Main outcome measures of biceps tendinopathy are: Conservative: Initial treatment should consist of pain management and use of NSAIDs. Alphabet door / clockwise / counterclockwise circles with ball. Proximal biceps tendon tendinitis may be a grade 1 or 2 strain of the . Keep your arm straight and hold for 15 seconds. These may include a rotator cuff tear, AC joint arthritis, shoulder labrum injury, or cervical (neck) radiculopathy. Do something to help reduce tension in your biceps whether its foam rolling, muscle floss, or self-myofascial release. Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis. Methods: Eighteen patients with twenty unrepaired distal biceps tendon ruptures were assessed retrospectively. During the first week and up to about the third week, range of motion exercises will be performed in the brace. This sheath provides lubrication to the tendon and allows it to glide and slide normally in the front of your upper arm. Beyond that point, the patient wears a sling for comfort and weans it after 3 weeks Clinical Goals <> The heat increases blood flow to the area, bringing in oxygen and nutrients and flushing out waste material that may have gathered as a result of inflammation. National Strength and Conditioning Association. Surgical Subacromial decompression protocol. Distal biceps tendonitis is an injury that results from overuse, and continuing to use an injured tendon can cause more damage. Rotate your body in the opposite direction of the raised arm until you feel a stretch in your biceps. K(-fr Hip Replacement for Residual Hip Dysplasia, Long Head of Biceps Pathology (at shoulder), Shoulder Arthritis and Total Shoulder Replacement, Chronic Compartment Syndrome Fasciotomy Rehab Protocol, Rotator Cuff Repair, including Subscapularis, Rehab, Shoulder Instability Bankart Repair Rehab, For the first post op week, the patient is in a posterior splint that is not to be removed. Horschig et al. Biceps tendonitis is usually caused by overloading and overusing the biceps tendon. It can also help improve circulation to the tendon and help facilitate healing. LHB tendon instability/dislocation (seen in association with subscapularis injuries/tears). A word of caution: K-tape is a newer treatment in PT and has not been proven to be effective in the treatment of tendon disorders. Diagnosis of biceps tendonitis involves performing a clinical examination of your shoulder, elbow, and upper arm. Primary bicipital tendinitis is much less common than cases where it is associated with concomitant primary shoulder pathologies (i.e., secondary cases). Larson Sports & Orthopaedics. The most common surgery for bursitis is a bursectomy, which removes the inflamed bursa to help relieve pain and promote healing. 2010 Apr;29(2):229- 46, vii-viii. It is attached to the bones of the shoulder and elbow by tendons strong cords of fibrous tissue that attach muscles to bones. Distal Biceps Tendon Repair Rehab Protocol. [10][11] Or for more persistent presentations, corticosteroid injections along the tendon sheath may be indicated. The retractedbiceps tendon is retrieved through the incision. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 2. Start at weight and rep ranges that are very light and work your way up. Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. Ice decreases blood flow and can be used to control localized pain, swelling, and inflammation. Heat and Ice: Ice can help reduce the pain, but heat is typically better to improve blood flow and help speed healing. Our doctors also perform some procedures at UHS Chenango Memorial Hospital as well. PMID: 30997282 PMCID: PMC6449020 And this is no exception. Return to lifting: Take it slowly. 