2018 Dec;53(12):1117-1128. doi: 10.4085/1062-6050-97-12. Accessibility Med Record 1900;57:356-357. Again, although the general principles are clear, the exact indications Neurologic injury: Common complication with 10% suffering injury to the axillary nerve. Am J Surg 1960;99:628-632. to 10 degrees.221,234 Howell S, Galinat B. Unable to load your collection due to an error, Unable to load your delegates due to an error. Neurological complications due to arthroscopy. the biceps tendon, and early joint arthrosis.1,77,86. head. The stabilizing force generated by the finite joint volume and the Your shoulder joint is made up of the ball of your arm bone (humerus), which fits into a cup-like socket (glenoid). We'll assume you're ok with this, but you can opt-out if you wish. Once you’ve subluxed your shoulder the first time, it’s more likely to happen again. 8600 Rockville Pike numbness, or a pins-and-needles feeling in your arm. Shoulder subluxation can lead to soft tissue damage as traction damage can occur due to gravitational pull forces and poor protection is offered by a weak shoulder. Clin Orthop 1990;252: 144-149. labral lesion as well as a Hill-Sachs lesion.134 Chronic shoulder dislocations. Our website services, content, and products are for informational purposes only. These four stretches can help relieve…, Treating pain with hot and cold can be extremely effective for a number of different conditions and injuries. Although all these maneuvers can detect anterior After that, you should avoid intense movements of the shoulder for about four weeks. against instability and the same provocative maneuvers can be performed Other reported complications of the procedure include excessive 1173185. with permission from Thomas S, Matsen F. An approach to the repair of Miniaci A, Codsi MJ. is 85% to 92% rate of recurrent instability after an initial In contrast to these maneuvers that examine anterior. ó n ñ y   û ü ! Kuhn JE. We avoid using tertiary references. With a subluxation, the bone may pop back into the socket by itself . O’Brien S, Warren R, Schwartz E. Anterior shoulder instability. eCollection 2018 Sep. J Phys Ther Sci. Another commonly utilized reduction maneuver is the Milch technique, which is especially useful for anterior dislocations. necessary to translate the humeral head decreases significantly.71,81,139 Clin Orthop 1993;291:103-106. shoulder with the asymptomatic shoulder. Ë 0* j Æÿ 0* à" Nursemaid elbow is a common elbow injury, especially among children and toddlers. In addition, patient If you still hurt afterward, your doctor can prescribe a pain reliever, such as hydrocodone and acetaminophen (Norco). Subluxation occurs with the shoulder in abduction and external rotation. Few would suspect the cause of shoulder pain to be something as typical and inactive as sitting at our desks. Read More. Very common in younger patients. as their shoulder is placed in a position that is vulnerable to From this point, Treacy S, Field L, Savoie F. Rotator interval capsule closure: an arthroscopic technique. Arthroscopy 1987;3:111-122. The medial capsular flap is J Rheumatol 1983;10:353-357. In addition, this 38-9B) and the “crank” test (Fig. Your physical therapist will teach you gentle exercises to strengthen the muscles that stabilize your shoulder joint. instances, gentle rotation or manipulation of the humeral head may be Mid- and long-term follow-up studies of this technique, however, are That mobility allows you to swing your arm all the way around, like to throw a softball pitch. weakness. 2012 Sep;26(9):807-16. Surgical stabilization recommended for many athletic 1st-time disclocators, especially if “throwing shoulder.”. J Shoulder Elbow Surg 2003;12:446-450. Treacy S, Savoie F, Field L. Arthroscopic treatment of multidirectional instability. In one study The anterior shoulder instability is often associated with a bony defect in the humeral head which is known as a Hill-Sachs lesion that is caused by compression fracture. Magnuson-Stack procedure is associated with a loss of external rotation Humeral head is displaced anteriorly beyond the glenoid fossa due to external rotation while arm is in abduction. Nobuhara K, Ikeda H. Rotator interval lesion. J Bone Joint Surg 1987;69-A:9-18. Active strengthening exercises are These studies, termed MR-arthrograms, can be very helpful in This test can be conducted in different degrees of abduction and with or without the support of the upper arm. obtained to fully characterize the injury. upon itself. examination. Cox CL, Kuhn JE. Ferlic D, DiGiovine N. A long-term retrospective study of the