It may also take time to regain full strength in the muscles used during movement of the arm and shoulder. }. Do the icing and heat if you need to. In essence, early on, your surgeon is trying to thread the needle between limiting shoulder activity so as to maximize tendon to bone healing . Even with the bone spur, there is minimal to np impingement according to the mri. These activities will help to keep your shoulder strong, and they will help you prevent injury to the area again. Best wishes. Day of Surgery Rotator cuff surgery is an outpatient procedure. Actually, this is a very good suggestion even if you do not have a balcony. dbahn Line Up and Wait. Surgery is not a cure for rotator cuff tears and is a last resort, especially if conservative methods have failed. I have objected because of the concern in flaring so the surgeon said continue on the 6 1/2 mg. but he is still very concerned of the healing of . I am 47 and I'm ten months post op. I also had my neck fused 3,4 5 6 7 and a plate put in 10/18/17. But, I still hurt. I miss my real bed and my real life. Important to note: Do NOT force anything. first listens to your symptoms and performs an examination. "https://twitter.com/azaleaortho", 3 weeks ago today. When appropriate, non-surgical treatment may be the first line of defense, but our physicians will also inform you when surgery is needed. Normally at ten weeks you should have been doing resistance and strength training with bands and 2-3 pound weights. Yet another battle front! "https://www.linkedin.com/company/azalea-orthopedic/", It requires a long, slow recovery. ] This is normal, and the doctor may prescribe pain medication to help reduce the pain during the first few days. Call your doctor if you have a temperature of 101 degrees or more, redness or discharge from the wound, sudden and severe pain, or numbness or tingling in your fingers or hands. Patience is key and doing your stretches. I've spent at least an hour per day since week 2 on ROM and strength rehab. Dec 12, 2018. If you experience rotator cuff pain, call. Some patients find it easier to sleep on a reclining chair, while others use pillows to prop themselves up on the bed. The day after surgery was . Move your elbows up and down and close to your body when not in the sling. Everybody told me itll be 12 months to 14 months to heal. The pain at night wakes me and I can't get back to sleep. It mostly works fine. I hope you can go on the cruise and both of you can have a nice relaxing time. Thanks. Patient testimonial 16 weeks post rotator cuff surgery. Ouch! It just feels impossible to keep the shoulder from moving 24/7. If you have a sedentary job, you should be able to return to work in just two to three weeks. The incision can remain open when it stops flowing. The physio says that the overall shoulder inflammation is likely to continue for 3 to 6 months, which came as a surprise to hear. Thanks to everyone here that let me unload and offered me tons of sympathy! We are on the same time line. I had full range of motion back by 8 months, and worked on strength for the next 6 months. It was my dominant arm, alas. Still soreness during and after every single run at 5 months this week. They told me to take the pain medication an hour before going. Also ,most of the muscle mass on my R. arm has disappeared. My physical therapist told me yesterday that when your body is in movement it sends messages to the wouned area and it doesnt hurt as much because youre moving & the blood flow is going there. /. Will it ever end? Usually, rotator cuff surgery is performed as an outpatient procedure. To prevent the need for surgery, physical therapy will help you achieve a well-balanced rotator cuff. Even walking was agony, any time my shoulder "moved". My doctor said he expects me to have full range of motion at 8 weeks. How long does it take to recover from rotator cuff surgery? New to the forum here. Wow! ARTHROSCOP ROTATOR CUFF REPR, Repair biceps long tendon rupture, Arthscpy shldr dstl claviculectomy, Arthscpy shldr decompression, are the procedures that were done. No sudden movements just stretches as per my Dr. Im better everyday and hope to be healed completely within a couple months! I hope you are better than me and can actually sleep in a bed, it was much later for me before I could even lay down and I hated not being able to lay down! I had the same thing happen when walking. But it's definitely better even than a month ago, I can tell it is still improving. The "new" therapist used the concept of manual passive massage. I'm still in the immobilizer unless I'm doing my excercises, visiting PT, or taking a bath. Aren't they the most important people to ask? }, { I went back to work ( I work at a high school) after 2 weeks as I couldn't stand being inactive at home. I am a 55 year old female and had my surgery on 12/02. This observation is supported by a study showing that in patients who have had rotator cuff surgery, strength in the shoulder muscles is not fully recovered until nine months after the surgery. Of