6xB3:at1cu" &sDVz9P fHC Ultrasound has been in use in PT clinics for many years. Apply online today to get started! STRENGTH: UBE forward and backward. Since Hamilton Orthopaedics, Spine and Sports Medicine was founded by Dr. Ivan Gowan in 1984, the practice has grown exponentially to serve the ever growing demand in Central New York. FAQs and information from BayCare Clinic. Distal Biceps Tendon Repair Protocol Phase I ( 0-7 days post-op): Posterior splint at 90 degrees of elbow flexion. Human kinetic. ruptures tend to occur in the dominant elbow (86%) of men (93%) in their 40s. If these simple steps are ineffective, other treatments such as cortisone injections, needle tenotomy, or PRP injections are possible. As the pathophysiology escalates, there is an ensuing LHB sheath thickening, fibrosis, and vascular compromise. Gentle pulley while limiting elbow extension to -10 degrees. Phase I: 1-3 weeks Clinical Goals Elbow ROM from 30 of extension to 120 of flexion (this may vary depending on patient's situation. There are several muscles that help with both of these. The biceps and triceps muscles are the major flexors (biceps) and extensors (triceps) of the arm at the elbow joint. During ultrasound treatment, you should feel nothing except for mild warming around the ultrasound head. Your thumb will keep your hand in place on the wall and gently turn away from the wall, stretching your biceps as you move. Even kids try to show off their biceps when they want to prove how strong they are! Your physical therapist may perform various massage techniques for your biceps tendonitis. He specializes in spinal deformity and complex spinal reconstruction. The biceps muscle is responsible for bending (flexing . 1 week post-op 45-100. These are designed to help decrease pain and inflammation, improve ROM and strength, and improve pain-free use of your arm and shoulder. Tears occur secondary to unexpected extension forces and are typically associated with a "pop". The patient must meet specific objectives to progress from one phase of healing to the next. Other more invasive treatments for persistent biceps tendonitis may include cortisone injections, platelet rich plasma injections, or surgery. Long head of the biceps pathology combined with rotator cuff tears. Talk with your PT about how long your specific condition is expected to last. Surgery to reattach the tendon is usually necessary and its best to do so within two weeks. Ball toss / trampoline chest pass 1kg weight. Your email address will not be published. When the tendon is subjected to repetitive stresses, it can become irritated, swollen, and painful. <> Proximal biceps tendinitis and tendinopathy, https://www.ncbi.nlm.nih.gov/books/NBK533002/. Surgical treatment options . David Smith, SPT, Missouri State University, Springfield, Missouri. Icing can also be effective. If you need a few new core exercises, check these ones out. Massage may also improve tissue mobility, allowing your shoulder and arm to move more freely. Study Design: Case Study Objective: To describe the use of conservative treatment of a proximal long head of the biceps (LHB) tendon rupture for a patient preferring to forego surgery.. Background: The patient was a 49 year old male who presented with pain and weakness in the left shoulder, and a bulge in anterior, left brachium. Some research has shown that iontophoresis can be effective for tendon problems, while other studies do not support its use as an anti-inflammatory treatment. Active extension limit changed to 10 degrees. Distal Biceps Tendon Reconstruction Rehab Protocol First 10-14 days Immobilization in Splint with Elbow at 90 of flexion Encourage digital , shoulder ROM Elevation Pain Control Phase I (2 weeks to 6 weeks) Elbow immobilized in flexion-assisted Bledsoe brace with extension stop at 30 Shoulder Passive, Active Assisted, and Active Range of motion as tolerated all planes. 3 0 obj It is the responsibility of the physical therapist to establish these guidelines. During the PT evaluation for biceps tendonitis, your physical therapist will perform various tests and measures. All of our locations are handicapped accessible. Tendonitis occurs most commonly in the long head of the biceps tendon. Of the thousands of people treated every year, many are children, adults and senior citizens who have chosen Hamilton Orthopaedics, Spine and Sports Medicine as the best place to give them the most advanced orthopaedic care. Biceps stretch: Stand facing a wall (about 6 inches, or 15 centimeters, away from the wall). )Ed#. This heat increases blood flow and cellular activity in the area. The biceps also play a very important role in rotating your forearm during activities such as turning a screwdriver or doorknob. Biceps pulley: normal anatomy and associated lesions at MR arthrography. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> These objectives may depend on ROM, strength, or activity. Stuart Hershman, MD, is a board-certified spine surgeon. Surgical Bankart & Anterior Labral Repair. Structures causing primary and secondary impingement may be removed, and the biceps tendon may be repaired if necessary. Ladder with arm supported by unaffected extremity. Heat can also be used to decrease pain and improve tissue mobility. <> Hold 15 seconds. Verywell Health's content is for informational and educational purposes only. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Stand and hold your affected arm out to the side, with your hand at about hip level. Baechle. It should be noted that the initial injury and inflammation of the biceps tendon is called tendonitis. Surgical Reverse Bankart & Posterior Labral Repair. It is theorized that this type of contraction remodels the collagen that makes up the tendon, helping it to heal properly. Various exercises may be included in your biceps tendonitis rehab program, including: Shoulder ROM exercises. If this is unsuccessful the use of steroid injections may be helpful in managing pain. Although much less common, primary isolated cases are typically observed in young athletes participating in baseball, softball, volleyball, gymnastics, and/or swimming. Notify your therapist if you feel discomfort during ice use in the PT clinic. endstream endobj 173 0 obj <. This can confirm (or rule out) biceps tendonitis. Passive supination and pronation stretch. This is indicated in higher functional level patients or athletes with extensive active pathology accompanied with other shoulder pathology such as rotator cuff tears. This thickening of the ligament may cause abnormal rubbing on the tendon, leading to inflammation and irritation. ~F*.`(Eflws*PVLlq[na@3Z1>,w_y^yY1vKtWp$6&]&Y7,OZ8{u*^.o^+S SPFepov=$`9~9gOgjSHPxc!WV 'h*$=DVtaS+inqS&Dm{ Sg&nUQha9yq6R'x zFcqk'h' Q[!s.||~Fp-GHGaU4n]y Brace locked at 90 when not working on therapy exercises. It is by no means intended to be a substitute for one's clinical decision making . Supination/pronation through pain-free range. A small incision is made over the upper forearm, where the biceps should attach onto the radius bone. https://www.youtube.com/watch?v=j4vYM7JXSW8, Diagnosis and treatment of biceps tendinitis and tendinosis, The shoulder in baseball pitching: biomechanics and related injuries--Part 1, The long head of biceps and associated tendinopathy. Since the biceps tendon works to stabilize the front of your shoulder, it may become overworked if you have shoulder instability or rotator cuff tear. The stimulation, or e-stim, can be used to decrease pain, improve muscle function, or increase circulation. x\ms~3Q4Bd2sg_[;'v{hK#* @P|sLJv;ovlb/&{XX{{u~uG`w_qa When a direct current that is also negatively charged is applied to the medicine, it repels it, driving the drug into your tendon. 9. 2012;2012:405472. Conservative Posterior Instability. The biceps bends your elbow (flexion) and twists your forearm to turn your palm upward (supination). JOSPT. If any exercise causes pain to increase, you should stop performing it and check in with your PT. Cross-friction massage may be done to stimulate collagen formation around your injured tendon. Thats only going to make the issue worse. The Most Common Causes Of Elbow Pain While Lifting. BayCare Clinic, baycare.net, is the largest physician-owned specialty-care clinic in northeastern Wisconsin and Michigans Upper Peninsula. The treatment involves passing an ultrasound wand with a coupling gel over your injured tissue for five to 10 minutes. stream Working with a physical therapist can help you gain motion and strength, relieve pain, and return to your previous level of function and activity. A burning sensation may be felt if ultrasound is not applied properly. b__67W{.z}[vCK' IhVGyq? Diagnosis and determination of a plan of care is important early on if surgical treatment is necessary. Physical therapy initially focusing on unloading followed by reloading the effected tendon (see Tendinopathy rehab page for full details). Kevern MA. . Ice for 10 minutes every hour for the first couple days after the injury may be recommended. Many physical therapists do not use ultrasound due to this lack of benefit. 