procedure, the surgeon moves the biceps tendon. Corticosteroids, which can delay healing and cover up symptoms, Quick, sharp pain in the arm, with or without a popping sound, Using non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and acetaminophen. [17] While our series is not as large as the series by Nho et al., we did not have any failures, deep infections, fractures, or neurologic injuries. The examination 41 patients had a minimum of 6 months clinical follow-up (range, 6 to 45 months). The biceps tendon is contained in the rotator interval, a triangular area between the subscapularis and supraspinatus tendons at the shoulder (Figure 1). These tendons can easily become unstable and torn, causing pain in the shoulder. During the Hawkins test, the patient flexes the elbow to 90 degrees while the physician elevates the patient's shoulder to 90 degrees and places the forearm in a neutral position19 (Figure 4). PMC legacy view The .gov means its official. Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? 2014 Apr;42(4):820-5. doi: 10.1177/0363546513520122. Long head BIceps TEnodesis or tenotomy in arthroscopic rotator cuff repair: BITE study protocol. Patients with unsatisfactory There were 4 superficial wound infections (stitch abscesses) (4%) of which 2 were treated with oral antibiotics alone and 2 required superficial debridement in the operating room and oral antibiotics. This makes it difficult to distinguish from pain that is secondary to impingement or tendinitis of the rotator cuff, or cervical disk disease.14 Pain from biceps tendinitis usually worsens at night, especially if the patient sleeps on the affected shoulder. The average length of follow-up was 7 months (range, 1 to 45 months). The electronic medical record for all patients was retrospectively reviewed for early postoperative complications within the first 12 months of surgery including wound infection, hematoma, wound dehiscence, rupture, hardware failure, and requirement for re-operation. The subpectoral approach provides excellent versatility and ability to meet technical objectives when performing revision tenodesis, by removing the tendon completely from the groove and preserving biceps function. They drill a small hole in your upper arm bone. The biceps tenodesis procedure treats shoulder and biceps muscle pain and weakness that happens when you tear your long head biceps tendon. If you experience progress, you can start with active range of motion exercises around the fourth week. Last time I only had to wait a week which was easy peasy compared to this time. eCollection 2017 May. The medial CHL is the number one biceps stabilizer for prevention of subluxation or dislocation, Dr. Arce said. 2005 - 2023 WebMD LLC. However, rotator cuff injuries are common in younger people as well, especially athletes. Background: The biceps tendon is then re-cut 20 mm proximal to the musculotendinous junction. You can read the full text of this article if you: Keywords Not smoking can help your heart and lung function better during surgery. Orthop J Sports Med. Outcomes following long head of biceps tendon tenodesis. This website uses cookies. Slowly withdraw the needle while injecting the remaining lidocaine and sodium bicarbonate. Institutional review board (IRB) approval was obtained prior to initiating the study. Pathologic disorders of the LHBT can be divided into 3 categories: inflammatory/degenerative conditions, instability of the biceps tendon, and SLAP lesions/biceps tendon anchor abnormalities. This will flush any remaining corticosteroid solution out of the needle, lessening the chance that any remaining solution might cause skin atrophy or depigmentation. You can re-injure your biceps tendon by resuming sports and other activities before your tendon heals. Clinical outcomes after subpectoral biceps tenodesis with an interference screw. 1): Preoperatively, the Abbott-Saunders test is very useful. A patient with an unstable biceps may experience pain and locking sensations when the arm is moved from abduction and external rotation to adduction and internal rotation. If a corticosteroid injection is required, use a hemostat between the needle and skin to hold the needle in place while changing to the 1- or 3-mL syringe containing the corticosteroid solution. All rights reserved. If degenerative changes are distal to the groove, arthroscopic distal suprapectoral tenodesis is the preferred procedure. appropriate medical assistance immediately. The long head of the biceps, which is a stabilizer of the shoulder joint, is found within these muscles. Another potential limitation is that only early complications were evaluated and it is likely that some re-ruptures were missed. 2015 May;43(5):1077-83. doi: 10.1177/0363546515570024. The clinical implications are that when we repair a supraspinatus cuff tear, we should try to fix it at the groove edge.. Tenodesis has been recommended for the younger, active patient. Your surgeons make several tiny cuts in your shoulder to insert a tiny camera called an arthroscope. Epub 2015 Mar 29. Disclaimer, National Library of Medicine [11] While the increased stiffness prevents any minor elongations in the construct as it heals, it may place the construct at more risk for catastrophic failure. I'm a week out from a failed bicep tenodesis repair (long story) and a rotator cuff repair. Failed biceps tenotomy generally results from a lack of thorough preoperative discussion of potential outcomes rather than from technical problems. These may include rheumatologic (e.g., rheumatoid arthritis, lupus), infectious, or other types of reactive or inflammatory conditions. This movement is one of the most specific findings of biceps tendon injury.1. Purpose: A positive test is a click or pop localized to the anterior shoulder and felt underneath the examiner's hand on the acromion, or the reproduction of painful symptoms.21, Injections of a local anesthetic may further differentiate the origin of shoulder pain. Patient demographics recorded included age, sex, hand dominance, surgical side, associated surgical procedures, biceps tendon diagnosis, and diagnoses requiring other surgical procedures. clinical6. Biceps tendinitis is a disorder of the tendon around the long head of the biceps muscle. Exclusion criteria included all patients undergoing a biceps tenotomy or tenodesis utilizing another technique besides the dual suture anchor subpectoral technique. The diagnosis of biceps instability or tendinosis must be based on a complete preoperative examination, imaging studies, and the findings of arthroscopic examination of the structures involved, he said. It usually takes four to six months to recover from biceps tenodesis. [6] We have recently shown that a dual suture anchor tenodesis and interference screw tenodesis have equivalent biomechanical strength when performed in the subpectoral region. One limitation of this study is that this is a retrospective review of a large number of patients and a prospective evaluation was not performed. I called my doc's PA and, while he was concerned that I had done active flexion only 10 days out from surgery (usually allowed after 6 weeks), he seemed confident that as long as I didn't hear or feel a pop it should be fine just don't do it again. Koch BS, Burks RT. Pathology of the biceps tendon is most often found in patients 18 to 35 years of age who are involved in sports, including throwing and contact sports, swimming, gymnastics, and martial arts. 2019 Sep 12;3(3):199-200. doi: 10.1016/j.jses.2019.07.007. MeSH Structures causing primary and secondary impingement may be removed, and the biceps tendon may be repaired if necessary. How it helps arthritis, migraines, and dental pain. to maintaining your privacy and will not share your personal information without and transmitted securely. In his presentation, Dr. Arce, of Buenos Aires, Argentina, focused on tenodesis and covered different arthroscopic techniques for performing LHB tenodesis. [15] They reported that 35% of patients had a failure of the tenodesis followed by an autotenodesis more distally in the groove. Fig. In outlining the preoperative and arthroscopic assessment for instability, Dr. Arce noted that many anatomic structures contribute to prevent biceps instability, including the following primary restraints (Fig.

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