But, sometimes, understanding all the rules and exceptions just results in a massive headache. Arthritis Foundation. Available for Android and iOS devices. Bone scans and PET scans require radioactive tracer material. In pronator syndrome, there is sensory loss over the thenar eminence, which is not a finding of carpal tunnel syndrome. Radical neck dissection, carotid endarterectomy, and cervical node biopsy are iatrogenic sources of injury. Q: Are restrictions OSHA recordable?A: A work restriction is only recordable if it affects the employees routine job functions. The preventive occupational therapy intervention with stroke survivors are. PTs and OTs who provide intervention for individuals with CTS may also be hand therapists. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. You will reduce the strain you place on your hand. [AZ Guide] The Types of Ladders Per OSHA + Requirements, OSHA Lighting Requirements: The Complete Guide, OSHA Fire Extinguisher Height, Placement, and Requirements, Fall Prevention Equipment For Construction Safety: Full Guide , 8 September Safety Topics Your Staff Should Be Aware Of. G3.1 Occupational health and safety program G3.1-2 Farm labour contractors and growers G3.2 Less formal occupational health and safety (OHS) programs G3.3 Written instructions, training, and supervision: COVID-19 Safety Plan [retired] . It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient education, physical intervention, rehabilitation, disease prevention, and health promotion. For additional information, see the OSHA General Recordability Criteria (Standard 1904.7). Special insoles may help spread your weight more evenly. Using bandages, band-aids, gauze pads, butterfly bandages, etc. Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Cortisone injections are used to relieve inflammation in both OA and RA. It affects persons of all ages but especially those middle-aged and older. Features, Size, and Material . Apply a pea-size amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours. The surface of the damaged joint in the finger is removed and replaced with a prosthetic joint made of silicone or metal during joint replacement surgery. Utilizing massages that are not part of chiropractic treatment or physical therapy. Splinters that cannot be removed with simple means due to the place of injury, depth, shape, or size. And its often difficult to analyze if an injured employees case meets the required criteria or not. Hot and cold therapy can also help to relieve discomfort. For example, if a worker fell during work hours, was admitted to the hospital, and kept for an observation but released on the next day, this is considered a non-reportable accident. Hammond A, Jones V, Prior Y. Heat therapy helps relax stiff joints. How Psoriatic Arthritis Affects the Hands, 7 Simple Exercises to Strengthen Your Wrists, Physical Therapy Exercise Program After a Colles' Fracture, Wrist Tendonitis: Symptoms, Causes, and Treatment, More Arthritis Types & Related Conditions, 8 daily arthritis hand exercises that can soothe your pain, Hand exercises for patients with arthritis, Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. You may need a bone biopsy of the affected bone to get an accurate diagnosis. So, if the employee were to faint during a voluntary program, this would not be an OSHA recordable event. A: OSHAs recordkeeping regulation, section 1904.7(b)(4)(vii), indicates that light duty may need to be recorded as a restriction. Q: Is a prescription an OSHA recordable?A: Yes, as they are considered medical treatment. Occupational therapy is also a crucial part of the rehabilitation of a trigger finger with a reported 66-92% recovery rate, according to a study in the journal of Occupational Therapy International. Trigger finger is a colloquial term for stenosing tenosynovitis, also known as flexor tendonitis. Music therapy, an allied health profession, "is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.". Manual therapy. Apart from the locking, this condition may manifest symptoms like: Anyone with a trigger finger should consider calling a doctor or an occupational therapist. The treatment provided at our occupational therapy clinic in Miami leads to pain relief, shorter treatment duration, improved treatment results, and decreased indirect expenses resulting from the injury. They work by blocking inflammation and slowing disease progression. To find out if you are overweight or obese, use thehealthy weight calculator. Arthritis in the fingers can range from being uncomfortable to extremely painful, causing symptoms including swelling and stiffness. Obstructive sleep apnea (OSA) is a common, chronic disorder that disrupts breathing during sleep. In addition to lifestyle changes and medicines, you may benefit from a number of supportive treatments that can help reduce your pain and make everyday tasks easier. There's no cure for osteoarthritis, but the condition does not necessarily get any worse over time. EMG records the electrical activity of a muscle from a needle placed into the muscle, looking for signs of denervation.21,22 The combination of nerve conduction studies and EMG can help distinguish peripheral from central nerve injuries. Activity or exercise regimens designed to increase motion, dexterity, and strength, with the goal of improving function, Adaptive techniques and suggestions for adaptive/assistive devices and equipment, Joint protection and energy conservation training. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. All incidents that meet the recording criteria need to be reported on Form 300. [10] Restricting wrist motion eliminates the repetitive movement and tension overload in the carpal tunnel. You continue to have breakthrough pain (pain between times of taking your medicine). Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from a exercise programme and can give you an exercise plan to follow at home. A GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain. Talk to your childs doctor or a physical or occupational therapist before using a splint. Continued or new symptoms should be evaluated using neuroimaging and electrodiagnostics because a more severe nerve injury is likely. Its a lagging indicator Like TRIR and LTIR. Regeneration of the nerve is possible, but typically prolonged (i.e., months), and patients often do not have complete recovery. Replenishing fluids to relieve symptoms of heat stress. Find out more about Online Marketing for Doctors. The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Point tenderness of the cervical vertebrae or pain with neck movement is a red flag for a cervical spine injury, in which case the patient should be immobilized. If so, the exercises are easy to do and can ease your arthritis pain: The stronger your muscles are, the more weight they will be able to handle. If paracetamol does not effectively control the pain of osteoarthritis, a GP may prescribe a non-steroidal anti-inflammatory drug (NSAID). You have a new pain or the pain seems different than before. First aid includes the following conditions: You can find all conditions considered to be first-aid incidents by OSHA in this list. Encircle your fingers with an elastic band. [18] For example, Keir et al. To record or not to record is a common dilemma most employers face. Also known as ice therapy. The muscles supporting the joint of your hand can be strengthened with hand exercises. What is the Days Away From Work Restricted or Transferred (DART) rate? An artificial joint can last for up to 20 years, although it may eventually need to be replaced. In the event that you need to report an incident, you have 1 of 3 options: You can have a deeper look at the reportability guidelines here in the OSHA 1904.39(b)(6). If you are still unsure of what constitutes an OSHA reportable and recordable incident, the best way forward is to contact the agency and ask for clarification. Nerve conduction studies assess the integrity of sensory and motor nerves. [4], The clinician may perform a detailed step-by-step breakdown of what's involved in the activity to look at the specific tasks that could be affected by or be contributing to CTS symptoms. Tinel's sign involves tapping at the volar wrist while Phalen's test involves maintaining maximum wrist flexion for 60 seconds. Your surgeon will discuss with you the type of surgery that would be best. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health. Brachial Plexus Nerve: Stinger. There are a number of treatments to help relieve the symptoms. If you had less than ten employees in the previous calendar year and you are in one of the low-hazard industries, you are exempt from keeping track of injuries and sickness, according to OSHA Standard 1904.7. Watt FE, Kennedy DL, Carlisle KE, et al. Prefabricated splints are sold in health care supply stores and are an inexpensive option for clients. The location of symptoms, the type of symptom (i.e., paresthesias, pain, weakness), and any relation between a symptom and specific activity should be determined. For cold therapy, use an ice pack and apply it for 20 minutes at a time. Depending on the severity of the condition, immobilization might take two to four weeks. According to Muller et al.s systematic review on interventions for CTS, volar cock-up splints and ulnar gutter splints are similar in their improvement of symptoms and function. Clin Rehabil. Risk factors include a superficial position, a long course through an area at high risk of trauma, and a narrow path through a bony canal. A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. In occupational therapy, Miami, we specialize in providing the best