2017;8, 395-401. doi:10.4236/ijcm.2017.86037. endobj Surgical procedures are performed in the ultra-modern surgical suites at Community Memorial Hospital in Hamilton. Demographics. During tissue healing, controlled therapeutic stress is necessary to optimize. There are many different treatments and modalities that may be used to treat biceps tendonitis. Save my name, email, and website in this browser for the next time I comment. Mcdevitt AW, Snodgrass SJ, Cleland JA, Leibold MBR, Krause LA, Mintken PE. In advanced, end-stage conditions, the LHB tendon can eventually rupture at its origin near the superior glenoid tubercle, or as it exits the bicipital groove near its musculotendinous junction. Initiate resisted wrist supination and pronation. 4 0 obj A biceps tendon rupture occurs when the biceps muscle is torn from the bone at the point of attachment (tendon) to the shoulder or elbow. Protection & Education Time Frame 0 to 6 weeks post procedure Key Goals Protection of surgical repair Minimise pain & inflammation Ensure patient understanding of appropriate post-operative management and restrictions Regain ROM zy6 >E/{xT D:L=3=tCk,&S 8}f"k)7nlVanCH1XtRN$-8u7S8+BsfF/ g 4Q\wHmMd0(jIn61N(0.M0L^>. The long head of the biceps is most commonly affected by tendinitis, as the tendon from the muscle runs up the length of the arm and attaches to the labrum (a rim of cartilage) and the shoulder blade in the shoulder joint . The biceps tendon, the tendon associated with the biceps muscle, is made up of 2 parts: the long head and the short head. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This will help reduce the pain and swelling associated with the injury. Undergoing distal biceps tendon repair Exclusion Criteria: Revision Biceps tendon repair, Irrepairable tendon injury, Biceps repairs with biologic augmentation, Patients with concomitant neurovascular injury, Inability to tolerate BFR treatment, Unable to complete full course of physical therapy, Peripheral vascular disease, Other associated shoulder pathologies include: Primary LHB tendinitis represents about 5% of cases of proximal biceps pathology. Thank you, {{form.email}}, for signing up. endobj Physical therapy for biceps tendonitis can be helpful to decrease pain, improve shoulder strength and range of motion, and improve functional mobility and use of your arm. Physical Therapy: Therapists can use methods such as ultrasound, dry needling, TENS, IASTM, and more to help relieve pain. Download Distal Biceps Tendon Repair Rehab Protocol First Post-Op Visit: Sling and Splint all times 2-6 Weeks: Please make patient removable extension block splint at 45 Begin Active Assist ROM. ntYDSp6t^=p. %%EOF These exercises can help you maintain gains that you achieve in the clinic. It also plays a role in shoulder function. Your muscles adapt to exercise by getting bigger and stronger. When this tendon tears, however, the tear is usually complete and the muscle is separated from the bone and retracted back. They will ask how your injury occurred, how it is affecting your work and recreational activities, and if you have had any treatment so far for your condition. They have great blood flow and can repair damage from exercise quickly. If further information regarding the various biceps tenodesis surgical techniques the Distal bicep tendonitis is a common cause of elbow pain in gym-goers. endobj re^ 9W,F^.?Vez1`+^;qvfB\>9ek7x9V+S\yqXX5T|RMkC|R;sbZ9 }&lzDJzb7A;tWj$P mn(UqhrRx:ixv qvw`?IV]OU;gR4\2`Zxr+Q6 } |(IIi[B2I6V"^YvC7 EdL}:bcwS79EQB57\Gx0r02gCbKi#`yQVYxOK,=qf8K Interested in joining our wonderful team at Hamilton Orthopedics? He started LSO to keep more people moving better, longer. 3 weeks post-op 30-115 5 weeks post-op 15-130 Potential factors predisposing to biceps-related shoulder injuries include glenohumeral internal rotation deficit (GIRD) in overhead-throwing athletes/baseball pitchers, poor trunk control, scapular dyskinesia, and internal impingement. Biz C, Vinanti GB, Rossato A, Arnaldi E, Aldegheri R. Longo UG, Loppini M, Marineo G, Khan WS, Maffulli N, Denaro V. Nho SJ, Strauss EJ, Lenart BA, Provencher MT, Mazzocca AD, Verma NN, Romeo AA. The brace itself will be used for passive range of motion.Biceps Curl Hold a light weight (about 5 to 8 pounds), a . <>/Metadata 508 0 R/ViewerPreferences 509 0 R>> 43 Tenotomy is the . The patient will primarily experience pain localised in the bicipital groove and may radiate toward the insertion of the deltoid muscle, or down to the hand in radial distribution. Youll