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Liberación del túnel radial

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Post-operative exercises and precautions after radial tunnel release, including radial nerve glides.

Updated Jun 2026
Ilustración de un terapeuta de mano estirando el antebrazo y la muñeca de un paciente sobre una mesa de tratamiento.
Estiramientos suaves y ejercicios de deslizamiento nervioso tras la liberación del túnel radial. 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.

Este protocolo le servirá de guía durante su recuperación tras la liberación del túnel radial realizada por el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton. Explica qué puede esperar durante las semanas posteriores a la cirugía y detalla el programa de ejercicios que figura en el folleto postoperatorio. Lleve esta página o su versión en PDF a su primera sesión de fisioterapia o terapia de la mano para garantizar una rehabilitación coordinada. Su terapeuta podrá modificar el plan según el progreso de su recuperación.

Si tiene alguna duda respecto a la herida quirúrgica, no dude en contactar con el consultorio. A menudo resulta útil tomar una fotografía de la herida y enviarla por correo electrónico para su evaluación.

Qué esperar

El cuidado de la herida se explica en las indicaciones de cuidado de heridas del consultorio. A medida que la herida cicatriza, el nervio liberado puede adherirse al tejido circundante; los ejercicios de deslizamiento que se describen a continuación son muy importantes para mantenerlo en movimiento y evitar que quede fijado.

En ocasiones, la herida puede volverse sensible. Esto es normal, y se puede prevenir o minimizar iniciando una desensibilización diaria: tocando y frotando suavemente la herida (o el vendaje) a partir del día siguiente a la cirugía. Este tipo de “retroalimentación sensorial” ayuda al nervio a normalizar su respuesta al tacto y a las texturas.

Una vez que la herida haya cicatrizado por completo, comience a masajear la cicatriz: realice círculos firmes sobre la incisión. Consulte las indicaciones de cuidado de heridas para obtener más información sobre el manejo de cicatrices.

Es importante tener expectativas realistas respecto a la recuperación. El nervio radial debe desplazarse y estirarse una distancia considerable durante los movimientos habituales del brazo; por eso, mantenerlo en movimiento desde el principio evita que se adhiera a los tejidos en proceso de cicatrización [1]. Aun así, el alivio del dolor tras la liberación del túnel radial suele ser gradual y no inmediato; en algunas personas, el alivio es solo parcial. En realidad, esta intervención es menos predecible que otros procedimientos de liberación nerviosa: el síndrome del túnel radial es difícil de diagnosticar con certeza y a menudo se superpone al codo de tenista, lo cual explica las variaciones en los resultados. Los estudios a largo plazo publicados indican buenos resultados en aproximadamente dos tercios de los pacientes en general, siendo los mejores resultados aquellos con síntomas exclusivos del túnel radial [2][3]. La recuperación suele ser más lenta y menos completa cuando también existe codo de tenista (epicondilitis lateral), más de una compresión nerviosa en el mismo brazo o cuando se trata de un caso cubierto por seguros de accidentes laborales [2][4]. Su programa de deslizamiento nervioso y la desensibilización gradual son los aspectos de la rehabilitación que usted puede controlar mejor; la práctica diaria constante brinda al nervio la mejor oportunidad de recuperarse.

Precauciones y limitaciones

Se recomienda un uso funcional moderado de la mano para tareas cotidianas como el aseo personal, la alimentación, vestirse, escribir y teclear. Más allá de eso, las limitaciones son sencillas: no se debe levantar peso, agarrar objetos, soportar carga ni utilizar maquinaria vibratoria (por ejemplo, herramientas eléctricas o cortadoras de césped) durante las primeras 6 semanas tras la cirugía; además, la conducción queda restringida durante las primeras 2–3 semanas.

Para su fisioterapeuta:

Objetivos

  • Evitar que el nervio liberado se adhiera a la herida en proceso de cicatrización (programa de deslizamiento nervioso)
  • Reducir la sensibilidad de la herida mediante una desensibilización gradual
  • Mantener el rango de movimiento de la muñeca, el antebrazo y el codo
  • Facilitar el uso funcional moderado de la mano en actividades de la vida diaria