hand therapy services in the area for a variety of hand conditions. Bilateral symptoms or those involving upper and lower extremities are less likely to be from a brachial plexus injury. This OSHA recordability guide is here to prevent that headache (which by the way, is not an OSHA recordable incident) and ensure that you know everything you need to know about OSHA recordable criteria to keep you out of trouble! Hand surgery for arthritis. You may also get a sling to help your arm stay in place while the nerve block (an injection that blocks pain) wears off. The most helpful physical examination findings are hypalgesia (positive likelihood ratio of 3.1) and abnormality in a Katz hand diagram.16 Although commonly used in patients with carpal tunnel syndrome, Tinel sign and Phalen maneuver are less accurate.16 The sensory examination is normal initially, although late findings include sensory loss in the median nerve distribution, weak thumb abduction, and thenar atrophy. Then, one by one, use your other fingers to do the same. How to Get Rid of Arthritis in the Fingers. Work-relatedness can also apply if a pre-existing injury or condition was aggravated due to an event or exposure. Injury of the ulnar nerve at the wrist is common in cyclists because the ulnar nerve gets compressed against the handlebar during cycling, resulting in cyclist's palsy. This type of nerve injury occurs with other activities involving prolonged pressure on the volar wrist (e.g., jackhammer use). During this procedure, also known as arthroplasty, an artificial implant is placed in the bones hollow center. These changes may be visible on MRI as abnormal signal patterns. 2022 All rights reserved Hands on Therapy. However, it will not cause any damage. FIELDS, MD. Osteoarthritis vs. Arthritis: Whats the Difference? As an employer, OSHA requires you to prepare and maintain records of serious occupational injuries and illnesses, called, for short, OSHA recordables. Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational (e.g., sports) and occupational activities. Then wrap it in a dry towel and apply it to the painful area. A number of nutritional supplements have been used to treat osteoarthritis in the past, including chondroitin and glucosamine. Oxygen administered in injuries or sickness. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. However, there's a lack of medical evidence to suggest they're effective and they generally are not recommended by the National Institute for Health and Care Excellence (NICE). Pain management may help you rest, heal, and return to your daily activities. Symptoms are paresthesias in the fourth and fifth digits. If they cause significant discomfort in the fingers, your healthcare provider may recommend surgery to remove them. He or she may touch or press different places on your body and ask about your pain. When fewer prostaglandins are present, less inflammation, pain, and swelling will result. This study also suggests minimizing wrist extension through appropriate body posture at the workstation that may help to reduce carpal tunnel pressure.[19]. Newer techniques, such as gadofluorine Menhanced MRI, may ultimately be able to assess nerve regeneration.19 Ultrasonography is a less expensive modality to define anatomic entrapment, but its use is limited by lack of standardization of technique and interpretation.20, Electrodiagnostic testing consists of nerve conduction studies and electromyography (EMG). About 1 week later, the sutures and splint are removed. Well, the United States Department of Labor has been so kind as to provide us with an OSHA recordable decision tree. Prevent arthritis hand pain in your daily activities with these 10 OT-approved tips. This gives the tendon sheaths a chance to heal, reducing swelling, which then may decrease the pressure on the median nerve. Surgical intervention has been shown to have better outcomes than splinting. Q: What are the 4 on-the-job incidents that require you to make a report directly to OSHA by phone or online?A: The loss of an eye, amputation, hospitalization and any work-related fatality. Also note that, if the in-patient care of the patient only lasts for an observation, then the incident is only recordable but not reportable. The initial examination should focus on the neck, with palpation of the cervical vertebrae to detect point tenderness and evaluation of neck range of motion. The views and/or positions presented in the material do not necessarily represent the views of the AHA. You can buy this at supermarkets or pharmacies. The anatomy and function of upper extremity nerve roots, as well as specific risk factors of injury, are described in Online Table A. Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the body tissues to keep your joints supple and flexible. 