notice a hard time twisting doorknobs or using tools like wrenches and screwdrivers. Electircal stimulation may be used to help treat your biceps tendonitis or tendinopathy. Rehabilitation Protocol: Distal Biceps Tendon Repair - Accelerated Protocol; Rehabilitation Protocol and Post-op Instructions: Distal Biceps Tendon Repair - Moderate Protocol; Postoperative Extensor Mechanism Repair (Quad/Patella ORIF/Patellar Tendon Repair or Reconstruction) Physical Therapy Protocol When refering to evidence in academic writing, you should always try to reference the primary (original) source. If you have pain in the front of your elbow when lifting, in the little hollow, it could be distal biceps tendinopathy. Often, physical therapy may be prescribed. 10. The continuum of clinical pathology ranges from acute inflammatory tendinitis to degenerative tendinopathy. Author: Ryan Preszler Step 1: Allow your injured arm to hang at your side, then bend your elbow to a 90-degree. Distal Bicep Tendon Repair Protocol . Supine scapula stabilization with 1kg weight. Distal biceps tendon repair - early mobilization: Salyapongse This protocol is intended to provide the clinician with a guideline for the postoperative rehabilitation course of a patient who has undergone a distal biceps tendon repair by Dr. Salyapongse. Sports Medicine Division Physical Therapy Protocols Brad E. Brautigan MD Rehabilitation Guidelines for Distal Biceps Tendon Repair The intent of this protocol is to provide the clinician with a general guideline of the post-operative course of the patient that has undergone the above stated procedure. A distal biceps rupture occurs when the tendon attaching the biceps muscle to the elbow is torn from the bone. Biceps tendinitis occurs when there's inflammation of the biceps tendon. Our team of highly renowned orthopedic specialists and surgeons focus on advanced sports medicine, spine, joint replacement, shoulder, elbow, foot, ankle and much more. Long Head of the Biceps Tendon Pain: Differential Diagnosis and Treatment. 2009; 39(2): 55-70. Surgical Biceps Tenodesis. He supports weight training and high-intensity exercise throughout the lifespan. Simple treatments can reduce pain and improve mobility. So over time, your tendons can accumulate a lot of damage while working out, eventually leading to problems. (2008) Essentials Of Strength Training And Conditioning. Forearm twists help keep your arm flexible and help your tendon glide smoothly along the biceps muscle. Surgical management focuses on restoring the distal biceps tendon anatomy by repairing the tendon at its insertion site on the radius and allowing it to heal. This often happens in repetitive overhead activity, such as racquet sports or when throwing a baseball. Your doctor may prescribe a nonsteroidal anti-inflammatory medication (NSAID), like aspirin or ibuprofen, for pain relief and to reduce swelling. needs to learn more about biceps tenodesis and rehabilitation we recommend reading: Krupp RJ. }ws}B}hr|*-*zK/b>$y`7_> <> Dr. Gerhardt will make final determination). Your PT will also ask about your medical history and may review any medication that you are taking. *>c~%Is/c0.dLyP"Yydvl$8QZ ;1jD9H.oC~;,k^eMS={$I38Pm%.y{q![lt}Iwno6!VSnE&1$M> mO|@'$xJ!& IFzW8E=YoiX{IY,F2z2,$?rPO!Pp{-U[oNHM9wldb A distal biceps rupture is rare compared to ruptures where the top of the biceps connects at the shoulder. 1 0 obj endstream endobj startxref Kotara S. Singleton SB. This injury occurs mainly in middle-aged men during heavy work or lifting. Our orthopedic surgeons have trained and practice at the most advanced orthopedic facilities and have years of experience. These tears occur in men more than women; most injuries occur at 40 to 60 years of age due to chronic wear of the biceps tendon. Surgical Massive Rotator Cuff Repair protocol. Rehabilitation of a Surgically Repaired Rupture of the Distal Biceps Tendon in an Active Middle Aged Male: a case report. This focuses on a slowly letting the elbow relax from a curl, as seen below. This condition can make using your arm for normal work and recreational activities difficult. Read our, Physical Therapy Evaluation for Biceps Tendonitis, Physical Therapy Treatment for Biceps Tendonitis, Therapeutic Ultrasound in Physical Therapy, Physical Therapy for a Pectoralis Major Tear, KT Tape for