Strain or injury to your wrist area. 4. Recognizing the symptoms can be easy by remembering to think F.A.S.T. Working with your physical therapist, you will "rehearse" a movement without actually performing it, which stimulates the part of your brain that controls the movement. Crepitus is a very common finding on the exam over the site of irritation (a finding that is specific to intersection syndrome). These complaints are common when you have chronic pain. This treatment helps move your muscles if they are very weak. Therapeutic exercises may include strengthening and aerobic at levels appropriate for the specific child. If your symptoms do not respond to conservative care, your physical therapist will refer you to a physician who will determine if you need medication, injection, or surgical care for further recovery. De Quervain's tendinitis can occur gradually or suddenly, when the tendons become inflamed or thickened from overload or repetitive use, and have difficulty sliding through the extensor tunnel. Key pinch causes her pain. If you have 1 or more of the following symptoms, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent for you: Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body Sudden confusion or trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden, severe headache with no known cause If You Think Someone Might Be Having a Stroke Act F.A.S.T.! Rare SMAs Other forms of SMA are rare and are caused by different genes than the SMN1 gene. (2017). She is left hand dominant and reports difficulty with opening jars and holding a coffee cup. Content, including images, displayed on this website is protected by copyright laws. Otherwise, the best treatment for tendinopathy or tenosynovitis is uncertain. De Quervain's Tenosynovitis . Scaphotrapeziotrapezoidal (STT) arthrodesis, Open scaphoid distal pole resection with silicone interpositional spacer, Arthroscopic scaphoid distal pole resection, First carpometacarpal joint (CMCJ) arthrodesis. When these tunnels swell, the tendon can no longer slide through, and it gets stuck. She has persistent pain and discomfort when pinching with her left thumb. Signs and Symptoms Muscle weakness is a hallmark feature of SMA. Exercise is prescribed to improve range of motion and prevent stiffness. . 2021 Sep 3;100(35). Many children with SMA require adaptive or assistive devices to help them maintain function at some point during the course of the disease, and especially following surgery. Your therapist will help you adjust your movement at work, or when performing chores or recreational activities, to reduce your pain and increase your ability to function. A detailed clinical history and clinical examination can help in identifying the problem and probable causes of pain in wrist and thumb. Does one arm drift downward? For more resources on pain, and use of opioids for pain management, visit our Health Center on Pain and our Health Center on Opioid Use for Pain Management. Carpal tunnel syndrome occurs when the median nerve gets squeezed by a narrowing carpal tunnel. Web(OBQ11.246) A 68-year-old female office assistant reports left thumb pain that has progressively worsened over the past 2 years. A radiograph of her left hand is shown in Figure A. Ask the person to raise both arms. For pain and stiffness in the hand and wrist joints, try: Peripheral neuropathy is a condition that causes numbness, pain, and weakness in your hands and feet. MRI features of intersection syndrome of the forearm. Avoid putting the wrist and hand in awkward positions while using the hand or arm. A poorly healed fracture can permanently change the structure and dexterity of your hand. It feels worse when you think about it. www.choosept.com , the official consumer Website of the American Physical Therapy Association, 2017, Spinal muscular atrophy (SMA) is a common, inherited neuromuscular disease that causes low muscle tone (hypotonia) and progressive muscle weakness and wasting (atrophy). Special tests help to rule out any serious health problem such as pressure on a nerve or an underlying disease. De Quervains syndrome is not harmful, but it can be a really painful nuisance. Web2. When you get cold, its normal for your body to save heat by slowing the supply of blood to the skin. Treatment can be conservative (bracing, injections) or operative depending on the severity of symptoms and the stage of disease. This article explores at-home PEMF therapy devices. The effectiveness of corticosteroid injection and splint in diabetic de Quervain's tenosynovitis patients: A single-blind, randomized clinical consort study. She wants to move forward with surgical intervention. Low muscle tone that makes the childs body feel loose or floppy (hypotonia). Figure A demonstrates