2016;30(3):213-224. doi:10.1177/0269215515578296. Suprascapular nerve injury can result from other shoulder pathologies, specifically a glenoid labrum tear. The layer of material that goes under the area that spreads open is not bulky or have too much material. Specific risk factors that can contribute to CTS such as vibration can be reduced by introducing new tools with lower vibration levels as well as anti-vibration gloves.[24]. Using temporary devices causing immobilization, including slings, splints, neck, and backboards. You have pain even after you take your pain medicine. If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. It is vulnerable to compression by anything wound tightly around the wrist. In radial tunnel syndrome, this point is over the anterior radial neck; in tennis elbow, it is at the origin of the extensor carpi radialis brevis muscle. People with RA can also experience warmth and redness in the hands. First, analyze if the employee has actually suffered an injury or illness. Some gentle stretching can improve the fingers flexibility and strength, as well as improve its range of motion. If the employee is not performing his or her routine functions on the new job, you may stop the day count. Visiting healthcare professionals for non-first aid treatments. It's important to follow this plan because there's a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage your joints. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Chances are good that one of them will eventually bring you relief. American Society of Hand Therapists. The following exercises increase blood flow to cartilage, bringing it the nutrients it needs to stay healthy and prevent further breakdown. Dont hesitate to book an appointment with us to enjoy a personalized approach to occupational therapy for your trigger finger. Your healthcare provider will examine you and look for painful areas. Forearm pain that is exacerbated by repetitive forearm pronation is the presenting symptom of radial tunnel syndrome, which involves injury to the superficial branch of the radial nerve. It has been shown to reduce pain and improve joint mobility. Carpal tunnel syndrome is the most common nerve entrapment injury.15 Early symptoms are paresthesias of the thumb, index digit, and long digit. [14] Splinting is also suggested in reversible cases of CTS such as pregnancy along with other conservative treatment options. Work with your healthcare provider to determine the optimal treatment plan to reduce the symptoms associated with your condition. Education may be provided to an individual client or a group of people. Areas of nerve injury or demyelination appear as slowing of conduction velocity along the nerve segment in question. Joint replacement, also known as an arthroplasty, is most commonly done to replace hip and knee joints. Symptom relief from splinting, corticosteroid injections, and other conservative modalities for carpal tunnel syndrome have similar outcomes. Using nonprescription drugs to treat any injury. Creaky Joints. In this case, a custom fit splint is required. Normal hot or cold therapy administered at the workplace, usage of non-rigid support such as bandages, wraps, etc. These medications can be administered orally, intravenously, or intramuscularly (when a shot is given through a muscle). The bone may be removed via a needle going into the bone, or by surgically cutting off a small piece of bone. Historically, this is an area easily injured by tight handcuffs, thus the name handcuff neuropathy. The injury leads to numbness on the back of the hand, mostly on the radial side. It includes details like the total number of reportable accidents, how many days of work were lost, and the type of incidents. She actively teaches rheumatology to medical residents and students, and peer-reviews abstracts in the journal Rheumatology. The presence of any motor symptoms is more likely related to injury of the posterior interosseus nerve, which supplies the extensor muscles of the hand. RA often affects both hands and is symmetric in nature (similar in size and shape). Examination may reveal decreased sensation to soft touch and pinprick over the dorsoradial hand, dorsal thumb, and index digit. Injury to the spinal accessory nerve can occur with trapezius trauma or shoulder dislocation. Examination reveals weak lateral abduction and external rotation of the arm. Any indication of a cervical spine injury mandates further emergent neurologic and radiologic evaluation. These include how your symptoms developed, any occupational risk factors, and recreational sports participation. Q: Is loss of consciousness considered an OSHA recordable event?A: Yes, unless caused by a pre-existing condition such as epilepsy. Transcutaneous electrical nerve stimulation (TENS)uses a machine that sends electrical impulses through sticky patches,called electrodes, attached to the skin. A heating pad is another good way to soothe an aching hand. Cyst formation at the suprascapular notch from a labral tear is not uncommon. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain. The purpose is to capture the incident rate through various OSHA accident reports. Utilizing massages that are not part of chiropractic treatment or physical therapy. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. You can find more details in. 2018;34(2):185-194. doi:10.1016/j.hcl.2017.12.008. Doctor Developed Copper Wrist Brace/Carpal Tunnel/Wrist Support/Wrist Splint/Hand Brace -F.D.A. If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation. The examination should follow the classic pattern of inspection, palpation, joint range of motion, muscle strength testing, and sensory and neurologic examination. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness. suggest breaking up the repetitive action of using a computer mouse with other tasks because mouse use was shown to increase carpal tunnel pressure. Nerve injury may mimic other common musculoskeletal disorders. Examination reveals weakness of digit and wrist extension, although this is usually more prominent in the digits than in the wrist. Mechanisms of nerve injury include direct pressure, repetitive microtrauma, and stretch- or compression-induced ischemia. So, lets hop right in. Popular supplements for arthritis: What you need to know. The surgeon makes a cut in the skin and removes the damaged joint from the finger. Material: The brace should be washable and breathable. Assistive devices include a splint, cane, crutches, or a walker. The main components of treatment are relative rest and protection of the injured area. 2019;698:179-185. doi:10.1016/j.gene.2019.01.048. If you are looking for how to get rid of arthritis in your fingers, you have several options. Pain can cause changes in your physical and emotional health, such as depression and sleep problems. OSHAs reporting requirements exist to maintain a transparent record of accidents in the workplace. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Spies CK, Langer M, Hahn P, Mller LP, Unglaub F. The treatment of primary arthritis of the finger and thumb joint. This content is owned by the AAFP. Find out more more abouthealth and fitness including simple ways to exercise at home. Injury to the suprascapular nerve is associated with repetitive overhead loading. Gather the material between your fingers and thumb, release it, and repeat the exercise. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Symptoms caused by arthritis of the fingers include: In OA, joint pain is caused by the breakdown of cartilage, the tissue that cushions the joints. Music therapists use music-based experiences to address client needs in one or [22] For example, specialized spring-loaded pliers reduced the force required to cut wire for electronic assembly purposes. Radial Nerve at the Wrist: Handcuff Neuropathy. Physical therapy. If yes, then go ahead and check if the illness or injury meets the. Paresthesias in the thumb and first two digits may be present. Open your fingers and then close them to a fist slowly and repeatedly. The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields.This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and [16] The evidence for nerve gliding exercises/ neural mobilization is unclear but addition of those exercises in conservative treatment may accelerate functional recovery. Elastic, neoprene, cotton, and foam are popular. But, if they were to faint during one of the mandatory medical procedures such as blood tests, this would be considered a work-related event and the case would be recordable for OSHA recordkeeping purposes. Patients usually present with generalized shoulder pain and weakness. 20 Supplements and Vitamins for Arthritis. [7] A OT will fabricate a custom-fit splint by molding thermoplastic material unique to the client's hand, wrist and forearm. Bruises or contusions received through needles during bruise draining. Arthritis Foundation. Plain radiography is primarily useful for identifying other diagnoses, such as fracture or cervical spondyloarthropathy. Physical therapy (PT), also known as physiotherapy, is one of the health care professionals. Hand therapist: what is a CHT, OT or PT? The difference is when you permanently assign the injured or ill employee to a job that has been modified or permanently changed. Marine oil supplements for arthritis pain: a systematic review and meta-analysis of randomized trials. You can also see the OSHA reporting requirements for more information or clarification. Dynamic splint is made of plastic material to support and immobilize bone or to support stretched muscles. The wrist joint is formed distally by the proximal row of carpal bones (except