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Artroscopia de hombro

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Recovery after simple or diagnostic shoulder arthroscopy with no repair — an early-mobilisation fast pathway.

Updated Jun 2026
Ilustración de un hombro con dos pequeños apósitos de tipo “ojo de cerradura”, visto desde atrás.
Movilidad temprana tras la cirugía artroscópica de hombro. 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 describe la rehabilitación posterior a una artroscopia de hombro sencilla o diagnóstica realizada por el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton: se trata de una cirugía mínimamente invasiva en la que se inspeccionó, lavó o limpió la articulación (mediante desbridamiento), sin realizar ninguna reparación. Dado que no es necesario proteger ninguna reparación, se trata de una de las intervenciones quirúrgicas de hombro de recuperación más rápida; el objetivo es lograr movilidad temprana y un retorno rápido a la vida cotidiana. Lleve esta página o su versión en PDF a su primera sesión de fisioterapia para garantizar una rehabilitación coordinada.

Este protocolo es aplicable únicamente cuando la artroscopia no incluyó reparaciones: solo desbridamiento, lavado o evaluación diagnóstica. Si durante la intervención se realizó alguna reparación, descompresión o estabilización, deberá seguir el protocolo correspondiente a dicho procedimiento; por ejemplo, el protocolo de reparación del manguito rotador si se reparó dicho manguito. Si no está seguro de qué se realizó, consulte el informe quirúrgico o pregunte en el consultorio antes de continuar.

En caso de tener cualquier duda respecto a la herida postoperatoria, comuníquese con el consultorio. A menudo resulta útil tomar una fotografía de la herida y enviarla por correo electrónico para su revisión.

Qué esperar

Tras una artroscopia sin necesidad de reparación, no hay nada dentro del hombro que deba protegerse; por lo tanto, no existen restricciones estrictas de movimiento. El hombro se mueve desde el principio, siguiendo el nivel de comodidad del paciente y no el calendario. Se proporciona un cabestrillo únicamente para mayor comodidad: la mayoría de las personas lo usan solo el primer día o dos y lo dejan de usar por completo en la primera semana. No debe conducir durante al menos seis semanas después de cualquier operación de hombro, aunque deje de usar el cabestrillo mucho antes; su cirujano le dará autorización para conducir, generalmente en la revisión a las seis semanas.

Resumen del proceso de recuperación:

  • Fase I — Movilización temprana y adaptación — aproximadamente las primeras dos semanas
  • Fase II — Restauración de la movilidad completa y comienzo del fortalecimiento — semana 2–6
  • Fase III — Retorno a todas las actividades — a partir de la semana 6

La mayoría de las personas vuelven a trabajos de oficina en cuestión de días o una semana. La conducción se reanuda a partir de las seis semanas, una vez que el cirujano lo autorice. Los trabajos manuales más exigentes y la práctica deportiva suelen requerir más tiempo, generalmente entre seis y doce semanas, dependiendo de la carga que deba soportar el hombro. Es normal que el hombro presente cierta molestia o dolor leve durante varias semanas mientras la articulación se adapta; esto mejora a medida que la movilidad y la fuerza se recuperan.

Fase I — Movilización temprana y estabilización (Semana 0–2)

Durante las dos primeras semanas, el objetivo es permitir que el hombro se estabilice mientras se mantiene en movimiento. Utilice el cabestrillo únicamente cuando le brinde comodidad (normalmente el primer o segundo día); en lo sucesivo, quíteselo siempre que sea posible; no es necesario usarlo para dormir. Desde el principio, mueva libremente la mano, la muñeca y el codo, y utilice el brazo para tareas cotidianas sencillas como comer, lavarse y vestirse, siempre que le resulte cómodo. La movilización suave del hombro comienza de inmediato: ejercicios pendulares y movimientos asistidos, progresando hacia movimientos activos según lo permita el hombro. El hielo y los analgésicos sencillos ayudan a hacer los ejercicios más tolerables. Los vendajes de la herida son impermeables: puede ducharse desde el primer día y dejar que el agua corra sobre ellos (pero no los empape ni frote). Se retiran aproximadamente entre los diez y doce días posteriores a la cirugía.