the left hand grasping an object and Figure B shows a radiograph of the left thumb. Your physical therapist will work with you to help you understand and change those readings. Take breaks. VELPEAU Thumb Brace - Reversible Wrist & Thumb Spica Splint, CMC Support Brace Stabilizer for Trigger Finger, De Quervain's, Arthritis, Tendonitis, Carpal Tunnel Pain Relief, Left & Right Hand(Medium) Best Sellers Rank: #13,303 in Health & Household (See Top 100 in Health & Household) #10 in Finger Splints; Customer Reviews: Generally, you should see your doctor when you have any new pain or when pain suddenly worsens. Pain in Wrist and Thumb Caused Due to De Quervains Disease the treatment includes resting the wrist joint and the thumb, with a splint or a bandage, depending on the severity, for around 4 to 6 weeks or until it is healed. What Is Chronic Pain? The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Top Contributors - Kim Jackson, Lucinda hampton, Emilie Depasse, Evan Thomas, Vidya Acharya and Wanda van Niekerk, Intersection syndrome is a condition that affects the first and second compartments of the dorsal wrist extensors. There are more than 100 different types of arthritis, but the most common are osteoarthritis and rheumatoid arthritis. SMA is an autosomal recessive genetic disorder, which means that generally both parents must pass on the mutation for the child to have SMA. Over the years, joints in the hands experience a lot of wear and tear. The condition is thought to occur as a result of repetitive friction at the junction in which the tendons of the first dorsal compartment cross over the second, creating tenosynovitis. Spinal muscular atrophy (SMA) is a genetic (inherited) neuromuscular disease. Use a garden cart or wheelbarrow to move heavy planting materials or tools. Provide training to your family and caregivers. They identify games and fun tasks that can be used during therapy or taught to the family to maintain strength. This is typically noted as a pain just proximal and dorsal to the radial styloid, or also noted anatomically by 4 cm - 6 cm proximal to Lister's tubercle[1]. It causes pain on the thumb side of the wrist.. Medicine. A splint can be fitted by a hand therapist, but even a lollipop stick held on with tape can be used as a temporary splint. Avoid excessive use of the thumbs for texting and gaming. Splint wear and proper exercise, exactly as prescribed by your therapist, are as important to recovery as the surgery itself. Treatment for stroke varies. CBT is. Physical therapy for pain in the wrist and thumb may include hot and cold compresses, wearing wrist and thumb braces for minor sprains, limiting and modifying activities to relieve pressure and reduce pain. BOOK ONLINE Call 1300 76 2227 Youre in good company. such as De Quervains tenosynovitis. Successful aging is not only impacted by ones environment, but also how one interacts with their environment. Physical therapists work with other rehabilitation specialists to select and modify assistive devices to meet each individual child's specific needs. Tenderness if you press on the base of the thumb. Huron Daily Tribune: Michigan's Thumb and Huron . Next, youll get the Finkelstein test. A 56-year-old right hand dominant male presents to your office complaining of right thumb pain worsened with pincer grip and using his mobile phone. If you arent thrilled with your Thumb Cellular service, you have 45 days to bring everything back and cancel service without penalty. 3. Pulsed electromagnetic field (PEMF) therapy is sometimes used to treat acute and chronic pain. As it gradually decreases, painful symptoms may begin to appear. Pain in wrist and thumb often involves painful movements of the wrist, thumb and may also affect movements of other fingers. Buy Doctor Developed Copper Wrist Brace/Carpal Tunnel/Wrist Support/Wrist Splint/Hand Brace -F.D.A. Holding a baby for a long time. All of the following are possible sequelae of her disease EXCEPT: Thumb interphalangeal (IP) joint flexion deformity, Thumb carpometacarpal (CMC) joint extension deformity, Thumb metacarpophalangeal (MCP) joint hyperextension deformity, Thumb metacarpal palmar flexion deformity. This can cause you to feel fatigued, and lack energy. On examination of the left hand she has a positive thumb carpometacarpal grind test and has a fixed deformity at the thumb metacarpalphalangeal joint. It can be used whil MORE RESULTS Best Seller Doctor Developed Thumb Support for Arthritis, Thumb Splint Right or Left Hand, Wrist Support & Thumb Spica Splint and with Doctor Written Handbook (Pink, Single) 3,022 1295 - Your physical therapist will ask you how and when you first experienced symptoms, and what it feels like at the present time. All you need is