Shoulder Problems and Injuries

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Topic Overview

Minor shoulder problems, such as sore muscles and aches and pains, are common. Shoulder problems develop from everyday wear and tear, overuse, or an injury. They can also be caused by the natural process of aging.

Your shoulder joints move every time you move your arms. To better understand shoulder problems and injuries, you may want to review the anatomy and function of the shoulder. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collarbone (clavicle), and shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or cause problems. The acromioclavicular (AC) joint, which lays over the top of the shoulder, is also easily injured.

Shoulder problems can be minor or serious. Symptoms may include pain, swelling, numbness, tingling, weakness, changes in temperature or color, or changes in your range of motion. Shoulder injuries most commonly occur during sports activities, work-related tasks, projects around the home, or falls. Home treatment often can help relieve minor aches and pains.

Sudden (acute) injury

Injuries are the most common cause of shoulder pain.

A sudden (acute) injury may occur from a fall on an outstretched arm, a direct blow to the shoulder, or abnormal twisting or bending of the shoulder. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. If nerves or blood vessels have been injured or pinched during the injury, the shoulder, arm, or hand may feel numb, tingly, weak, or cold, or may look pale or blue. Acute injuries include:

  • Bruises (contusions), which occur when small blood vessels under the skin tear or rupture, often from a twist, bump, or fall. Blood leaks into tissues under the skin and causes a black-and-blue color that often turns purple, red, yellow, and green as the bruise heals.
  • Injuries to the tough, ropelike fibers (ligaments) that connect bone to bone and help stabilize the shoulder joints (sprains).
  • Injuries to the tough, ropelike fibers that connect muscle to bone (tendons).
  • Pulled muscles (strains).
  • Injuries to nerves, such as brachial plexus neuropathy.
  • Separation of the shoulder, which occurs when the outer end of the collarbone (clavicle) separates from the end (acromion) of the shoulder blade because of torn ligaments. This injury occurs most often from a blow to a shoulder or a fall onto a shoulder or outstretched hand or arm.
  • Damage to one or more of the four tendons that cover the shoulder joint (torn rotator cuff), which may occur from a direct blow to or overstretching of the tendon.
  • Broken bones (fractures). A break may occur when a bone is twisted, struck directly, or used to brace against a fall.
  • Pulling or pushing bones out of their normal relationship to the other bones that make up the shoulder joint (subluxation or dislocation).

Overuse injuries

You may not recall having a specific injury, especially if symptoms began gradually or during everyday activities. Overuse injuries occur when too much stress is placed on a joint or other tissue, often by overdoing an activity or through repetition of an activity. Overuse injuries include:

  • Inflammation of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, a tendon, or the skin (bursitis).
  • Inflammation of the tough, ropelike fibers that connect muscles to bones (tendinitis). Bicipital tendinitis is an inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation usually occurs along the groove (bicipital groove) where the tendon passes over the humerus to attach just above the shoulder joint.
  • Muscle strain.
  • A frozen shoulder, which is a condition that limits shoulder movement and may follow an injury.
  • Overhead arm movements, which may cause tendons to rub or scrape against a part of the shoulder blade called the acromion. This rubbing or scraping may lead to abrasion or inflammation of the rotator cuff tendons (also called impingement syndrome).

Other causes of shoulder symptoms

Overuse and acute injuries are common causes of shoulder symptoms. Less common causes of shoulder symptoms include:

Treatment

Treatment for a shoulder injury may include first aid measures, physical therapy, medicine, and in some cases surgery. Treatment depends on:

  • The location, type, and severity of the injury.
  • How long ago the injury occurred.
  • Your age, health condition, and activities, such as work, sports, or hobbies.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Emergencies

Do you have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.

  • Shoulder pain with chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack
  • Shoulder pain with shortness of breath or painful breathing

After calling 911 or other emergency services:

  • If the person becomes unconscious, see Rescue Breathing and Cardiopulmonary Resuscitation (CPR) in the topic Dealing With Emergencies.
  • If the person is awake, alert, not vomiting, and not allergic to aspirin, have the person chew and swallow one adult-strength aspirin (325 mg) or 4 low-dose aspirin (80 mg each) before emergency medical personnel such as paramedics arrive. Be sure to tell emergency personnel that aspirin has been taken.

Check Your Symptoms

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

Does your shoulder look twisted, bent out of shape, or out of its normal position?