course Ive talked to my therapist and doctor. By Dont drive. Maybe just as well, but would it have stopped us from having the operation in the 1st place? Important announcement regarding COVID-19 Pandemic. That was done on March 5. Recommendation is to repair. I have 3 weeks till my next follow up and I don't see how I can go back to work as a letter carrier without limitations at this point. Deb. Here is a step by step approach to return to golf after rotator cuff shoulder surgery: Get cleared by physician who performed the shoulder surgery Get a thorough evaluation from an expert physical therapist who specializes in golf and golf swing biomechanics Solve the root cause of your pain, identify any risk factors and other current impairments I truely will not go thru another surgery unless I get pain every night as I did with this other shoulder. The surgical procedure usually takes a few hours, depending on the extent of work needed to repair the torn tendons. (I was told an MRI that soon after surgery wasn't possible or advisableI don't know, but an mri that soon sure is going to show lots of stuff going on in there due to the actual surgery itself isn't it?.) Without seeing the knee, and possibly getting an x-ray, I cant be sure. If I feel Im not up to going, they will fill out the insurance forms for me. Sometimes the balcony only has chairs, not a lounger. Powered by Invision Community. That means that there is no need to stay overnight. This article will give you a general idea about how long will it take for you to recover from a rotator cuff surgery. Martin Kelley, DPT of Penn Rehab reviews a number of progressive exercises for the second phase of recovery, six weeks after shoulder surgery including: extensions, internal rotations,. I don't have any advice but my thought is about your "exercises." Restarted running 5-6 mile a day from week 3/4 after anchor and suture rotator cuff surgery at surgeons direction. My surgeon recommended physical therapy (passive range of motion) to begin four days after surgery. A half-inch long incision is made so a small camera can be inserted into the joint, allowing the surgeon to see the damaged areas. That's interesting. I got the throbbing pain too, but on reflection I guess given the type of surgery it would be odd for no reaction to exercising. You don't snap back to normal quickly; you can't sleep the way you would like to (I remember all those nights in a recliner), etc. respect of any healthcare matters. The physical therapist told me that the muscles around the surgery site often tighten up because they overcompensate for the injury. This can result in premature arthritis and lost work time. I also went back to work but more for a distraction than anything else. I started therapy 2 weeks after my surgery. The severity of your rotator cuff tears would obviously have a bearing on one's recovery as well. recovery, from 8-12 weeks after the surgery, is focused on getting the shoulder to move normally again, while still not doing any lifting that could pull apart the repair. I thought Id be further along in my recovery by now. Well I mostly got on this reply to say you Must be a Strong Person mentally, to be able to go through all that. The more often you move your fingers, the less stiff your fingers will be. At six weeks I'm hoping that the basic healing is done, and am lucky that I've always slept in my bed since the op, although at times sleep wasn't easy. Any thoughts on that? I had the MRI and it basically came back I'm ok. Notes on After Rotator Cuff Surgery-when will the pain end? This helps the surgeon check for any ligament or cartilage wear that may be affecting the stability and integrity of the joint. Especially at night. I'm driving with no problems and I'm happy for that! This way, you can move your arm away from your body and avoid causing pressure on the shoulder. Patient- and tear-specific demographics were analyzed in a retrospective series of patients who had undergone arthroscopic rotator cuff repair. Egton Medical Information Systems Limited. We want the forums to be a useful resource for our users but it is important to remember that the forums are Remember that rotator cuff surgery is the first step in repairing the joint. The surgeon will place your arm in a sling to protect it while the tendons heal. Bevmail. Fast forward to January 2019, six weeks ago, when I finally had the operation, and having previously gone through a lot of discomfort & healing of everything else in the shoulder area (Including long head of biceps tendon), particularly in the first 3 months after the fall, I thought the aftermath of the operation would be fairly straightforward by comparison. I also know I am losing more and more range of motion. Luckily I grew up with a guy. Good idea. How Long Is Recovery After Arthroscopic Rotator Cuff Surgery? You can reach Azalea Orthopedics at 903.939.7500 to schedule your appointment today. Each procedure includes a recovery time, but these tips can help you. start mid-range of motion range of motion rotator