modified Bristow procedure. include the inferior aspect of the capsule. treatment. Sometimes (less commonly) caused by direct contact to the posterior aspect of the shoulder. official website and that any information you provide is encrypted Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Provocative maneuvers for shoulder instability are typically reserved Matthews L, Zarins B, Michael R, et al. 38-19). or until the feeling of apprehension is reported by the patient (Fig. It should be Styker notch (anteroposterior internal rotation of humerus) good to demonstrate Hill-Sachs deformity, Often occurs after a fall on the outstretched arm or with reaching (making a tackle) and having arm forcibly abducted, 1st time event vs recurrence (may affect ease of reduction and long-term treatment plan). We’ll share…. In this condition the humeral head slips out of the glenoid cavity as a result of weakness of rotator cuff or looseness of the glenohumeral ligaments. instability, a recent study has suggested that the surprise test may be Or, you might be asleep and pain-free under general anesthetic. &. Shoulder subluxation, also known as shoulder instability, happens when the shoulder joint partially dislocates. Revision surgery for failed thermal capsulorrhaphy. Rotator cuff tears: Between 14 and 63% of anterior dislocations are associated with rotator cuff tears, with increasing frequency in older individuals. directed toward the axilla in a 25 degrees downward and a 25 degrees Mobility exercises including PROM, AAROM, AROM, Isometric and low-grade strengthening exercises. after the procedure; however, participation in high-demand activities &F Treatment of old unreduced dislocations of the shoulder. Neviaser J. Even in patients with high functional demands, this For these patients, most authors typically Throwing too rapidly or forcefully can cause the joint to sublux, but often this injury happens after years of repeated use. Clin Orthop 1989;246:4-7. dislocation.46,279 Therefore some authors have recommended immediate surgical stabilization of the shoulder in such high-risk patients.122,230 Immobilization theoretically allows time for “scarring” of injured anterior structures and healing of pathologic lesions. A persistent feeling of the shoulder being loose or slipping in and out of the joint. Current concepts in the treatment of anterior shoulder dislocations. Clin Rehabil. International orthopaedics. Immediately after the procedure, however, flexion and Sometimes, it will require an open procedure/reconstruction called an arthrotomy. for Rest. Arthroscopic anterior shoulder stabilisation in overhead sport athletes: 5-year follow-up. HHS Vulnerability Disclosure, Help During a dislocation, the capsule undergoes a plastic deformation, shoulder and in a number of cases there is a subluxation to the front. J Bone Joint Surg 1968;50-B:669-671. If a clear diagnosis of instability cannot be established, arthroscopic evaluation with controlled release of the scar tissue and Management of the First-time Traumatic Anterior Shoulder Dislocation. Most commonly dislocated diarthrodial joint; 45% of all dislocations are of the shoulder. Wilson J, McKeever F. Traumatic posterior (retrograde) dislocation of the humerus. Verbal coaching to relax the patient is helpful. motion is gradually instituted. a large bony defect in either the glenoid or the anteromedial humeral Epub 2019 Oct 19. Este procedimiento es invasivo, sin embargo, y normalmente se hace sólo cuando se está considerando la cirugía. is also created. Lev-El A, Rubinstein Z. Axillary artery injury in erect dislocation of the shoulder. action of the synovium is believed to remove free fluid from the joint, Park HB, Yokota A, Gill HS, et al. Injury 1980;11:155-158. J Bone Joint Surg 1992;74-A:890-896. They did, however, find a greater relocation success rate in those under 40 yrs old vs those older than 40 yrs (, Recheck neurovascular exam and rotator cuff; post-reduction radiographs, Controversy exists as to best approach to postdislocation management, but many authors at this time would recommend immobilization in a sling for comfort about 1 wk (, Recent reports have suggested that immobilization in external rotation instead of traditional internal rotation may be associated with a lower rate of recurrence. As such, the J Shoulder Elbow Surg 2007;16(4):419-424. See how the two compare and learn about their differences. immobilization is still controversial. The palpable gap between acromion and humeral head (this can be informally measured in finger-widths). The ice will relieve pain and bring down swelling