Manejo

  • Desensibilización diaria: golpecitos o fricción suaves sobre la herida (vendaje), comenzando inmediatamente después de la cirugía
  • Masaje de la cicatriz (círculos firmes sobre la incisión) una vez que la herida haya cicatrizado por completo
  • Programa de ejercicios en casa según las fichas siguientes: estiramiento de flexión/extensión de muñeca; estiramiento de supinación/pronación de muñeca; flexión/extensión de codo; deslizamientos del nervio radial
  • Se prefieren técnicas de deslizamiento nervioso suaves (“slider”) en lugar de tensiones bruscas en los límites de movimiento: estas técnicas logran un mayor desplazamiento nervioso con una tensión mucho menor, lo cual es más tolerable para un nervio recientemente descomprimido [1][5]
  • La movilización nerviosa puede considerarse como complemento al programa; la evidencia científica sobre la movilización neural en afecciones nerviosas es favorable aunque con grados variables de certeza; por ello, la progresión debe guiarse por los síntomas [6]

Precauciones

  • Solo se permite un uso funcional moderado de la mano (aseo personal, alimentación, vestirse, escribir, teclear)
  • No se debe levantar peso, agarrar objetos, soportar carga ni utilizar maquinaria vibratoria (p. ej., herramientas eléctricas, cortadoras de césped) durante las primeras 6 semanas tras la cirugía
  • La conducción queda restringida durante las primeras 2–3 semanas
  • Los deslizamientos y estiramientos nerviosos deben ser suaves y prácticamente indoloros; evite forzar el movimiento hasta rangos que reproduzcan el dolor nervioso previo a la operación

Estos son los ejercicios que figuran en su folleto postoperatorio; deben realizarse tras la cirugía y continuarse en casa según las indicaciones de su fisioterapeuta o terapeuta de mano. El número de repeticiones, el tiempo de mantenimiento y la frecuencia se indican en cada ficha.

Sus ejercicios

Este programa de ejercicios fue elaborado en colaboración con Sarah Farrell, Licenciada en Terapia Ocupacional (BOccThy) y Terapeuta de Mano Acreditada (AHT).

Después de seguir este protocolo

Este protocolo se complementa con las recomendaciones generales de recuperación del consultorio; consulte control del dolor postoperatorio, cuidado de la herida y conceptos básicos de la terapia de la mano. En cuanto a la intervención quirúrgica en sí y la afección que trata, consulte liberación del túnel radial y síndrome del túnel radial.

Referencias

[1] Wright TW, Glowczewskie F, Cowin D, Wheeler DL. Desplazamiento y tensión del nervio radial en el codo y la muñeca durante el movimiento de las extremidades superiores. J Hand Surg Am. 2005;30(5):990–996. https://pubmed.ncbi.nlm.nih.gov/16182056/ [2] Lee JT, Azari K, Jones NF. Resultados a largo plazo de la liberación del túnel radial: efecto de la existencia simultánea de codo de tenista, múltiples síndromes de compresión y seguros de accidentes laborales. J Plast Reconstr Aesthet Surg. 2008;61(9):1095–1099. https://www.sciencedirect.com/science/article/abs/pii/S1748681507004044 [3] Sotereanos DG, Varitimidis SE, Giannakopoulos PN, Westkaemper JG. Resultados del tratamiento quirúrgico del síndrome del túnel radial. J Hand Surg Am. 1999;24(3):566–570. https://pubmed.ncbi.nlm.nih.gov/10357537/ [4] Naam NH, Nemani S. Síndrome del túnel radial. Orthop Clin North Am. 2012;43(4):529–536. (Síndrome del túnel radial, StatPearls.) https://www.ncbi.nlm.nih.gov/books/NBK555937/ [5] Coppieters MW, Butler DS. ¿Se deslizan realmente los “deslizadores” y se tensan los “tensadores”? Análisis de las técnicas neurodinámicas y consideraciones sobre su aplicación. Man Ther. 2008;13(3):213–221. https://pubmed.ncbi.nlm.nih.gov/17398140/ [6] Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. Eficacia de la movilización neural en afecciones neuromusculoesqueléticas: revisión sistemática y metaanálisis. J Orthop Sports Phys Ther. 2017;47(9):593–615. https://pubmed.ncbi.nlm.nih.gov/28704626/

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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.

Radial Tunnel Release — Evidence Brief & Post-operative Rehabilitation

Topic scope: post-operative rehabilitation after surgical decompression / neurolysis of the posterior interosseous nerve (deep branch of the radial nerve) in the radial tunnel of the proximal forearm, performed for radial tunnel syndrome (RTS). This is an elbow / proximal-forearm topic — anatomically and clinically distinct from carpal-tunnel and cubital-tunnel decompression. Like other nerve decompressions it is an early-motion pathway (early elbow/forearm/wrist motion, radial-nerve glides, oedema and scar care). The scope deliberately foregrounds the diagnostic controversy and the more variable, lower success rates that distinguish RTS release from the better-validated carpal-tunnel and cubital-tunnel operations.