See significance of a shoulder that looks twisted, bent out of shape, or out of its normal position if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Does your shoulder look twisted, bent out of shape, or out of its normal position?

Do you think you have broken or dislocated your shoulder?

Call your health professional today if you answer "Yes" to the following question.

Did your shoulder pop, move, or get pulled out of its normal position and then return to its normal position?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Does your collarbone (clavicle) look twisted, bent out of shape, or out of its normal position?

See significance of a collarbone that looks twisted, bent out of shape, or out of its normal position if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Does your collarbone look twisted, bent out of shape, or out of its normal position?

Do you think you have broken or dislocated your collarbone?

Call your health professional today if you answer "Yes" to the following question.

Did your collarbone pop, move, or get pulled out of its normal position and then return to its normal position?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Do you have pain or tenderness in your shoulder?

See significance of pain or tenderness in the shoulder if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Do you have severe pain?

Call your health professional today if you answer "Yes" to any of the following questions.

Do you have shoulder pain (not from an injury) that does not change when you move your neck, shoulder, or arm? Note: Shoulder pain that does not change with movement may be related to chest pain or symptoms of a heart attack.

Do you have pain with swelling or bruising that began within 30 minutes of an injury?

Do you have moderate pain that is getting worse?

Is a young child protecting a shoulder or unable to use an arm?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

Do you have moderate pain that has not gotten better after 24 hours of home treatment?

Is your shoulder tender to the touch but not red or swollen after 24 hours of home treatment?

Does moving or lifting your arm still cause shoulder pain after 48 hours of home treatment?

Does shoulder pain keep you awake at night?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

Have you had mild pain that comes and goes with no other symptoms for 1 week or longer?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Has your hand or arm turned pale, white, blue, or cold after a shoulder injury?

See significance of pale, white, blue, or cold skin below the shoulder if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Is your arm pale, white, blue, or cold below the shoulder?

After having a shoulder splint applied, has your hand or arm turned pale, white, blue or cold? Note: See first aid for a cast or splint that may be too tight.

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Do you have numbness or tingling in or below your shoulder?

See significance of numbness and tingling in or below the shoulder if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Have you had new numbness or tingling for more than a few minutes?

Do you have numbness or tingling in your hand or arm, and your hand or arm is pale, white, blue, or cold?

Are you unable to move your shoulder normally (not because of pain or because a splint is in the way)?

Call your health professional today if you answer "Yes" to any of the following questions.

Have you had steady numbness or tingling in your arm or hand for 1 hour or longer without other loss of function?

Has your numbness or tingling become worse?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

Have you had brief episodes (less than 1 hour) of numbness or tingling off and on for 1 week or longer?

Has numbness or tingling that comes and goes slowly been getting worse for 1 week or longer?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

close

See significance of inability to move shoulder normally if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Is your shoulder locked in one position, and you are unable to move it normally?

Do you have severe pain?

Does your shoulder feel loose or unstable, and a lot of swelling has developed within 30 minutes?

After having a shoulder splint applied, are you unable to move your arm normally (not because the splint is in the way)?

Call your health professional today if you answer "Yes" to any of the following questions.

Does your shoulder feel loose or unstable, but you do not have other symptoms?

Is a young child carefully protecting his or her shoulder or unable to use an arm?

Are you unable to lift your arm above your head after an injury?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

Do you have shoulder stiffness or decreased movement after 48 hours of home treatment?

Do you have muscle spasms with movement?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.

Does your shoulder lock up from time to time, but it is not locked up now?

Has your shoulder felt loose or unstable off and on for a long time, and your symptoms have not been evaluated by a doctor?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Do you have swelling in or around the shoulder?

See significance of a swollen shoulder if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Is the area below the swollen area is cold or pale?

Call your health professional today if you answer "Yes" to the following question.

Has a lot of swelling developed within 30 minutes of an injury?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.

Do you have moderate swelling from an injury after 48 hours of home treatment?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Do you have snapping, popping, or grating in your shoulder?

See significance of a snapping, popping, or grating if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Does your shoulder look twisted, bent, or out of its normal position after an injury?

Are you unable to move your shoulder normally after an injury?

Call your health professional today if you answer "Yes" to any of the following questions.

Does your shoulder feel loose or unstable after an injury?

Do you have snapping, popping, or grating in your shoulder after an injury, but there are no changes in its appearance or movement?

Have you had a lot of swelling within 30 minutes of the injury?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.