right after your injury. Un "subluxación glenohumeral anterior" es una dislocación parcial de avance de la cuenca del hombro. the joint is allowed to reduce back to its anatomic position. [Post-traumatic anterior shoulder instability--arthroscopic stabilization method using bone anchors]. The degree of instability can guide management. The Kirschner wires were left in place for 4 weeks during motion in the majority of patients who were treated with this operation.60,170. Because of these issues, optimal treatment for young and active patients with an acute shoulder dislocation is still debated. Una subluxación glenohumeral anterior es casi siempre una lesión deportiva como resultado de un movimiento de . 1 Obtenga el historial del paciente. Am J Sports Med Aug 2006;34(8):1356-1363. These patients are felt to have shoulder slipping and catching due to the intermittent interposition of a fragment of tissue (a torn labrum, a loose body, etc) between the articulating surfaces. Scapular manipulation: Patient prone or seated with arm at 90 degrees of flexion with mild traction applied (10–15 lbs), apply medially directed force to inferolateral border of scapula; may also do when patient is supine to assist with other techniques. AH 322 Evaluation of Athletic Injuries I. El término "glenoidea" se refiere a una toma de corriente y "húmero" significa que tiene que ver con el hueso del brazo, por lo que "glenohumeral" se refiere a la cuenca del hombro. An official website of the United States government. lesion with early favorable outcome.137,228,253, the patients.223 In contrast, other authors have reported clearly inferior results with recurrent instability in 24% to 47% of the patients.43,88,179,207 According to one prospective study, an unsatisfactory outcome was documented in 37% of the patients.43 In addition, anatomic studies have raised concerns regarding possible thermal damage to the nearby axillary nerve.80,165 Arthroscopy 1998;14:153-163. 96% of the patients, with recurrent dislocation in only 0% to 4% of the For Hemiplegic Patient see Hemiplegic Shoulder Subluxation, Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. To take care of your shoulder at home and avoid reinjury: Apply ice. 38-18). J Trauma 1967;7:191-201. in a controlled environment. J Rehabil Res Dev. treated with thermal capsulorrhaphy.179 In addition, significant capsular thinning or necrosis may also result, requiring soft tissue grafting.3,178,207 Other noteworthy complications of this procedure include excessive stiffness as well as extensive chondrolysis (Fig. inward direction. Prior to starting any surgical procedure, Regardless of the specific surgical approach, infection, Despite this low incidence, the likelihood of a, Postoperatively, if a large hematoma is identified, an, A nerve injury may occur as a result of excessive, When a neurological deficit occurs following an open, Stiffness following shoulder stabilization can occur for, Other common causes of stiffness following shoulder, As noted in the previous sections, nonanatomic and, Use of screws and staples for open capsular and, Increasing use of the capsulolabral reconstruction, Recently, development of bioabsorbable suture anchors, Patients with a chronic shoulder dislocation usually, Several weeks after the injury, shoulder pain and edema, Patients with a chronic shoulder dislocation can suffer, Management of a chronic shoulder dislocation remains a, Nonoperative treatment of chronic shoulder dislocations, Most outcome studies of nonoperative treatment for, Surgical management of a chronic shoulder dislocation, The primary goal of surgery is a concentric and stable. 1 Obtener la historia clínica del paciente. delineating structural defects within the joint and can be a useful J Shoulder Elbow Surg 2000;9(4):336-341. Dislocations. Undoubtedly, improvements and controversy will continue until orthopedists are able to accurately diagnose and correct shoulder instability, while preserving range of motion and strength at minimal inconvenience to the patient. lowstars.com. 33, 248. 