Rotator Cuff and Shoulder Injuries, At-Home Exercises and Physical Therapy for Calcific Tendonitis, Causes of Shoulder Pain and Treatment Options, First Steps to Help Treat a Frozen Shoulder, Exercises to Improve Stability After a Shoulder Labrum Tear, Causes of Elbow Pain and Treatment Options, transcutaneus electic neuromuscular stimilation (TENS), neuromuscular electrical stimulation (NMES), Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series, Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis, Tenderness to touch in the front of your upper arm and shoulder. Classic Long Head of Biceps Tendinopathy. Initially Limit Extension to 45, Advance to full extension by 6 weeks Splint all times other than exercises Wrist/Shoulder ROM exercises 6-9 Weeks: Gently bend your wrist back so that your fingers point down toward the floor. Distal Biceps Repair Distal Triceps Repair Latarjet (Traditional and Accelerated) Medial Epicondyle ORIF Pectoralis Major Tendon Repair Posterior Shoulder Stabilization Reverse Total Shoulder Arthroplasty Return to Throwing (Softball) Rotator Cuff Repair (Large to Massive) Rotator Cuff Repair (Small to Medium) Arthroscopic_SLAP_Repair It is not only athletes who benefit from the considerable skill and experience assembled here. The best way to diagnose biceps tendinopathy, is by comparative palpation of the biceps tendon along the intertubercular groove, or otherwise by doing a ultrasonography (extra-articulair). A debate persists regarding the role of the long head of the biceps in the function of . Late Stage 8-12 weeks+ This injury occurs mainly in middle-aged men during heavy work or lifting. 2 0 obj But that takes a lot of work. Available from: Park SS, Loebenberg ML, Rokito AS, Zuckerman JD. Outpatient Physical Therapy to being POD 3 : Post Op - 2 weeks : Splint: x 2 weeks post op Sling: with elbow at 90 degrees when not in therapy x 4 weeks . complete distal biceps avulsion. endobj %PDF-1.6 % Rubinger et al. Ice may be used in the treatment of biceps tendonitis. 3 0 obj <>/Metadata 640 0 R/ViewerPreferences 641 0 R>> They can also help you to correct any muscle imbalances or problems with your form to prevent recurrent injury. Treatment of individuals with chronic bicipital tendinopathy using dry needling, eccentric-concentric exercise and stretching; a case series. The physical therapist must consider both the patient's subjective response to injury and the physiological mechanisms of tissue healing; both are essential in relation to a patients return to optimal performance. Distal biceps tendon ruptures occur primarily in males and risk factors include smoking, corticosteroid use, and anabolic steroid use. As a preface to discussion of the goals of treatment during injury rehabilitation, two points must be made: Biceps tendinopathy is an inflammation that can be caused by the normal ageing process as well by a degenerative process which usually occurs in athletes with repetitive overhead movements. The median duration of follow-up was thirty-eight months. Mobilize: Chronic excess tension in your muscles from weight training can lead to damage over time. But the biceps is a pretty important one. It commonly occurs in the dominant extremity of middle-aged men during an excessive eccentric tension as the arm is forced from a flexed . <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The LHB tendon undergoes degenerative changes, and associated scarring, fibrosis, and adhesions eventually compromise LHB tendon mobility. 172 0 obj <> endobj By Brett Sears, PT Prone T, Y, and W. Shoulder extension with T-band. Required fields are marked *. Distal Biceps Tendon Repair - REHABILITATION PROTOCOL Michael B. Gerhardt, M.D. BayCare Clinic offers expertise in more than 20 specialties, with more than 100 physicians serving in 16 area communities. Notify your PT if you feel any pain so adjustments can be made. RICE therapy (rest, ice, compression, elevation) may reduce the severity of symptoms. Supine scapula stabilization with no weight. For more of a stretch, bend your head to the opposite side of your affected arm. A tear of the biceps tendon at the elbow joint is called a distal biceps tendon rupture. Basically any action where you are pulling something toward you with your arms works the biceps.
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