Para su fisioterapeuta:

Objetivos

  • Reducir el dolor y la inflamación
  • Lograr una movilidad temprana, pasando de movimientos asistidos a activos según la tolerancia del paciente
  • Fomentar la independencia en actividades cotidianas sencillas
  • Dejar de usar el cabestrillo durante los primeros días

Manejo

  • Usar el cabestrillo únicamente para mayor comodidad; se recomienda dejar de usarlo durante los primeros días, y en todo caso dentro de la primera o segunda semana
  • Ejercicios pendulares; movilización asistida (con polea, bastón o varilla), progresando hacia movilidad activa en todos los planos según lo permita el paciente
  • Movilidad libre de la mano, muñeca y codo; ejercicios de agarre según la comodidad del paciente
  • Ejercicios de estabilización escapular y corrección postural
  • Isométricos suaves del manguito rotador y del deltoides, siempre que el paciente lo tolere
  • Aplicación de crioterapia y analgésicos para facilitar el programa de ejercicios

Precauciones

  • No conducir durante seis semanas (esto aplica a cualquier cirugía de hombro)
  • La progresión de los movimientos debe basarse en la comodidad: si aparece dolor intenso o persistente, se debe reducir el esfuerzo en lugar de insistir
  • Los vendajes son impermeables (puede ducharse sin problema); se retiran alrededor del día 10–12. Informe cualquier enrojecimiento excesivo o secreción anormal

Criterios para avanzar

  • El paciente ya no usa el cabestrillo y realiza sin dificultad actividades cotidianas sencillas
  • El dolor se ha reducido lo suficiente como para iniciar activamente la movilización del hombro

Fase II — Restauración de la movilidad completa y comienzo del fortalecimiento (Semana 2–6)

Ahora que el hombro se ha estabilizado, la atención se centra en recuperar la movilidad completa y comenzar el fortalecimiento. Se progresa gradualmente con movimientos activos en todas las direcciones hasta alcanzar el rango completo de movimiento; asimismo, se inicia suavemente el trabajo de resistencia, comenzando con mantenimientos isométricos y pasando a ejercicios con bandas elásticas para el manguito rotador y los músculos de la escápula, según la tolerancia del paciente. La mayoría de las personas vuelven a sus labores de oficina en la primera o segunda semana, si aún no lo han hecho. La conducción queda prohibida hasta que el cirujano lo autorice en la revisión de la semana seis. Durante esta fase, se reanudan actividades recreativas más ligeras bajo la guía de su fisioterapeuta.

Para su fisioterapeuta:

Objetivos

  • Alcanzar un rango de movimiento activo completo o casi completo en todos los planos
  • Iniciar un fortalecimiento gradual del manguito rotador y los estabilizadores de la escápula
  • Retorno a las actividades diarias normales, al trabajo y a la conducción

Manejo

  • Progresar el rango de movimiento activo en todos los planos hasta alcanzar el máximo; los objetivos intermedios habituales son una flexión anterior superior a 140–160° y una rotación externa superior a 40–60°
  • Pasar de ejercicios isométricos a ejercicios con bandas elásticas para el manguito rotador (rotación interna y externa cerca de la posición neutra), avanzando según la tolerancia
  • Fortalecimiento de la escápula: ejercicios de encogimiento, retracción, protracción y depresión, progresando hacia resistencia
  • A partir de la semana 4 aproximadamente, iniciar un fortalecimiento isotónico ligero con pesos bajos y mayor número de repeticiones, según la comodidad del paciente
  • Terapia manual y estiramientos para cualquier rigidez capsular residual; incluyendo estiramientos de la cápsula posterior cuando sea necesario

Precauciones

  • El fortalecimiento debe realizarse dentro del rango cómodo y no debe provocar dolor persistente
  • Introducir gradualmente la rotación con carga en abducción (posiciones 90/90); hacerlo una vez que los ejercicios de rotación en posición neutra sean tolerados
  • Evitar levantar cargas pesadas y realizar esfuerzos bruscos por encima de la cabeza mientras se recupera la fuerza

Criterios para avanzar

  • Rango de movimiento activo completo o casi completo con mínimo dolor
  • Tolerancia a los ejercicios con bandas y pesos ligeros sin desencadenar síntomas negativos

Fase III — Retorno a la actividad plena (a partir de la semana 6)

La fase final consiste en un retorno gradual a actividades que requieren mayor esfuerzo físico, trabajo manual, entrenamiento en el gimnasio y práctica deportiva. Por lo general, el entrenamiento con pesas convencional puede reiniciarse alrededor de la semana seis; se comienza con cargas ligeras y se aumentan progresivamente. La vuelta a deportes que impliquen lanzamientos o contacto suele producirse entre las seis y las doce semanas, dependiendo del deporte y del estado del hombro. El indicador para considerar finalizada la rehabilitación es un hombro cómodo, con movilidad completa y fuerza suficiente; la mayoría de las personas vuelven a realizar todas las actividades que desean alrededor de los tres meses, y cualquier molestia residual sigue disminuyendo posteriormente.