Defining principle of the rehab here: a decompressed nerve does not create a healing construct that needs months of protection — it needs early, gentle movement to stop it adhering to the operative bed and to restore its glide. So the rehab is an early-motion programme: light functional hand use from day 1, radial-nerve sliders, graded desensitisation and (once healed) scar massage; heavier loading deferred to ~6 weeks. But two honesty caveats sit over the whole topic. First, RTS is a contested diagnosis — there is no confirmatory imaging or electrodiagnostic test, it is a diagnosis of exclusion, and a substantial body of opinion regards it as a variant of recalcitrant lateral epicondylitis. Second, outcomes after release are more variable and on average lower than carpal- or cubital-tunnel release — good results cluster around two-thirds overall, and fall further with co-existing tennis elbow, multiple compression sites, or a workers'-compensation context. Patient expectations should be set accordingly.

A. THE DIAGNOSTIC CONTROVERSY (read first — it frames everything)

RTS is among the most contested entities in upper-limb surgery, and the rehab brief is incomplete without it:

  • No confirmatory test. Electromyography and nerve-conduction studies are characteristically normal in RTS (compression is intermittent/dynamic and predominantly of a motor nerve carrying few pain fibres), and MRI is frequently negative — denervation oedema in supinator/extensors is suggestive but inconsistent, and a normal scan does not exclude the diagnosis. RTS is therefore a clinical diagnosis of exclusion, resting on point tenderness ~4 cm distal to the lateral epicondyle (over the radial tunnel rather than the epicondyle), pain on resisted supination / resisted long-finger extension, and — for some surgeons — temporary relief from a diagnostic local-anaesthetic block at the radial tunnel.
  • Overlap with lateral epicondylitis (tennis elbow). The two coexist frequently and share the lateral-elbow pain territory. A recognised school of thought holds that "RTS" is often severe, recalcitrant lateral epicondylitis rather than a discrete compression neuropathy. Importantly, routine PIN release added to lateral-epicondylitis surgery has not been shown to improve outcomes, so the diagnosis should be secure before a decompression is planned.
  • Practical consequence. Surgery is a last resort after prolonged failed conservative care (activity modification, splinting, anti-inflammatories, sometimes a steroid injection), and is best reserved for patients with proximal-forearm pain and no better explanation. This uncertainty is the single most important reason post-operative expectations must be framed honestly.

B. RELEASE OUTCOMES (variable — and why)

  • Headline success ~two-thirds. Across the older long-term series, roughly 67% good, 15% fair, 18% poor after radial tunnel decompression — markedly more variable than carpal- or cubital-tunnel release. A 2008 long-term series (Lee, Azari, Jones) and a 1999 series (Sotereanos et al.) both document this spread; the Sotereanos cohort reported good/excellent results in only ~39% by objective assessment (though ~64% by patient self-rating), underscoring how outcome depends on the metric used.
  • Co-existing lateral epicondylitis lowers success. Success falls to roughly 40% when tennis elbow coexists, versus far higher with isolated RTS.
  • Multiple compression sites and workers'-compensation context lower success — reported ~58% success in compensation cases vs ~73% without. These are the same modifiers named in the patient protocol.
  • 2025 systematic review (Raymond et al., HAND). 11 studies, 401 limbs (381 patients). Outcomes were heterogeneous; a dorsal approach between ECRB and EDC was associated with the most favourable Roles-and-Maudsley scores and satisfaction. The review's central message is that the overall evidence is low-grade (observational), the diagnosis non-standardised, and the effectiveness of conservative treatment essentially untested — a "tendency" toward benefit rather than proof.
  • Resorption-style "spontaneous improvement" does not apply here — unlike calcific tendinitis, RTS does not self-resolve through a biological cycle; conservative care manages symptoms rather than curing a deposit.

C. SURGICAL APPROACH (shapes the early rehab)

  • What is done. Complete neurolysis of the radial nerve at its bifurcation, decompressing the deep branch (PIN) and superficial sensory branch, releasing the arcade of Frohse (the proximal supinator edge), the leash of Henry (radial recurrent vessels), the ECRB fascial edge, and the distal supinator border. Any constrictive bands or vessels are divided.
  • Approaches. Dorsal (Thompson, between ECRB/EDC or the brachioradialis–ECRL interval), volar/anterior (Henry), or transmuscular. Anatomical studies map the trade-offs; the dorsal ECRB–EDC interval performed best in the 2025 review. The superficial radial branch matters — it is a recognised source of post-operative dysaesthesia if irritated.
  • Rehab implication. A muscle-splitting/dorsal exposure through the extensor mass means early gentle forearm rotation and wrist motion are encouraged but heavy resisted supination/extension is deferred; the incision sits over a mobile, frequently sensitive area, so desensitisation and scar care carry real weight here.