Have you had snapping, popping, and pain in your shoulder with normal movement for 1 week or longer?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

Does your shoulder snap or pop during normal movement, but it does not cause pain?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Do you think that a shoulder injury may have been caused by abuse?

See significance of abuse and shoulder injury if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to the following question.

Do you think that a shoulder injury may have been caused by abuse?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

close

Do you think you have inflammation or infection in your shoulder?

See significance of inflammation or infection in a joint if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional immediately if you answer "Yes" to any of the following questions.

Do you have increased swelling, redness, or warmth around your shoulder?

Do you have severe pain with movement of your shoulder?

Do you have red streaks extending from your shoulder toward your chest or neck?

Is your shoulder tender to the touch?

Do you have any drainage of pus from your shoulder?

Do you know or think you have a fever?

Do you have diabetes?

Do you have a disease or take a medicine that causes problems with your immune system?

Call your health professional today if you answer "Yes" to the following question.

Do you have any symptoms of a skin infection around your shoulder?

You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around the shoulder for 48 hours or longer?

Have you had swollen lymph nodes in the armpit or neck for 1 week or longer?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

close

Is your shoulder bruised after an injury?

See significance of bruising if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional today if you answer "Yes" to any of the following questions.

Did a bruise that is as large as the injured person's palm develop within 30 minutes of an injury?

Did a painful, swollen bruise develop within 30 minutes of an injury?

You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.

Are you worried about how easily you bruise?

Have bruises from an injury lasted longer than 2 weeks?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

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Other Symptoms to Watch For

Do you have any of the following symptoms?

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home Treatment

First aid for a suspected broken bone

  • Control bleeding. Apply steady, direct pressure for a full 15 minutes. Use a clock—15 minutes can seem like a long time. Resist the urge to peek after a few minutes to see whether bleeding has stopped. If blood soaks through the cloth, apply another one without lifting the first. If there is an object in the wound, apply pressure around the object, not directly over it.
  • Remove all bracelets or rings. It may be difficult to remove the jewelry once swelling develops. See a picture of how to remove a ring that won't come off easily.
  • Use a sling to support an injured shoulder.
  • If a bone is sticking out of the skin, do not try to push it back into the skin. Cover the area with a clean bandage.

Splint care

If a cast or splint is applied, it is important to keep it dry and to try to move the uninjured parts of your limb as normally as possible to help maintain muscle strength and tone. Your doctor will give you instructions on how to care for your cast or splint.

Home treatment for minor symptoms

Home treatment may help relieve pain, swelling, and stiffness.

If your injury does not require an evaluation by a doctor, you may be able to use home treatment to help relieve pain, swelling, and stiffness. It may take up to 6 weeks or longer before your symptoms are gone.

  • Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
  • Ice will reduce pain and swelling. Apply ice or cold packs immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.
    • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
    • After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between heat and cold treatments.
  • Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling. Wear a sling for the first 48 hours after the injury, if it makes you more comfortable and supports your shoulder. If you feel you need to use a sling for more than 48 hours, discuss your symptoms with your doctor.
  • Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
  • Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
  • Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.
Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your fever or pain:
Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not take more than the recommended dose.
  • Do not take a medicine if you have had an allergic reaction to it in the past.
  • If you have been told to avoid a medicine, call your doctor before you take it.
  • If you are or could be pregnant, do not take any medicine other than acetaminophen unless your doctor has told you to.
  • Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

  • Signs of infection or inflammation develop.
  • Numbness, tingling, or cool, pale, skin develops.
  • Shoulder range of motion or strength in the joint decreases or does not return to normal.
  • Symptoms do not improve despite home treatment.
  • Symptoms become more severe or frequent.

Prevention

The following tips may prevent shoulder problems or injuries.

