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Síndrome de Dolor Regional Complejo (SDRC)

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What CRPS is, why it sometimes follows a wrist or hand injury or operation, how it is recognised and treated, and what recovery looks like.

Updated Sep 2026
Una mano con un suave halo que sugiere una sensibilidad aumentada.
En el SDRC, una extremidad puede volverse extremadamente dolorosa, hinchada y sensible, de forma desproporcionada respecto a la lesión original. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Qué está usted sintiendo

El síndrome de dolor regional complejo (SDRC) es una afección en la que el dolor y otros síntomas persisten después de una lesión o cirugía, a menudo de forma desproporcionada respecto al problema original. Puede afectar a la mano o al brazo tras una fractura o una operación, y se debe a una combinación de factores, no a una sola causa.

El síntoma principal es el dolor. Puede ser intenso y agotador, y a veces se extiende más allá del lugar de la lesión. Con frecuencia empeora por la noche o después de usar la mano, y puede estar presente al despertar. El movimiento, el tacto o la presión sobre la zona afectada pueden desencadenarlo. El reposo de la mano puede aliviarlo un poco, pero el dolor suele persistir.

Las tareas cotidianas pueden volverse difíciles. Es posible que le cueste agarrar una tetera, girar una llave, abrochar botones o sostener un bolígrafo. Escribir, cocinar y llevar las compras pueden resultar más complicados de lo normal. Algunas personas evitan usar la mano por temor al dolor que esto provoca.

El diagnóstico del SDRC se realiza a partir de la historia clínica y un examen físico, no mediante una sola prueba de imagen o análisis de sangre. El médico también descartará otras causas de dolor crónico antes de concluir que se trata de SDRC.

Es fundamental reconocer y tratar la afección a tiempo. Un tratamiento oportuno reduce la probabilidad de pérdida permanente de movilidad y funcionalidad. No obstante, a pesar de una atención temprana adecuada, algunas personas quedan con alguna discapacidad o limitación permanente.

Hay personas con mayor predisposición a desarrollar SDRC. Las mujeres, las personas mayores y quienes realizan trabajos manuales intensos corren más riesgo tras una cirugía por fractura de muñeca. Los problemas nerviosos preexistentes, como un nervio comprimido o una afección nerviosa cervical, aumentan aún más ese riesgo. Después de una cirugía para la contractura de Dupuytren, las mujeres y quienes requieren liberación de más de un dedo tienen mayor probabilidad de padecerlo.

Si siente un dolor inusual o que no mejora como cabría esperar, comuníquelo a su médico cuanto antes.

¿Qué está ocurriendo realmente?

El SDRC no es un daño que se pueda ver en un escáner. Es posible que la lesión en el hueso o el tejido esté sanando bien, pero la forma en que el cuerpo procesa el dolor ha cambiado. Los nervios y el cerebro envían y interpretan las señales de dolor de manera distinta a como lo hacían antes; por eso, una mano que parece normal por fuera puede sentirse ardiente, sensible o dolorosa al usarse.

Imagínese un detector de humo que se ha vuelto demasiado sensible: una pequeña cantidad de humo activa toda la alarma. De igual modo, un roce leve o un movimiento suave pueden desencadenar un dolor intenso. Por esta razón, los síntomas descritos anteriormente son consecuencia de la propia enfermedad y no se deben a que usted haya hecho algo mal.

Dado que las propias señales de dolor han cambiado, los escáneres y los análisis de sangre no son fiables para detectar el SDRC. No existe una sola prueba que lo confirme. En su lugar, el médico analiza su historial clínico y realiza un examen, descartando primero otras causas posibles. El SDRC solo se diagnostica una vez que se han excluido todas las demás explicaciones; por eso es posible que se le realicen pruebas para detectar, por ejemplo, un tumor glómico: un pequeño crecimiento en los vasos sanguíneos situados bajo la uña que puede provocar un dolor persistente e inusual.

Se trata de una afección compleja; sus causas exactas siguen siendo objeto de estudio. Lo que sí se sabe es que varios factores pueden combinarse para desencadenarla. Los problemas nerviosos preexistentes, como un nervio comprimido o una afección en los nervios del cuello, son los factores predictivos más importantes tras una cirugía por fractura de muñeca. El estrés emocional previo a la fractura, como la ansiedad o la depresión, prácticamente duplica la probabilidad de desarrollar SDRC durante el tratamiento. Las mujeres, las personas mayores y quienes realizan trabajos manuales intensos también presentan un riesgo mayor.

Es fundamental detectarlo a tiempo, pues un tratamiento oportuno reduce la posibilidad de que se produzca una pérdida permanente de movilidad. No obstante, algunas personas siguen presentando cierta discapacidad crónica a pesar de haber recibido una atención temprana adecuada.