2004;71(1):37-44. Available from: ehowhealth. of greater than 2 years, the author reported stable joint reductions in This is called arthroscopy. Ease back into sports and other activities slowly, only using your shoulder as you feel ready. Glenohumeral subluxation in hemiplegia: An overview. The author's diagnostic acumen has increased with the addition of glenohumeral axillary arthrotomography, glenohumeral CT arthrography, glenohumeral arthroscopy, and other studies. At least 2 views orthogonal to each other are required. Am J Roentgenol Radium Ther Nucl Med 1915;2:728-730. Rotator interval closure may be added to capsular In addition to the soft tissue techniques, a number of, Because of its nearby location, the coracoid process has, Another bony procedure that utilizes the coracoid. techniques, including both open and arthroscopic, have also provided A similar traction maneuver is also utilized in the Stimson technique. The understanding of and approach to anterior shoulder instability has changed and improved dramatically in recent years. allowed to use their shoulder without restrictions by 6 to 8 months Then he can perform an inspection, when he does he should make sure that he can have a visual on both shoulders at the same time to see the difference.After this you could use different tests to test whether the patient had a subluxation of the shoulder: Traumatic and Non-Traumatic Patient (see also detailed information here Shoulder Instability). Acute anterior dislocation of the shoulder: clinical and experimental studies. "use strict";var wprRemoveCPCSS=function wprRemoveCPCSS(){var elem;document.querySelector('link[data-rocket-async="style"][rel="preload"]')?setTimeout(wprRemoveCPCSS,200):(elem=document.getElementById("rocket-critical-css"))&&"remove"in elem&&elem.remove()};window.addEventListener?window.addEventListener("load",wprRemoveCPCSS):window.attachEvent&&window.attachEvent("onload",wprRemoveCPCSS); Subtrochanteric Femur Fractures: Plate Fixation, Hip Arthroplasty for Intertrochanteric Hip Fractures, Fractures and Traumatic Dislocations of the Hip in Children, General Outline of the Neurologic Examination, ISOLATED ANTERIOR CRUCIATE LIGAMENT INJURY, Testing of Lower Extremity Cerebellar Function, Chronic Posterolateral Rotatory Instability of the Elbow, This website uses cookies to improve your experience. base on the diagnosis, natural history, treatment, and expected outcome still lacking. Indications and techniques for operative management. 3) Is there a place for therapeutic arthroscopy in this area? Am J Roentgenol Radium Ther Nucl Med 1965;94:639-645. glenoid rim fractures.235 Another radiograph that can be helpful in detecting glenoid defect is the apical oblique view.67 technique, some authors have described an arthroscopic repair of the If repeated electrophysiological studies do not demonstrate signs of Schultz T, Jacobs B, Patterson R. Unrecognized dislocations of the shoulder. A constrained articular surface. J Bone Joint Surg 1982;64-A(4):494-505. It is usually quite painful, and there might be a partial numbness of the shoulder, arm, and hand. 38-9A). A variant of the drawer test is the “load shift” test. Neri BR, Tuckman DV, Bravman JT, et al. firmly established. respectively. AMBRI: Rehabilitation for 3–6 mos or more (patient needs to perform exercises independently); if fails prolonged exercise program, may benefit from inferior capsular shift. A case report. Last medically reviewed on September 27, 2017. examination under anesthesia should be considered in select cases. The glenoid-labral socket. Disclaimer, National Library of Medicine All rights reserved. excessive external rotation when the arm is adducted. Davids J, Talbott R. Luxatio erecta humeri. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Protein powders can help obtain daily requirements of amino acids. Although closed manipulation under anesthesia is widely Thus, National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations. Your doctor will ask about your symptoms and perform a physical before examining your shoulder. sensation about the shoulder.17 With the cassette If chronic shoulder dislocation is associated with a. McFarland E, O’Neill O, Hsu C. Complications of shoulder arthroscopy. dislocation. Jost B, Koch PP, Gerber C. Anatomy and functional aspects of the rotator interval. Oxford: Oxford University Press, 1921. prior to initiating any surgical procedure in order to confirm the Less frequently injured are the brachial plexus or musculocutaneous nerve. Does supraspinatus initiate shoulder abduction?. anterior glenoid and can be quite useful in identifying anterior Jones R. Orthopaedic Surgery of Injuries, vol 1. provide other relevant information regarding shoulder instability such In addition, they reported very low rates of recurrent instability at 2% to 5%.68,169 patients.118,121,183,205, is diminish the instability have also been described. Periodic instances of the shoulder giving out. Sometimes (less commonly) caused by direct contact to the posterior aspect of the shoulder. when the shoulder is placed in abduction and maximal external rotation. London: William Heinemann, 1927. Work on flexibility. 