cuff external and internal rotations active and light resistance exercises (through 75% of range of motion as patient's symptoms permit) without shoulder elevation and avoiding extreme end range of motion. As you said, don't sit and wallow. Always speak to your doctor before acting and in cases of emergency seek These pains make it rough for me to be up on my feet styling hair everyday, I hope most of you are doing much better than me. I still wear the sling when outside the house as it is an uncontrolled environment. This allows a skilled surgeon to examine the joints key structures. "https://www.instagram.com/azaleaortho/" I had forgotten. Only a couple of nights ago was I finally able to turn just a bit onto my left shoulder. I start PT in 11 days. It happened about four months ago with surgery scheduled next week. Phase one: 1-6 weeks In the first phase of recovery, a. My biggest problem at this point is sleep. These problems may be caused by upper quarter restriction or ball and socket joint issues. I couldn't move, I couldn't sleep, I couldn't do anything. Everytime I start to fall asleep, bam. I got released to sleep without the immobilizer at 2 weeks but other than that, I have to keep it on constantly. I seem to have turned a corner where the pain is not bad and Im able to sleep, drive, & do many things. Use of the forums is subject to our Terms of Use "@id": "https://azaleaortho.com/contact", I think because of the lack of sleep also, you don't feel you are living in the real world - I wasn't going to the gym, feeling sociable, all of the normal things I was used to doing. While it depends upon the nature of the surgery, the skill of the surgeon, and your personal resilience, most people I've known are much further along than you are. I am always nervous that maybe I harmed based on the pain I am starting to get. Oh I can so relate. The result is a pain radiating down the arm (cervical radiculopathy). They do ice and the tens unit for 15 minutes after each PT. It's true, no one really tells you about the level of pain involved and as a result I have been nervous as well about re-injuring myself doing more than I should. Sorry for the long post- I wish all of you out there a speedy recovery and want to say-don't get frustrated, it really does take a year. Imamom, May 26, 2019 in Ask a Cruise Question. I have an old boyfriend who is a fabulous skier. I am up all night with my tens unit and ice. After this time, youll be encouraged to start a rehabilitation program. So I know the pain that you are in. I've tried everything. During this process, you may feel a lot of pain, which is an essential part of the recovery process. Casing in the morning and lifting 50lb trays of mail, carrying a mail sack and opening and closing the sliding door on the van will be a challenge. "latitude": 32.3123176, Shoulder Stiffness. Always hold the sling unless you are changing clothes or doing physical therapy. During the early phases of recovery, you may need to limit your activities to reduce pain. Need to make some income. I think you are right to do exercises daily but I wouldn't beat yourself up about the amount of reps. Try our Symptom Checker Got any other symptoms? I hope that once you are on board, you *can* relax and enjoy it. I feel medium pain and discomfort all the time. They did an mri and the Dr. said I have a tear in my rotator cuff. Revision rotator cuff surgery is more risky than primary surgery, but fortunately, many patients are satisfied with the outcome. Patients AND therapists. It is very emotionally draining. Im extremely fortunate. No, it sounds like you were in more pain than I currently am. } Does this sound typical. Nobody seems to want to tell you what you are about to experience. If particular attention is not directed to the patient during the positioning, a cervical disc may be injured or aggravated. Interesting to read all of these comments above, but one has to bear in mind that those who have had a better experience overall than the people above have had, wont be writing on sites like this, and so experiences here are somewhat skewed. Hmmm. That's interesting. I'm glad your pain level is good! He called back and said it sounds like I have a "Popeye condition" and nothing to worry about, but this morning I could lift my arm overhead now, it's too painful. I had extra pain meds, but I didn't want to be medicated into a stupor! Change your bandage 4-5 days after surgery and cover the incision with a bandage. Although the goal of surgery is to restore a painless and functioning shoulder, there may be limitations depending on the age and size of the tear. I panicked and called the answering service for my surgeon. After rotator cuff surgery, you might be wondering how long the pain will last. started PT 9 weeks ago. This can cause shoulder pain, stiffness, muscle spasms, numbness, and tingling. One thing I noticed that helped me that i want to share was to not sit around and wallow and watch TV. Goals: 93 users are following. If this muscle or tendon is torn or strained, doctors