Qué podemos hacer al respecto

Hay muchas cosas que usted mismo puede hacer; por lo general, todo comienza con el movimiento. Mantener la mano y el brazo en actividad es un aspecto fundamental del tratamiento; la fisioterapia tiene como objetivo recuperar el movimiento, la fuerza y la confianza para usar la mano. Puede resultar extraño mover algo que duele, pero una actividad suave y constante ayuda a calmar las señales de dolor excesivamente sensibles mencionadas anteriormente. Adoptar un enfoque más activo en la recuperación también reduce la probabilidad de que se desarrolle el SDRC tras una lesión. Pruebe este método durante semanas, no días, y continúe aunque el progreso parezca lento. Algunas personas también encuentran útil la terapia con espejo: mueven la mano sana mientras la observan en un espejo; además, su terapeuta puede emplear otros tratamientos, como la terapia láser, para aliviar el dolor.

Si el autocuidado no basta, existen medicamentos que pueden ayudar. Los analgésicos y antiinflamatorios pueden atenuar los brotes de dolor y hacer que el movimiento sea más cómodo, lo cual es importante, pues mover la mano constituye el tratamiento principal. Su médico también podría recomendar un ciclo corto de comprimidos de esteroides, como la prednisona, que disminuyen la inflamación y alivian los síntomas, especialmente cuando resulta difícil acceder a tratamientos especializados. También hay opciones de aplicación tópica, como cremas medicadas, que ofrecen una forma sencilla de controlar el dolor. En casos persistentes, a algunas personas se les administra una infusión de ketamina en el hospital, la cual actúa directamente sobre las vías del dolor. Cada uno de estos tratamientos presenta ventajas y desventajas en cuanto a efectos secundarios y duración del beneficio; por eso vale la pena analizar cuál se adapta mejor a usted.

Si sus síntomas son graves y no mejoran a pesar de seguir los pasos anteriores, consulte la posibilidad de acudir a un especialista. Su médico podría derivarlo para una evaluación especializada; en ciertos casos, cuando existen problemas subyacentes específicos, se podría considerar algún procedimiento. Por ejemplo, cuando un nervio comprimido en la muñeca provoca los síntomas, liberarlo permite la resolución total en muchas personas; asimismo, las articulaciones rígidas y contraídas pueden ser liberadas con cuidado y luego inmovilizadas con férulas. Estas decisiones se toman caso por caso, una vez descartadas otras causas, como se explicó antes. Cuanto antes se reconozca y trate el SDRC, mayores son las posibilidades de evitar una pérdida permanente de movilidad; por eso no demore en buscar ayuda.

Qué esperar

El curso clínico de la SDRC varía de una persona a otra; no existe un cronograma fijo al que se pueda aferrar. En algunos pacientes los síntomas se estabilizan en cuestión de semanas o meses, especialmente cuando el tratamiento se inicia a tiempo. En otros, el dolor persiste por más tiempo, y un pequeño número de personas conserva alguna discapacidad o limitación funcional incluso tras un tratamiento temprano y adecuado. El reconocimiento precoz y el tratamiento inmediato son la mejor garantía para evitar una pérdida permanente de movilidad; por eso es fundamental no demorar la búsqueda de ayuda.

Si se maneja correctamente, el pronóstico suele ser de mejora gradual en lugar de una solución repentina. Mover la mano, aunque duela un poco, ayuda a calmar las señales de dolor hiperactivas mencionadas anteriormente; el progreso, por lo general, se observa lentamente a lo largo de semanas y meses. Algunos tratamientos pueden marcar una verdadera diferencia: la terapia con espejo y la terapia láser pueden reducir el dolor, a veces ya en las primeras sesiones. Cuando un nervio atrapado en la muñeca es la causa de los síntomas, su liberación permite la desaparición completa de éstos en muchos pacientes. Las articulaciones rígidas y contraídas pueden ser estiradas con cuidado y luego inmovilizadas mediante férulas, con resultados generalmente favorables.

Si no se interviene, el pronóstico es menos predecible: el dolor puede seguir apareciendo periódicamente, y cuanto más tiempo pase, mayor es el riesgo de rigidez duradera y pérdida de funcionalidad. En casos graves y crónicos que no responden a ningún otro tratamiento, en ocasiones se contempla la cirugía como último recurso. En un reducido número de pacientes con dolor nervioso intenso y persistente, la amputación de la pierna por debajo de la rodilla ha proporcionado un alivio significativo del dolor y una funcionalidad aceptable. No se trata de una opción habitual; se evalúa únicamente después de haber probado todas las demás alternativas.