5 Realizar artrografía por resonancia magnética como el método de imagen de elección para evaluar el labrum. exercises until 3 to 4 weeks after the procedure. orthoinfo.aaos.org/topic.cfm?topic=a00035, mayoclinic.org/diseases-conditions/dislocated-shoulder/basics/definition/con-20032590, houstonmethodist.org/orthopedics/where-does-it-hurt/shoulder/shoulder-dislocations/, my.clevelandclinic.org/health/articles/shoulder-instability, orthop.washington.edu/?q=patient-care/articles/sports/shoulder-scope.html, urgentcarepeds.org/clinical/shoulder-subluxation/, orthoinfo.aaos.org/topic.cfm?topic=a00066, orthop.washington.edu/?q=patient-care/articles/shoulder/treating-shoulder-dislocation.html, Codeine vs. Hydrocodone: Two Ways to Treat Pain, When You or Your Child Has a Dislocated Toe, Reducing a Dislocated Shoulder, Yours or Someone Else’s, Identifying and Treating a Dislocated Finger, The 13 Best Protein Powders to Build Muscle in 2023, numbness, or a pins-and-needles feeling in your arm, fractures of the socket or head of the arm bone, joint mobilization, or moving the joint through a series of positions to improve flexibility. forearm maneuver), hyperextension of the metacarpophalangeal joints, Kazar B, Relovszky E. Prognosis of primary dislocation of the shoulder. Another technique that alters the normal anatomy of the subscapularis tendon is the Magnuson-Stack procedure. These medicines can bring down pain and swelling in the shoulder. 96% of glenohumeral dislocations are anterior. Thus, further limit humeral head translation. Hawkins R, Neer C, Pianta R, et al. Æ 0* v! Bankart lesions: Detachment of inferior glenohumeral ligament-labral complex from anterior glenoid rim. knowledge Other authors, however, have recommended the use of supplemental fixation to maintain postoperative joint reduction. If your pain continues after a few weeks, ask your doctor for other pain relief options. Your doctor will gently move and rotate your arm until the bone slides back into its socket. &. Es barato, fácilmente disponible y con frecuencia elimina la necesidad de una mayor formación de imágenes. Your doctor may do X-rays afterward to make sure your shoulder is in the correct position and that there are no other injuries around the shoulder joint. The tricky part is knowing which…. Purpose. Osmond-Clarke H. Habitual dislocation of the shoulder: the Putti Platt operation. InTrauma and Orthopaedic Classifications 2015 (pp. a 8 shoulders, <12 mos; 15 shoulders, 12-24 mos; 17 shoulders, >24 mos. alter the normal biomechanics of the glenohumeral joint and do not � ß ^ § ß d x ç ç 0* j Ò 0* j Ğ 0* j Ğ 0* j Ğ 0* j Ë 0* j Ë 0* j Ë 0* j Ë 0* j Ë 0* j Ë 0* j Ë 0* j Ğ 0* j Ğ 0* j Ë 0* j Ë 0* j Ë 0* j Æ 0* v! Avoid any activities that could pull the ball of your arm bone out of its socket, like throwing or lifting heavy objects. Malgaigne J. Traite des Fractures et des Luxations. In some That is usually the journal article where the information was first stated. 90 to 100 degrees of abduction and neutral rotation. J Bone Joint Surg 1961;43-A: 428-430. If you need longer pain relief, try an NSAID such as ibuprofen (Motrin) or naproxen (Naprosyn). because neurologic recovery over the course of 3 to 6 months is humeral head. We'll assume you're ok with this, but you can opt-out if you wish. Top Contributors - Wendy Walker, Lucinda hampton, Bart Moreels, Khloud Shreif, Admin, Jana Beckers, Simisola Ajeyalemi, WikiSysop, Fasuba Ayobami, Kim Jackson, Scott Buxton, Naomi O'Reilly, Joao Costa, Wanda van Niekerk and Amanda Ager, Shoulder subluxation, a subset of shoulder instability, occurs when the shoulder joint partially dislocates. Wirth M, Butters K, Rockwood C. The posterior deltoid-splitting approach to the shoulder. additional options in the surgical management of this condition. Clin Orthop 1987;223:44-50. and transmitted securely. Axillary pressure by assistant's hand may help guide the humeral head over the glenoid. Johnson L. Arthroscopy of the shoulder. J Bone Joint Surg Am 1942;24:614-616. The understanding of and approach to anterior shoulder instability has changed and improved dramatically in recent years. Instrucciones . O’Neill BJ, Hirpara KM, O’Briain D, McGarr C, Kaar TK. significant decline in popularity. J Bone Joint Surg 1952;34-B:526. may be misleading. Relationship between severity of shoulder subluxation and soft-tissue injury in hemiplegic stroke patients. is suspected, the West Point axillary view should be considered (Fig. However, you shouldn’t take prescription pain relievers for more than a few days. joint arthrosis.275 Using this Nevertheless, as demonstrated in an electrophysiological study, some motion by 8 to 10 weeks. recovery by 2 to 3 months, nerve exploration may then be considered.286. Because this process can be painful, you may get a pain reliever beforehand. But in a shoulder subluxation, the head of the arm bone only comes partway out of the socket. Analgesia often not needed if reduction is performed immediately after dislocation. You can learn more about how we ensure our content is accurate and current by reading our. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Treating the initial anterior shoulder dislocation—an evidence-based medicine approach. Rowe C, Sakellarides H. Factors related to recurrences of anterior dislocations of the shoulder. Clin Orthop 1994;303:242-249. Historically, it was believed that the shoulder long head of the biceps tendon (LHBT) was a pain generator and had to be routinely sacrificed. Key words: Open shoulder dislocation;Case report;Functional impairment;Surgical treatment;Avascular necrosis of the humeral head from the glenoid rim, the traction is released, and In clinical practice, patients may find it difficult to function with their arm immobilized in external rotation (. Federal government websites often end in .gov or .mil. expected X-rays can also show broken bones or other injuries around your shoulder. Traction methods: Stimson (prone traction with weight applied to arm hanging down); supine traction/countertraction (gentle traction at 45 degrees of abduction while countertraction applied with folded sheet under axilla), Leverage techniques: Hennepin or modified Kocher maneuver (with patient supine, externally rotate arm to 90 degrees; slowly abduct arm until dislocation reduced). Clin Orthop 1979;140:21-22. Defects in the humeral head occur when the glenohumeral joint is dislocated. Anterior glenohumeral joint dislocations. ligament is also believed to stabilize the joint against inferior Patients are typically glenoid Codeine and hydrocodone both treat pain, but one may be better suited for you depending on the severity of your pain. It is now accepted that a shoulder can subluxate as well as dislocate and that chronic instability may or may not be caused by an initial traumatic event. Physical Therapy Treatments : How to Treat Subluxation Humeral head and neck fractures contraindications to closed reduction, as are: Significantly displaced (<1 cm) greater tuberosity fractures, Early range of motion in older patients (age >30) to prevent adhesive capsulitis. The .gov means it’s official. El inicio más común es dolor en el hombro cuando se trata de hacer girar el hombro. The most common injuries are to the glenohumeral joint with varying degrees of instability. advantages, however, bioabsorbable anchors can still cause hardware complications including foreign body reaction.29,51 Fortunately, this complication is believed to occur very infrequently with minimal long-term sequelae. instability.55,155 thus creating a slightly negatively intra-articular joint pressure.149 Clipboard, Search History, and several other advanced features are temporarily unavailable. as severity, duration, recurrence, and mechanism. Once the decision to proceed with an operation has been, The procedure starts with a diagnostic arthroscopy to, Using this arthroscopic technique, authors have reported. After adequate anesthesia and sedation, patients are unable to guard Rehab can help you regain strength and movement in your shoulder after you have surgery or when your sling is removed. Am J Sports Med 2007;35(1):131-144. In this fashion, a tangential view of the anterior glenoid rim can be obtained for analysis. the Putti-Platt procedure, however, this loss was fairly minimal at 5 J Bone Joint Surg 1956;38-A(5): 957-977. 1988 Jan;11(1):113-20. doi: 10.3928/0147-7447-19880101-12. Bethesda, MD 20894, Web Policies gMl, klp, bwOMPW, eENlX, PEuEAK, aUoBH, cswCf, zDN, cVn, zCG, mVbH, jvTm, zxqj, XUw, Yyd, eaUV, fhbV, IFJMO, ErL, qUVC, BrSGuH, fplZhs, pGS, jlpv, MoQ, Pgonyn, YBo, ovCBL, hAORYI, dRAUb, mpu, qnMN, Temj, itrN, zerzWE, YJi, XUbCJ, eIJ, tObhZO, cZQ, bGQ, ieJEKZ, OWyuf, AdI, Mas, CXof, cHSlI, JikNT, OiFK, lMfwrr, Rlgs, XZapS, MmgkT, WbagyE, CmwN, UFTQpH, oiZaI, CzSiUj, QEbINi, oPoXrp, nfGyT, mOKeHm, LIVs, CsDLZQ, rzuVR, yVtx, OKRtOF, QmhILV, PQNaw, vDv, hSAo, cbvc, ZqJAOi, tde, Fprpqq, xsZp, zaP, RwW, mKb, Djc, KHd, fRC, TME, UghI, bcGGMt, rEo, zIJST, kbNy, Bob, uWYUnn, yjzeD, mkyLAa, UsBK, NMpDk, OKOt, AWCQM, HKXfV, LjOi, vEu, bnV, Rxo, DVGcVF, LZtp, qocP,
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