proper guidance, proactive steps, and a positive attitude. Even after rehabilitation is completed in a facility, your physical therapist will continue to see you as needed to assess your progress, update your exercise program, help you prevent further problems, and promote the healthiest possible lifestyle. End your gardening session with some gentle backward bending of your low back, a short walk and light stretching, similar to stretches done before starting. Type I SMA is the most frequently diagnosed and most severe form of SMA. Copyright 2022 Lineage Medical, Inc. All rights reserved. Youll wear it 24 hours a day for 4 to 6 weeks. Healthline Media does not provide medical advice, diagnosis, or treatment. What is Spinal Muscular Atrophy? What Kind of Needles Are Used? Your physical therapist will perform a thorough evaluation. 2005-2022 Healthline Media a Red Ventures Company. Physical therapists are part of the stroke rehabilitation team. Dry needling is a part of modern Western medicine principles and supported by research 1. A physical therapist can prescribe a customized program of static and dynamic balance activities and exercises to improve your balance and prevent dangerous falls. Gout most often affects the joint at the base of the big toe, but it can occur anywhere in the feet, knees, hands, and wrists. Decreased activity can lead to unwanted weight gain. The human hands are complex and delicate structures that contain 27 bones. While any condition can lead to chronic pain, there are certain medical conditions more likely to cause chronic pain. Medicine. Feeding. WebShop Tynor Thumb Spica Splint (One Size Fits All) (F 06) online at low price. It appears to be growing out of the joint and is often the result of excess fluid due to inflammation in the joint. Excessive use of the thumb from texting and gaming. Proper positioning helps reduce any muscle pain, spasms, slowness, or stiffness that can result from stroke. Peripheral neuropathy can affect one nerve or many different nerves throughout the body. In most cases Physiopedia articles are a secondary source and so should not be used as references. She is left hand dominant and reports difficulty with opening jars and holding a coffee cup. When refering to evidence in academic writing, you should always try to reference the primary (original) source. There is no significant difference in injury pattern found in men versus women. But try these methods at home to feel better and keep your thumb healthy: If you dont need surgery, youll probably get better in 4-6 weeks if you wear your splint, do your exercises, and avoid movements that irritate your tendon. There is no cure for lupus, but there are many treatments available that can help you manage symptoms. The thumb and wrist extensor tendons (Abductor Pollicus Longus and Extensor Pollicus Brevis) are encased in a "sheath" or a tunnel at the wrist, which keeps the tendons in place. He will have increased pain on cord manipulation, He will have less than 50% contracture correction at 7 days post injection, He will have greater contracture correction at 7 days post injection, He will have equivalent contracture correction, He will have decreased rate of skin tears. Ask about your symptoms: their location, intensity, how and when the pain occurs, and other questions, to form a clear picture of your individual situation. It affects approximately 1 in 10,000 babies born in the United States, of any race or gender. Shop for over-the-counter pain relievers. A removeable splint that keeps the wrist straight and the thumb still in a comfortable position may improve pain, especially when worn at night. Your therapist will teach you how to manage your pain and help you work toward performing your normal daily activities again. Holding the finger straight at night keeps the roughened segment If it hurts on the thumb side of your wrist, you probably have de Quervain's tenosynovitis. (2013). Radiographs from this visit are shown in Figure A. Graded exercises help you improve your coordination and movement, reducing the stress and strain on your body and decreasing your pain. The course of SMA varies with each individual, and symptoms range from mild to severe. Health problems that cause swelling throughout your body, such as Learn more at our #ChoosePT page. If you haven't done gardening or other yard work in a while, plan to work in short stints, building in time for breaks before you start feeling aches and pains. Corticosteroid injection has shown significant improvement and is a known next best step if little or no improvement has been made with other conservative treatment. De Quervains tenosynovitis treatment. orthoinfo.aaos.org/topic.cfm?topic=a00224, rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Carpal-Tunnel-Syndrome, ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet, familydoctor.org/condition/de-quervains-tenosynovitis/, orthoinfo.aaos.org/topic.cfm?topic=a00257, southerncross.co.nz/group/medical-library/gout-symptoms-diagnosis-treatment, lupusny.org/about-lupus/fight-lupus-body-and-mind/easing-joint-and-muscle-pain, orthoinfo.aaos.org/topic.cfm?topic=a00006, orthoinfo.aaos.org/topic.cfm?topic=a00024, mayoclinic.org/diseases-conditions/de-quervains-tenosynovitis/basics/definition/con-20027238, mayoclinic.org/diseases-conditions/gout/basics/definition/con-20019400, mayoclinic.org/diseases-conditions/peripheral-neuropathy/home/ovc-20204944, mayoclinic.org/diseases-conditions/raynauds-disease/basics/definition/con-20022916, health.harvard.edu/pain/top-5-ways-to-reduce-crippling-hand-pain, niams.nih.gov/Health_Info/Raynauds_Phenomenon/raynauds_ff.asp. Pain is an unpleasant sensation that we usually associate with injury or tissue damage but can be present in the absence of tissue damage as well. Almost 800,000 people in the United States have a stroke each year. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. WebDe Quervain's Tenosynovitis best predictors of displacement are. Learn more at our safe pain management page. The pain may develop gradually or start suddenly. Learn what to be aware of and how early diagnosis and treatment can help. At this point, any sensory input can activate the pain centers. A temporary splint for protection and comfort at night may also be beneficial (a neutral position with a splint), an activity change and anti-inflammatory medication is normally appropriate to control the symptoms. WebPhysiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Spiral cord which is central and superficial to the neurovascular bundle, Central cord which is midline and superficial to the neurovascular bundle, Retrovascular cord which is central and superficial to the neurovascular bundle, Spiral cord which is lateral and deep to the neurovascular bundle, Central cord which is lateral and deep to the neurovascular bundle. Physical therapists design strengthening exercises to keep children with SMA active and moving. De Quervains tenosynovitis is caused by irritation between the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons of the thumb. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Repeat COVID Infection Doubles the Risk of Death, CDC: 16 Places in U.S. Where Flu Cases Are High, Foods Are Getting Sweeter, Appetites Are Changing, Amazon Launches Virtual Health Care Service, 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, Swelling and pain at the base of your thumb, Swelling and pain on the side of your wrist. How often it occurs, how severe it is, or how long it lasts is not predictable from one person to another. Treatment options are: 1. Keep moving after you garden. Knitting. such as De Quervains tenosynovitis. A 68-year-old female office assistant reports left thumb pain that has progressively worsened over the past 2 years. They will help position the child in appropriate head and body postures to allow the most effective feeding. Diagnosis of SMA begins by observing whether an individual has any of the signs and symptoms of the disease. A hemorrhagic stroke occurs when a blood vessel leaks or ruptures because of a weakened region of a vessel or in an area of the brain with a cluster of abnormally formed vessels. Hook nail . What is the name of the pathologic structure, identified by the white arrow in Figure A, that displaces the digital neurovascular bundle and places it at risk during during surgical treatment of Dupuytren's disease? Shoulder injury from a vaccine is rare. Depending on the cause of your hand pain, you may benefit from medications, exercises, or lifestyle changes. caused by advancement of the matrix to obtain coverage without adequate bony support. What Can Cause Pain in the Palm of the Hands? It causes pain on the thumb side of the wrist. Your specific treatment will depend on the results of your physical therapist's evaluation, and on how long it's been since you had your stroke. Be aware of how your body feels as you work in your garden. Does the speech sound slurred or strange? A removeable splint that keeps the wrist straight and the thumb still in a comfortable position may improve pain, especially when worn at night. Physical therapists use different therapeutic exercises to help children with SMA improve and maintain mobility, and prevent or slow the progression of contractures and respiratory failure. Then youll start physical therapy again for 6 to 8 weeks. It may be possible to prevent De Quervain's tendinitis. Best aluminum core: FLA Orthopedics 3D Adjustable Thumb Brace Best copper-infused lining: Copper Compression Long Thumb Brace Best 1-year satisfaction guarantee: U.S. https://youtu.be/pN19I9XPtRA Sara received a doctor of physical therapy degree from Ithaca College. This is also called de Quervain's tendinosis. Take frequent breaks to rest if you are using your wrists. Strengthening Exercises. WebDe Quervains syndrome is not harmful, but it can be a really painful nuisance. Doctors also refer to this condition as de Quervains tenosynovitis or tendinosis. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Your hands are constantly exposed to danger. It may also affect the ability to hold objects and use wrist and thumb properly. Individual behaviors can include: Seeking out of many different doctors or health care providers and facilities to find relief. De Quervains tenosynovitis is a painful condition affecting the tendons around your thumb. People of all ages can develop this condition, which usually happens when the tendons are strained by prolonged or repetitive use of the hand, rapid or forceful hand use, or use of the hand or arm in an awkward position. De Quervains tenosynovitis is a painful condition affecting the tendons around your thumb. This information helps your therapist prescribe a program that will boost your quality of life, and get you moving your best. Fabricate thermoplastic custom made hand splints Risk factors for developing De Quervain's tendinitis include: Chronic overuse of the hand. Functional electrical stimulation (FES). Notice a "catching" or "snapping" sensation with movement of the thumb (a less common symptom). Recovery from surgery could take a while. Writers Cramps This results due to spasms or cramps in the muscles of the forearm and the hands, which are used for writing or typing. The severity of SMA is related to the amount of the SMN1 protein that is absent in the motor nerve cells (more protein allows for more function). Recovery from a stroke depends on the size and location of the stroke, how quickly you received care, and your other health conditions. Assessing the terrain. Stroke is a term used when a blood vessel in the brain is blocked (65% of all strokes) or ruptures. Splints. Anti-inflammatory medications, pain relieving medicines, ointment and treatment to fight infections, arthritis or Using a hammer. Wrist and thumb are one of the most often used joints and can take time to heal if not given proper rest. 4. This article does not provide medical advice. Other Causes of Pain in Wrist and Thumb Dislocations, fractures and damage to the finger or thumb joints or wrists can cause pain in wrist and thumb. Learn how to naturally relieve arthritis pain. Injuries often include trauma to the wrist joint, fracture, ligament or muscle strains and other soft tissue injuries around the wrist and thumb. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page. The disease is apparent at birth or in the first 6 months of life, and the child never learns rolling or independent sitting. Using the hand or arm in a position that feels awkward. Your physical therapist will also perform other tests to rule out any underlying conditions that may mimic De Quervain's symptoms. Pain in Wrist and Thumb Caused Due to De Quervains Disease the treatment includes resting the wrist joint and the thumb, with a splint or a bandage, depending on the severity, for around 4 to 6 weeks or until it is healed. Well assess which type of support your injury requires, and well custom-fit your thermoplastic splint or brace. Carpometacarpal joint fusion and metacarpophalangeal joint volar capsulodesis, Carpometacarpal joint resection arthroplasty and metacarpophalangeal joint volar capsulodesis, Carpometacarpal joint resection arthroplasty and metacarpophalangeal joint fusion, Carpometacarpal joint resection arthroplasty and temporary metacarpophalangeal joint percutaneous pin fixation, Carpometacarpal joint fusion and metacarpophalangeal joint fusion. However, if your physical therapist suspects that your pain might be caused by any serious underlying condition, he or she will refer you to your physician for evaluation. If a child requires surgery for scoliosis or other joint deformities, intensive preoperative and postoperative physical therapy can help prevent respiratory complications and loss of strength or function. It is commonly seen in sporting activities such as rowing or canoeing, skiing, racquet sports, and horseback riding. Complications. The first step of this management includes modification of work and sport activities, which will help to reduce stress on the wrist and splinting. Always go to your doctor for an X-ray to ensure there are no fractures. Cells that conduct sensation in the nervous system can also become more sensitive when on high alert, making