D. POST-OP THERAPY ROLE (nerve/tendon glides, oedema, scar)

The decompressed nerve must glide, not adhere. The mechanical rationale is well quantified: the radial nerve translates and stretches a measurable amount across the elbow and wrist during ordinary arm motion (Wright et al. 2005), so early motion is what keeps it free of the healing bed.

  • Early motion, immediately. Early active elbow, forearm and wrist movement within pain limits from the first post-op days; most protocols use no rigid splinting (or a removable splint for comfort/night only).
  • Radial-nerve glides — favour "sliders" over "tensioners". Sliding (slider) neurodynamic techniques achieve substantially greater nerve excursion at much lower nerve strain than end-range tensioners — preferable around a freshly decompressed nerve. Neural-mobilisation evidence across neuromusculoskeletal conditions is supportive but of variable certainty, so progression is symptom-guided and essentially pain-free; mechanism work (e.g., the MONET protocol) is still maturing.
  • Oedema and desensitisation. Graded desensitisation (tapping/rubbing over the dressing) from day 1 normalises touch and pre-empts a sensitive scar — particularly relevant given superficial- radial-branch proximity.
  • Scar management once healed. Massage, pressure, and silicone are advocated to loosen skin–tissue adhesions and aid remodelling, started once the wound is closed/sutures out.
  • Strengthening deferred. Light functional ADL use throughout; resisted strengthening of wrist/ elbow and fine-motor work introduced from ~6 weeks. Heavy work and vibration tools avoided to ~6–8 weeks.

Phased post-op timeline (maps to the patient protocol phases)

Phase Window Splint Motion / nerve work Load / strengthening Notes
I — Protect & glide Day 0–2 wk None, or removable for comfort/night Early pain-free active elbow/forearm/wrist ROM; radial-nerve sliders; desensitisation from day 1 Light functional ADL use only (self-care, feeding, dressing, writing, typing) Stop the nerve adhering; settle the wound. No lifting/gripping/weight-bearing/vibration tools. Driving limited first 1–2 wk
II — Restore motion 2–6 wk Off Progress full active + gentle assisted ROM; continue sliders; scar massage once healed Still no resisted loading; ADL use continues Sensitivity/dysaesthesia common and usually settles; keep glides gentle
III — Strengthen & return ~6 wk onward Off Full ROM goal; sliders as needed Begin graded wrist/elbow strengthening + fine-motor work from ~6 wk; advance work/heavy tasks thereafter Vibration tools/heavy work resume ~6–8 wk. Pain relief is often gradual and may be partial — counsel accordingly

E. COMPLICATIONS / DOWNSIDES

  • Incomplete or no pain relief — the dominant "complication," tied directly to diagnostic uncertainty; relief is frequently gradual and sometimes partial.
  • Superficial-radial-branch dysaesthesia / scar sensitivity — recognised; desensitisation and careful technique mitigate it.
  • Transient PIN weakness (finger/thumb extension) from retraction — usually recovers.
  • Adhesion/recurrence of symptoms if early glide is neglected.
  • Standard wound risks (infection, haematoma) — uncommon.

F. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Does RTS exist as a discrete entity? Genuinely contested. No confirmatory test; substantial opinion equates much of it with recalcitrant lateral epicondylitis. This is the defining controversy and must shape consent and expectation-setting. Unresolved — expert opinion divided.
  2. Patient selection drives outcome more than technique. Isolated RTS does best; coexisting tennis elbow, multiple compressions, and compensation context predict worse results. Moderate (consistent across cohorts).
  3. Approach choice. A dorsal ECRB–EDC interval was favoured in the 2025 SR, but the evidence is observational and confounded by diagnostic heterogeneity. Weak–moderate.
  4. The rehab protocol itself is consensus/expert — drawn from surgeon and hand-therapy guidance (early motion, sliders, desensitisation, scar care), not from a rehab RCT. Phase timings are typical, not trial-derived. Weak / consensus.
  5. Conservative-treatment efficacy is essentially untested — the 2025 SR notes no usable trials of non-operative care, so "failed conservative management" before surgery rests on practice convention. Weak.

G. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG: the mechanical rationale for early nerve glide — quantified radial-nerve excursion/ strain across elbow and wrist (Wright et al. 2005); slider-vs-tensioner excursion/strain physiology.
  • MODERATE: patient-selection modifiers of outcome (lateral epicondylitis, multiple compressions, workers' compensation lower success); ~two-thirds overall good-result rate from long-term cohorts; dorsal-approach signal from the 2025 systematic review (low-grade studies).
  • WEAK / CONSENSUS: the existence and diagnostic criteria of RTS (no confirmatory test; overlap with lateral epicondylitis); the post-operative rehabilitation protocol (surgeon/ hand-therapy guidance, no rehab RCT); neural-mobilisation certainty (supportive but variable); efficacy of conservative care (essentially untested).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Posterior Interosseous Nerve Compression in the Forearm, AKA Radial Tunnel Syndrome. HAND. 2022. DOI: 10.1177/15589447221122822
  • Radial Tunnel Syndrome: Emphasis on the Superficial Branch of the Radial Nerve. J Hand Surg Eur. 2009. DOI: 10.1177/1753193408099832
  • Anatomical Study of the Surgical Approaches to the Radial Tunnel. J Hand Surg Am. 2015. DOI: 10.1016/j.jhsa.2015.03.009
  • MR Imaging Features of Radial Tunnel Syndrome: Initial Experience. Radiology. 2006. DOI: 10.1148/radiol.2401050028
  • Management of Lateral Epicondylitis: Current Concepts. J Am Acad Orthop Surg (JAAOS). 2008. DOI: 10.5435/00124635-200801000-00004
  • Uncommon Nerve Compression Syndromes of the Upper Extremity. J Am Acad Orthop Surg (JAAOS). 1998. DOI: 10.5435/00124635-199811000-00006
  • Radial Nerve Excursion and Strain at the Elbow and Wrist Associated With Upper-Extremity Motion. J Hand Surg Am. 2005. DOI: 10.1016/j.jhsa.2005.06.008
  • Evidence and Techniques in Rehabilitation Following Nerve Injuries. Hand Clin. 2013. DOI: 10.1016/j.hcl.2013.04.012
  • Preventive Strategies, Exercises and Rehabilitation of Hand Compression Neuropathies. J Hand Ther. 2022. DOI: 10.1016/j.jht.2021.11.003
  • Mechanisms of Neurodynamic Treatments (MONET): a protocol for a mechanistic study. BMC Musculoskelet Disord. 2024. DOI: 10.1186/s12891-024-07713-6

Radial-tunnel literature (URLs)

  • Clinical Outcomes of Operative Management for Radial Tunnel Syndrome According to Surgical Approach: a Systematic Review. HAND. 2025. https://journals.sagepub.com/doi/10.1177/15589447251315761
  • The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis. J Hand Surg Am. 2023. https://www.jhandsurg.org/article/S0363-5023(23)00138-7/abstract
  • Lee JT, Azari K, Jones NF. Long-term results of radial tunnel release — the effect of co-existing tennis elbow, multiple compression syndromes and workers' compensation. J Plast Reconstr Aesthet Surg. 2008. https://www.sciencedirect.com/science/article/abs/pii/S1748681507004044
  • Sotereanos DG, et al. Results of surgical treatment for radial tunnel syndrome. J Hand Surg Am. 1999. https://pubmed.ncbi.nlm.nih.gov/10357537/
  • Interventions for treating the radial tunnel syndrome: a systematic review of observational studies (DARE). https://www.ncbi.nlm.nih.gov/books/NBK75403/
  • Radial Tunnel Syndrome (StatPearls). https://www.ncbi.nlm.nih.gov/books/NBK555937/
  • Orthopedic Management of Radial Tunnel Syndrome: A Diagnostic and Treatment Dilemma. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10081130/
  • Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9896270/

Published rehab protocols (patient-guidance — basis for the phase structure)

  • Radial Tunnel Release post-op protocol (Santa Barbara Orthopedic / Mencias). https://www.sbortho.com/wp-content/uploads/2023/09/radial-tunnel-release-new.pdf
  • Radial Tunnel Syndrome — conservative and post-operative rehabilitation. Physiopedia. https://www.physio-pedia.com/Radial_Tunnel_Syndrome
  • Basson A, et al. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017. https://pubmed.ncbi.nlm.nih.gov/28704626/
  • Coppieters MW, Butler DS. Do "sliders" slide and "tensioners" tension? Man Ther. 2008. https://pubmed.ncbi.nlm.nih.gov/17398140/

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a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

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.