Es justo reconocer que la SDRC aún no se comprende por completo y que sus causas siguen siendo objeto de investigación. Lo que sí sabemos es que mantenerse activo, iniciar el tratamiento a tiempo y colaborar estrechamente con el equipo médico constituyen la mejor estrategia. Esperar una mejora gradual, no una solución inmediata, y comunicar cualquier cambio o anomalía a su médico son pasos fundamentales en este proceso.

¿Cuándo consultar a un especialista?

Acuda a su médico de cabecera o a un especialista si el dolor posterior a una lesión o cirugía persiste por la noche, se extiende más allá del lugar de la lesión o resulta mucho más intenso de lo que cabría esperar. Busque ayuda si el simple contacto, un movimiento suave o los cambios de temperatura desencadenan un dolor intenso; también si su mano le duele tanto que evita usarla. El diagnóstico y tratamiento tempranos del SDRC reducen el riesgo de pérdida permanente de movilidad; por eso no espere a que los síntomas desaparezcan por sí solos. Dado que el SDRC solo se diagnostica tras descartar otras causas, cualquier dolor persistente e inusual debe ser evaluado, en lugar de atribuirse únicamente a la lesión inicial.

Reviewed by Kieran Hirpara · 13 June 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • The diagnosis of CRPS is a clinical diagnosis based on history and physical examination [9].
  • Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function [9].
  • Patients with CRPS may still experience permanent impairment and disability despite early recognition and prompt treatment [9].
  • Quantitative sensory testing outcomes indicate altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and how the fracture is managed [15].
  • A more active treatment approach seems to lower the incidence of CRPS-1 following distal radius fracture [2].
  • CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
  • The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].

Background & Causes

Pathophysiology and Diagnosis

  • Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].

Risk Factors and Incidence

  • Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [11].
  • Elderly patients, females, and manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
  • Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [17].
  • Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment [20].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].

Modifiable Factors and Management Implications

Symptoms & Presentation

  • CRPS is a multifactorial condition [3].
  • Pain is a highly debilitating symptom in CRPS-I [7].
  • Patients with CRPS may experience permanent impairment and disability [9].
  • Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [19].
  • The diagnosis of CRPS should only be a diagnosis of exclusion [19].

Management

Pharmacologic

  • In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
  • Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
  • Topical application of doxepin may represent a simple option for the management of CRPS [18].

Non-Pharmacologic

  • A more active treatment approach seems to lower the incidence of CRPS-1 [2].
  • High-intensity laser therapy and mirror therapy provide conclusive evidence of pain reduction in CRPS-I, even after the third HILT treatment session [7].
  • The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Operative

  • A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [12].
  • The positive outcome for a patient with Dupuytren's and CRPS-I after collagenase clostridium histolyticum injection is encouraging [16].

Assessment and Prognosis

  • Early recognition and prompt treatment are important to minimize permanent loss of function in CRPS [9].

Key Considerations

Diagnosis and Pathophysiology

  • The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed [15].

Risk Factors and Incidence

Treatment

  • High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
  • A positive outcome was observed for a patient with Dupuytren's contracture and CRPS-I after collagenase clostridium histolyticum injection [16].

Prognosis and Assessment

Key Evidence

  • [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [1] (10.1177/15589447221131847)
  • [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [2] (10.1177/1558944719895782)
  • [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [3] (10.1007/s40122-021-00279-4)
  • [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [4] (10.1016/j.jht.2025.02.004)
  • [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [5] (10.1186/s13018-022-03461-2)
  • [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [6] (10.1186/s12891-024-07333-0)
  • [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [7] (10.1016/j.jht.2025.02.009)
  • [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [8] (10.1177/17589983221138610)
  • [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [10] (10.1016/j.jhsg.2026.101028)
  • [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [11] (10.1177/1558944720963915)
  • [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [12] (10.1016/j.jhsa.2024.09.024)
  • [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [13] (10.1186/s12891-024-07948-3)
  • [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [14] (10.5397/cise.2021.00080)
  • [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [15] (10.1177/1758998320910179)
  • [L4] The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection is encouraging. [16] (10.1016/j.jht.2024.09.002)
  • [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [17] (10.1016/j.jhsa.2026.01.004)
  • [L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [18] (10.1016/s0020-1383(01)00054-7)
  • [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [19] (10.1177/1558944719895618)
  • [L2] Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. [20] (10.1186/s12891-021-04977-0)

References

[1] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[2] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[3] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[4] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[5] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[6] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[7] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[8] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[9] Complex Regional Pain Syndrome. 2021.

[10] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[11] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[12] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[13] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[14] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[15] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[16] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[17] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[18] Topical application of doxepin hydrochloride can reduce the symptoms of complex regional pain syndrome: a case report. Injury. 2002. DOI: 10.1016/s0020-1383(01)00054-7

[19] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[20] Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-021-04977-0

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b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.