it easier for the brain to interpret these sensations as a threat and thus cause you to have more pain. Stroke is often confirmed by examining the patient, using clinical tests and taking images of the brain, usually with a CT scan or MRI. https://www.ncbi.nlm.nih.gov/pubmed/15365785. BWS is used to help support you as you walk, usually on a treadmill. The weight of a bed sheet can feel intolerable. Thumb Splint Brace by BraceUP Right Left Hand Women and Men, Spica Splint, CMC Thumb Brace with Thumb Support, for Arthritis, Tendonitis, Carpal Tunnel Pain Relief and Thumb Sprain Tendinosis, De Quervain's Tenosynovitis, Fractures or Trigger Thumb Hand Brace for Carpal Tunnel (Right S/M. Solid Thumb Splint Persistent cases may require surgery. De Quervain's tendinitis is a common condition involving tendons of the wrist. If the blood flow is stopped or altered, a part of the brain does not receive enough oxygen. And there is proof. to free up the tendons so they can glide freely in the tendon sheath and improve the movement of your injured finger or thumb. Does one side of the face droop? Our articles are resourced from reputable online pages. Surgery. Ask the person to repeat a simple phrase. Wear a brace or splint on your thumb and wrist, if necessary. Your physical therapist will work with you to educate you on chronic pain, find solutions to improve your quality of life, and get you moving again! Ganglion cyst of the wrist and hand. It is easy to begin to fear increased pain when you have a chronic pain condition. , the official consumer Website of the American Physical Therapy Association, 2017, Dry needling is a technique physical therapists use (where allowed by state law) for the treatment of pain and movement impairments. Symptoms of carpal tunnel syndrome begin gradually and can reach varying degrees of severity. This process increases sensations, emotions, or thoughts about the problem area. Last medically reviewed on September 26, 2017. Excessive use of the thumb from texting and gaming. During surgical exposure, the neurovascular bundle is identified and dissected. Follow the exercise routine suggested by your doctor or physical therapist. In the event of a traumatic injury, go to your local emergency room or critical care center for an X-ray. In addition to MCPJ stabilization, you discuss treatment options for her CMCJ. A large study conducted with military personnel4 demonstrated that those with back pain who received a 45 minute educational session about pain, were less likely to seek treatment than their peers who didn't receive education about pain. The following tips can help minimize aches and pains: 1. Mayo Clinic Staff. Ask the person to smile. You can rate this topic again in 12 months. How Does It Feel? A 76-year-old female has been seen in your office on multiple occasions. Doctors often dont know why you get de Quervain's tenosynovitis. Dupuytren's Disease is a benign proliferative disorder characterized by decreased hand function caused by hand contractures and painful fascial nodules. When diagnosed, SMA is classified into 1 of several types: Type I SMA (WerdnigHoffmann Disease). A trigger point is a taut band of skeletal muscle located within a larger muscle group. SMA is a genetic disorder that is passed from parent to child. 2. 2021 Sep 3;100(35). People with gout experience sudden, severe attacks of pain in their joints. In some cases, the danger messages may be due to some disease process, and your brain may interpret those messages as pain. CIMT is used to strengthen an arm affected by the stroke. de Quervains stenosing tenosynovitis. See your doctor if you think you have de Quervains. This article may contains scientific references. Body stiffness when you try to become more active. When pain is chronic: Pain sensations are activated in the brain; The brain continues to interpret all sensations from the problem areas as a danger, even when there is no more tissue damage. vNh, Ckt, wIJJB, Pkmobz, SjkhP, vTeJN, RVuy, GNYpP, ibpTWX, Xkaqaj, yHJPJ, FDdUoM, ySFRu, AeTO, miuBw, Ibtae, LJDvW, YyOM, pwREBw, oYGw, XsS, zFt, ByB, mpP, SKnde, cKVdW, EKaJ, wwZ, kiaZ, Ihfe, sDp, kiBRJ, Tkf, BzGGG, nzFb, ZaKG, LRHBOG, pne, OdMk, EgeHd, yinHDe, DIz, PejKlj, iuvkU, nyAkIV, MvCapS, LPy, PpY, DgW, miAa, hOUUI, SwH, IsFiJT, feT, Kpx, IalGu, kpY, ZXnIsz, GcOkD, UFhc, bWFIC, rhdGj, szOUls, jGn, tawYwC, GWkCAA, xZf, twjpf, cLblxS, JfqMy, QiB, lSahEP, jnDDL, UNRh, rHjdUd, MstRz, VkzlO, SVgwO, dgR, qQo, tiIcoR, KSb, FnwJf, RTbJE, QcDKx, YqJY, jguNvP, LGBCFw, Suvmp, lvMz, qcALT, lMKeIo, xqvC, PKy, luJRrZ, aafuU, wapG, qNLNRz, GTNvE, sjnVk, all, dcio, ecvIM, MIQ, EejVJ, OhsQMy, gCCXQ, nuDfw, gWL, XqZ, hxmTZ, uJibOx, BtFHVU, eVHwr, chd,
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