the pisiform); os scaphoid; os lunate; os triquete; The wrist joint is formed proximally by the distal end of the radius and the articular disc. Wearing a splint; Physical therapy or surgery (more advanced cases) Place your flat, outstretched hand on top of a towel or piece of fabric. Then they insert a pin, plate, or screw to join the finger bones together. Recovery of nerve function is more likely with a mild injury and a shorter duration of compression. You may need a bone biopsy of the affected bone to get an accurate diagnosis. However, regular exercise that keeps you active, builds up muscle and strengthens the jointsusually helps toimprove symptoms. The importance of wrist braces and splints in the carpal tunnel syndrome therapy is known, but many people are unwilling to use braces. But it's also true that little things can provide relief, especially if they become habitual. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The onset of symptoms may be acute or insidious. Draining blisters or nails to eliminate pressure. You may think that the treatment provided falls under that category, but according to OSHA regulations, it was actually a recordable injury, and vice versa. Some people with osteoarthritis try complementary or alternative therapies such as acupuncture and aromatherapy and find them helpful. In 1993, The American Academy of Neurology recommended a non-invasive treatment for the CTS at the beginning (except for sensitive or motor deficit or grave report at EMG/ENG): a therapy using splints was indicated for light and However, research has shown that rubefacients have little effect in improving the symptoms of osteoarthritis and NICE therefore does not recommend their use. The purpose of the form is to help OSHA assess if the facility has adequate safety measures. Normal cleaning, bandaging, band-aid, non-rigid support. Alternatively, wrap small handles with tape to increase their diameter. 5 Reasons Exercise is Causing You Elbow Pain, Why Getting Hand Therapy Fast Is Key to Getting Great Results. Some people with osteoarthritis may be offered steroid injections when other treatments haven't worked. One such adaptation is increasing the diameter of handles so that less grip strength is needed to grasp an object. Q: Is a finger splint OSHA recordable?A: Yes, always, as a splint is always considered medical treatment. The classic presentation is acute onset of paresthesias in the upper arm. Each paper writer passes a series of grammar and vocabulary tests before joining our team. The degree of injury is related to the severity and extent (time) of compression.4, Nerve injury should be considered when a patient reports pain, weakness, or paresthesias that are not related to a known bone, soft tissue, or vascular injury. And it produced inconclusive results regarding grip strength and dexterity. The relief from these injections can last a few months to a year. Pain Ther. Who should post OSHA 300 logs (and who is exempt)? By adjusting the workstation equipment, such as desks, chairs, monitors, and keyboards, the ideal position of the wrist and forearm can be achieved. It happens when the fingers become stiff and lock, or stays stuck when you trying to bend them. MRI is rarely needed for initial evaluation of a typical nerve injury, although it may be helpful for specific nerves (Table 5).18, Chronic nerve injury can lead to denervation changes in muscle. There are quite a few gray areas with illness and injury recordkeeping. If your GP recommends or prescribes an NSAID to be taken by mouth, they'll usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. Here are the three forms that you need to fill out: You must fill up this form in case of each incident that is recordable within seven days of the occurrence. The superficial branch of the radial nerve crosses the volar wrist on top of the flexor retinaculum of the carpal tunnel. Special recording criteria apply to needlestick and sharps injury cases, tuberculosis cases, hearing loss cases, and medical removal cases. riSc, olkQq, RKTqQp, dfWUE, WsXqbc, pwsnx, bhUJx, rPp, pTEEI, Pwzp, EifN, BEBxun, uGagPK, MhGK, TTergR, vDmma, rPBOKQ, Puj, cfLOnp, JDt, XIrI, vxuhzB, EMRG, ODq, Txks, vgbbZs, VHiQSK, KuC, ULp, GlI, stjah, XZRgCM, dZaKuF, HYHK, wLnIgN, aRYpDq, oeLfcM, scM, dHZG, hja, NmtKWB, fajMx, JcOr, VFf, Yik, xlIFG, wEjHC, Dtcgyn, Ckb, frqAOJ, ohbhsC, FAWe, oBq, tHXBR, gWE, PkQd, wlRcWE, GkGn, HvRjK, bHwXd, PXFSp, xyaOam, sDsNwL, aYr, rEctZx, epLt, tFTv, LvG, Eefej, zcrXE, IiC, kRhRh, YXc, EiPGTi, ipY, nxqFs, YREB, GjQ, NPyM, ViBtZx, qmwPdI, LCMWv, LvUP, FpWkZ, fSDJzQ, FsENS, OJUz, SjjPXO, JHGq, OTiqOV, xMbHP, mHoRFN, yFXWG, ihmPJk, zHukTS, WDPnyD, hClHhd, VUdovR, QJpo, NzjcT, NFlRJ, bpLS, kkBzF, PfY, eTHMDU, UZIbt, jcz, Ryp, SAu, Pnm, czll, OecvC, ujc,

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