General prevention tips

  • Stay in good overall physical shape. Strengthen your wrist, arm, shoulder, neck, and back muscles to help protect and decrease stress on your shoulder. Do stretching and range-of-motion (ROM) exercises for your arms and shoulders.
  • Maintain good posture. Stand straight and relaxed, without slumping.
  • Warm up well and stretch before any activity. Stretch after exercise to keep hot muscles from shortening and cramping.
  • Wear protective gear during sports or recreational activities, such as roller-skating or soccer.
  • Wear your seat belt when in a motor vehicle.
  • Do not use alcohol or other drugs before participating in sports or when operating a motor vehicle or other equipment.
  • Don't carry objects that are too heavy.
  • Avoid catching falling objects.
  • Use a step stool. Do not stand on chairs or other unsteady objects.
  • Use the correct body movements or positions during activities, such as lifting, so that you do not strain your shoulder. Do not lift objects that are too heavy for you.
  • Avoid overusing your arm doing repeated movements that can injure your bursa or tendons. In daily routines or hobbies, think about the activities in which you make repeated arm movements. Try alternating hands during activities such as gardening, cooking, or playing musical instruments. Use rest, ice, compression, and elevation (RICE) for home treatment.
  • Avoid keeping your arms out to the side or raised overhead for long periods of time, such as when painting a ceiling. If you must do these things, take frequent breaks, and use RICE for home treatment.
  • Consider consulting a sports-training specialist if you are a competitive or serious recreational athlete. The specialist can recommend training and conditioning programs to prevent shoulder problems or injuries.
  • Make sure your child's backpack is the right size with good support. Carrying heavy backpacks may increase his or her risk of shoulder problems or injury.
  • If you feel that activities at your workplace are causing pain or soreness from overuse, call your human resources department for information on alternative ways of doing your job or to discuss equipment modifications or other job assignments.

Reduce falls

  • To prevent falls in your home, remove raised doorway thresholds, throw rugs, and clutter. For more information, see Preventing Falls.
  • To prevent falls in babies and toddlers use stair gates to block stairways. Use gates at the top and bottom of the stairs, and use the gates properly. For more information, see tips to prevent falls in babies and toddlers.

Keep bones strong

  • Eat a nutritious diet with enough calcium and vitamin D, which helps your body absorb calcium. Calcium is found in dairy products, such as milk, cheese, and yogurt; dark green, leafy vegetables, such as broccoli; and other foods. For more information, see the topic Healthy Eating.
  • Exercise and stay active. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have been inactive. For more information, see the topic Fitness.
  • Avoid drinking more than one alcoholic drink per day. People who drink more than this have a higher risk for weakening bones (osteoporosis). Alcohol use also increases your risk of injuries related to falls.
  • Stop or do not begin smoking. Smoking puts you at a much higher risk for developing osteoporosis. It also interferes with blood supply and healing. For more information, see the topic Quitting Tobacco Use.
  • Cut down on caffeine. Caffeine in coffee and soda pop may increase calcium loss from your body and increase your risk for osteoporosis.

Possible abuse

Shoulder injuries such as bruises, fractures, or dislocations may be caused by abuse. Suspect possible abuse when an injury cannot be explained or does not match the explanation, repeated injuries occur, or the explanations for the cause of the injury change. Seek help if:

  • You suspect abuse. Call your local child or adult protective agency, police, or a doctor, nurse, or counselor.
  • You or someone you know is a victim of violence.
  • You have trouble controlling your anger with a child or other person in your care. Resources are available for help.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms?
  • How long have you had your symptoms?
  • What were you doing when you first noticed your symptoms?
  • Have you had this problem in the past? If so, do you know what caused the problem at that time? How was it treated?
  • How and when did an injury occur? How was it treated?
  • Have you ever had any injuries to the same area? Do you have any ongoing problems because of the previous injury?
  • What activities related to sports, work, or your lifestyle, make your symptoms better or worse?
  • Do you think that activities related to your job or hobbies caused your symptoms?
  • What home treatment measures have you tried? Did they help?
  • What prescription and nonprescription medicines have you taken? Did they help?
  • Were illegal drugs or alcohol involved in your injury?
  • Do you have any health risks?

If you have a shoulder problem, the following list of questions may help you and your doctor determine how much your shoulder and arm function has changed.

Arm position

  • Is your arm comfortable hanging at your side?
  • Can you sleep on your affected side?

Movement

  • Can you wash your back or opposite shoulder?
  • Can you toss an object underhand?
  • Can you toss an object overhand?
  • Can you put your hand behind your head?
  • Can you tuck in the back of your shirt?

Lifting

  • Can you carry 20 lb (9 kg) at your side, such as carrying a light suitcase?
  • Can you put a 1 lb (0.5 kg) object up on a shelf at chest level or higher?
  • Can you put an 8 lb (3.6 kg) object up on a shelf at chest level or higher?

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer William M. Green, MD
- Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD
- Emergency Medicine
Last Updated September 24, 2007
Last Updated: 09/24/2007

© 1995-2007, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED.

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here. Privacy Policy. How this information was developed.

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