may recommend rotator cuff surgery to repair the damage. Which really meant they couldn't do much else for me. While this stiffness may be unpleasant, the study found it typically resolved with six to 12 months after the surgery. He feels that in future the wearing of a sling will be reviewed, as evidently not required by everyone, especially with the risk of a 'frozen shoulder' which I had 30 years ago, and was keen to avoid again at all costs this time. I'm informed this is likely to be from unhappy lymph nodes. About 12 weeks in, I was experiencing major pain so I had an ultrasound to see if everything was still in place. { I feel like a walking zombie. I believe stretching is the key to recovering your range of motion (ROM). Pain in my right shoulder has become unbearable. The PT seems to think it is from a nerve in my neck. The common symptoms of rotator cuff tears (RCTs)are shoulder pain and shoulder dysfunction, which are similar to other shoulder diseases such as frozen shoulder and bursitis [15, 29, 30].Patients with shoulder pain and limited range of motion are usually assessed by physical examinations in an outpatient setting to obtain an initial diagnosis of their shoulders []. Egton Medical Information Systems Limited. I don't know when that will stop. I really missed my bed. We are similar ages. Can't lift arm. I have PT twice a week and the pain afterwards is terrible. I'm 57 and am going for an ultrasound scan on my shoulder next week to try and source the root of my shoulder problems. My physio is happy with this lack of sling, and says that as far as passive movement is concerned, I'm on target. B first listens to your symptoms and performs an examination. This is now starting the 5th month of pain. Shoulder bursitis affects the subacromial bursa, which sits over the rotator cuff. I'm sure the crew will take very good care of you. The fact that your doctor has you off work for six months suggests that your surgery was even more extensive and debilitating that many of us have experienced. If you can't get a recliner and must go the lounge-chair route, ask your steward to bring a quilt to fold up and lay on the chair, to give you a bit cushier base for sleeping/relaxing. So foggy it was like walking through water. I used ice for the first few weeks then I preferred heat. I was released by my surgeon May 5, 2017. "opens": "08:00", I was told no swimming for awhile. The neck, shoulder and arm are all moved. "text": "Dr. Foreman Says:It is possible you could be having some problems from the hardware. For starters, it takes between 6-8 for the tendon to heal to the bone. I share a lot of your same issues. I spend most of the night in a recliner. After a good few months, I did get some deep tissue massage which helped immensely and made me realise I was ready to be a bit braver with exercise, but up to that point I was nervous of overdoing it, and also because of the pain that followed. I've been using ice, but like you, I prefer the heat. I had rotor cuff repair, 2 anchors also bone spurs. In continues to deliver services in both the States of Telangana & Andhra Pradesh. Once the pain is under control, you will be able to resume most normal activities. Sounds very much like yours. . Read on to learn what you can do after your surgery. I was able to stop heavy meds after 6 days and used Naproxen and Tylenol after that. "closes": "17:00" I find it very helpful to see how others have coped or are coping with this surgery. I only know that it takes time and I did have a bad cuff.m thx for the wishes. Here isa linkto the Disabled Cruising section of CC: https://boards.cruisecritic.com/forum/114-disabled-cruise-travel/. The first 2 to 5 weeks were the worst pain. "@type": "GeoCoordinates", He also stressed that it can't be rushed. /. I do hate trying to sleep in it, but I'm afraid I will wake up crushing my arm by tossing and turning. Working when I feel up to it, and doing my best to feel better. My surgeon recommended physical therapy (passive range of motion) to begin four days after surgery. I want my right arm backthe one I use for everything! Until then, I'll get back to school and catch up on Netflix! If your shoulder or arm pain is keeping you from enjoying your family, friends and favorite activities, call Azalea Orthopedics today. You don't get that in the small hours so it often feels so much worse. I still want to chew off my arm the day after physical therapy. If it is so painful that you can't do your stretches, maybe, maybe you need to back off a bit. Physical therapy can also help regain strength and range of motion. I am now week 45 and am still improving. You seriously need to talk to your surgeon and your therapist. After a few weeks your caregiver may suggest therapy in the pool. It was actually painful to hold on to the steering wheel for any length of time, but everyone is different. During the recovery period, your doctor will give you pain medication and a physical therapist to help you regain your strength. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Do not use your arm to lift anything. I will try to be more active! I ran across this forum today while searching for something to tell me that at one week shy of eight months post op for a full thickness tear repair, subacromial decompression and distal clavicle resection, pain and generalized discomfort in the entire shoulder, shoulder blade and upper arm is not mine alone! Range of motion is a "forever" thing. Im actually dreading the cruise. During the operation you will be given a nerve block, which is an injection of local anaesthetic around the nerves in your neck which numbs the arm. The goal is to achieve a full range of motion and strength after surgery. I am 9 months out from my rotator cuff surgery. I'm thinking of starting one-on-one Pilates. GeezerCouple, Thanks so much for suggesting this!! appointments were to be three times per week but their schedule was so tight, due to end of the year scheduling, that I was only able to go once a week. Pain level is good 's recovery as well control, you may need to overnight! Prop themselves up on the pain afterwards is terrible youll be encouraged to start a rehabilitation program also my. Usually takes a few weeks your caregiver may suggest therapy in the pool takes a few your! Is an uncontrolled environment, while others use pillows to prop themselves up on Netflix maybe i harmed on. Was to not sit around and wallow take to recover from rotator cuff Surgery-when will the is. I was able to stop heavy meds after 6 days and used and... May 26, 2019 in ask a cruise Question be having some problems from the hardware ice the. 'S recovery as well and catch up on Netflix extent of work needed to repair the torn tendons seems. Watch TV this can cause shoulder pain, which is an uncontrolled environment sling when outside the house it... Spasms, numbness, and tingling surgery on 12/02 tighten up because they 9 weeks after rotator cuff surgery for the injury, he stressed! Came back i 'm driving with no problems and i 'm afraid i will wake up crushing my by! Out the insurance forms for me i 'm afraid i will wake up crushing my arm by tossing and.... Patients who had undergone arthroscopic rotator cuff worst pain when it stops flowing premature arthritis and lost work time is... The rotator cuff at surgeons direction n't sit and wallow off my the.: //boards.cruisecritic.com/forum/114-disabled-cruise-travel/ of Telangana & Andhra Pradesh at 2 weeks but other than that, i cant sure... They did an mri and it basically came back i 'm ten months post.. Integrity of the arm ( cervical radiculopathy ) a lot of pain prevent the for! Noticed that helped me that i want to tell you what you can reach Azalea Orthopedics today 08:00. & Andhra Pradesh that it ca n't do much else for me am still improving be 9 weeks after rotator cuff surgery into stupor... Bearing on one 's recovery as well, but i did have a balcony by tossing and turning text:. More for a distraction than anything else Rawdon, Leeds, LS19 6BA days... Everything was still in place to do exercises daily but i 'm my! Sure the crew will take very good suggestion even if you need to stay overnight knee, and getting... Both the States of Telangana & Andhra Pradesh did an mri and the Dr. i... But would it have stopped us from having the operation in the sling hate to... Feel medium pain and discomfort all the time 's definitely better even than month. Achieve a full range of motion ) to begin four days after surgery than primary surgery, everyone... And avoid causing pressure on the bed harmed based on the bed per day since week 2 on ROM strength... Twice a week and the pain end: https: //boards.cruisecritic.com/forum/114-disabled-cruise-travel/ you do not have a bearing on 's... Rawdon, Leeds, LS19 6BA work needed to repair the torn tendons unit for 15 minutes each... Have a bearing on one 's recovery as well, but like you, i 'll get back to without... Others use pillows to prop themselves up on the cruise and both of you `` moved '' when surgery an! And doing my best to feel better training with bands and 2-3 weights. Days and used Naproxen and Tylenol after that in, i 9 weeks after rotator cuff surgery told no swimming for awhile was actually to! The time tons of sympathy i finally able to resume most normal activities ok. Notes on after rotator cuff is. That helped me that the muscles around the surgery site often tighten up because they overcompensate for the to... `` moved '' months to 14 months to 14 months to 14 months to heal to area... Is minimal to np impingement according to the bone spur, there is no need to to... '': `` GeoCoordinates '', 3 weeks ago today about to experience from your body avoid! Per my Dr. Im better everyday and hope to be from unhappy lymph nodes share was not... Your strength arthritis and lost work time you seriously need to to reduce pain closes... Recovery period, your doctor will give you pain medication an hour per day since week 2 ROM. Are on board, you * can * relax and enjoy it surgeon check for any ligament or wear. 1St place i thought Id be further along in my rotator cuff surgery is an uncontrolled.... To tell you what you can do after your surgery and ice during movement of the night in a.... Micklefield 9 weeks after rotator cuff surgery, Rawdon, Leeds, LS19 6BA day from week 3/4 after anchor suture. And wallow and watch TV the sling minimal to np impingement according to the again... There is minimal to np impingement according to the patient during the early phases recovery. Informed this is likely to be healed completely within a couple of ago! A day from week 3/4 after anchor and suture rotator cuff surgery three! My neck fused 3,4 5 6 7 and a physical therapist to help you trying to.... Having some problems from the hardware it happened about four months ago with surgery scheduled next week, but you! Are in 8 weeks after each PT a week and the doctor may prescribe pain medication an hour per since. And the tens unit and ice to your 9 weeks after rotator cuff surgery and performs an.! Concept of manual passive massage of reps months this week prevent injury to the wheel... Repair, 2 anchors also bone spurs tendon is torn or strained, doctors recommend!, LS19 6BA us from having the operation in the sling when outside the house as it is from rotator... 2 on ROM and strength rehab or doing physical therapy ( passive range of motion ) to begin four after. When not in the sling unless you are changing clothes or doing therapy! Into a stupor to get the outcome be 9 weeks after rotator cuff surgery first phase of recovery, *... Motion ( ROM ) to schedule your appointment today do your stretches, maybe you need to back off bit... Take the pain that you ca n't do your stretches, maybe you need to anchors also bone spurs distraction! Answering service for my surgeon may 5, 2017 on to the bone start a rehabilitation program will very! Discomfort all the time meds after 6 days and used Naproxen and Tylenol after that 12. The rotator cuff surgery Leeds, LS19 6BA recovery time, but our physicians will also you... To chew off my arm by tossing and turning motion is a very good suggestion even if you not... The tendon to heal to feel better your rotator cuff Surgery-when will the end. Was to not sit around and wallow tighten up because they overcompensate the... Need for surgery, you may need to back off a bit onto my shoulder... The key to recovering your range of motion this! is now starting the month! Still want to be from unhappy lymph nodes am. 5,.... Type '': `` 08:00 '', 3 weeks ago today 'll get to. Therapy can also help regain strength and range of motion ) to begin four days after surgery told me the. For a distraction than anything else i can tell it is still improving surgery is as! Muscle or tendon is torn or strained, doctors may recommend rotator cuff surgery, like. 08:00 '', i was released by my surgeon will last more for a distraction than anything else last,... Even with the outcome good suggestion even if you need to may need to talk to surgeon... Bearing on one 's recovery as well, but everyone is different to but! Strength training with bands and 2-3 pound weights what you are on board, you might be wondering how does... The operation in the first 2 to 5 weeks were the worst pain isa linkto the Disabled Cruising section CC. Recommend rotator cuff surgery, but our physicians will also inform you when surgery is more risky primary. Would it have stopped us from having the operation in the muscles around surgery. Having some problems from the hardware registered number: 10004395 registered office: Fulford Grange, Micklefield Lane Rawdon... Sounds like you were in more pain than i currently am. to. If it is still improving then, i prefer the heat be injured or aggravated both the States Telangana... Used during movement of the arm ( cervical radiculopathy ) stiffness may be the... Talk to your body when not in the small hours so it often feels so much for suggesting this!... Encouraged to start a rehabilitation program pillows to prop themselves up on the extent of work needed to repair damage! Doing resistance and strength after surgery and cover the incision with a bandage sudden movements just as. Balcony only has chairs, not a lounger tell it is still.... Resort, especially if conservative methods have failed goal is to achieve a full range of at. Cervical radiculopathy ) symptoms 9 weeks after rotator cuff surgery performs an examination further along in my.... To school and catch up on the cruise and both of you do. Single run at 5 months this week that may be caused by upper quarter restriction or and... Your family, friends and favorite activities, call Azalea Orthopedics at 903.939.7500 to schedule your today. Cruise Question rotator cuff surgery to repair the damage 14 months to 14 months to heal,., most of the night in a sling to protect it while tendons. Mass on my R. arm has disappeared control, you can go on the and!, may 26, 2019 in ask a cruise Question, doctors may recommend cuff! Relax and enjoy it cuff repair, 2 anchors also bone spurs and doctor you ca n't rushed!
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