Para su fisioterapeuta:

Objetivos

  • Rango de movimiento completo y sin dolor
  • Recuperación de la fuerza, resistencia y confianza para el trabajo y el deporte
  • Retorno gradual a trabajos manuales pesados, entrenamiento en el gimnasio y actividades deportivas

Manejo

  • A partir de la semana 6, pasar a entrenamientos de resistencia convencionales; avanzar de máquinas a pesas libres según la capacidad de control del paciente
  • Ejercicios excéntricos y de cadena cerrada según tolerancia
  • Entrenamiento específico para el deporte, incluyendo programas progresivos de lanzamiento o movimientos por encima de la cabeza cuando corresponda
  • Limitar el fortalecimiento intenso del manguito rotador a unas tres sesiones por semana para evitar tendinopatía por sobrecarga

Precauciones

  • La progresión debe guiarse por los síntomas: si el dolor aumenta con la carga o persiste después del ejercicio, se debe reducir dicha carga
  • El retorno a deportes de contacto o con movimientos por encima de la cabeza solo se permite cuando el rango de movimiento sea completo y sin dolor, y la fuerza sea adecuada

Criterios para avanzar

  • Rango de movimiento completo y sin dolor, con fuerza comparable al lado contralateral para la actividad prevista
  • Realización de tareas específicas del deporte o del trabajo sin desencadenar molestias

Después de seguir el protocolo

Las fases descritas anteriormente se han adaptado de protocolos de rehabilitación publicados para la artroscopia de hombro diagnóstica y sencilla, elaborados por el Dr. Jorge Chahla (Rush University Medical Center), el Dr. Benedict Nwachukwu (Hospital for Special Surgery), el Dr. Blake Obrock (medicina deportiva ortopédica, Amarillo) y la guía para pacientes del Royal National Orthopaedic Hospital sobre la artroscopia de hombro diagnóstica. Los plazos semanales indicados son orientativos y no fijos; su rehabilitación será guiada individualmente por su fisioterapeuta, en colaboración con nuestra consulta, según la evolución de su hombro. Esta página complementa los consejos generales de recuperación que ofrece nuestra consulta: consulte control del dolor postoperatorio y cuidado de la herida. Para información sobre la intervención quirúrgica en sí, consulte artroscopia de hombro. La base científica de este protocolo (el fundamento de la movilización temprana, los ensayos quirúrgicos controlados con placebo y los protocolos de rehabilitación en los que se basa) se resume en la sección de evidencia, disponible en formato PDF en la parte superior de esta página.

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.

Shoulder Arthroscopy (Diagnostic / Debridement / Washout) — Post-operative Rehabilitation

Topic scope: Post-operative rehabilitation after a generic keyhole shoulder arthroscopy in which nothing was repaired — diagnostic assessment, washout (lavage), debridement of degenerate tissue, removal of loose bodies, and isolated subacromial decompression or distal clavicle excision. Specific repair or reconstruction procedures have their own protocols that take priority — rotator-cuff repair, labral/instability stabilisation (anterior-Bankart, posterior-stabilisation, Latarjet), capsular release, biceps tenodesis and AC-joint stabilisation each convert to a slower, construct-protecting pathway. This page is the default keyhole pathway used only when the operation note confirms no repair was performed.

Defining principle of the rehab here: when nothing is repaired there is no construct to protect, so the rehab is an early-motion pathway — a sling for comfort only (days, not weeks), unrestricted use below shoulder height from day one, motion progressed on comfort rather than the calendar, and strengthening as soon as range and pain allow. The single branch point is whether anything was actually repaired or stabilised; if it was, recovery converts to that procedure's protected protocol. Unlike a cuff repair or a labral repair, there is no healing tissue that early movement can disrupt, so the usual risks of early motion (re-tear, construct failure) do not apply — the main thing early motion prevents here is post-operative stiffness.

The operation and why the rehab is fast

A keyhole (arthroscopic) shoulder operation in this scope involves looking inside the joint and subacromial space through small portals and doing one or more of: confirming a diagnosis, washing out the joint, trimming (debriding) frayed labrum, degenerate cuff or inflamed bursa, removing loose bodies, or shaving bone in a subacromial decompression or distal clavicle excision. None of these creates a repair that must heal under protection. That is the central fact that separates this pathway from cuff repair, stabilisation and the other audited protocols: the tissue is either removed or simply inspected, so the post-operative soreness — not a healing construct — is what paces recovery.

Because of this, recovery is among the quickest of any shoulder operation. Most people are back to desk-based work within days to a week, out of the sling within the first week, driving within one to three weeks once the sling is off and they can control the car confidently, and back to heavier manual work and sport somewhere between six and twelve weeks depending on the demands placed on the shoulder.

Evidence by theme

1. Early motion is the goal — there is no construct to protect

The case for early movement here is largely a mechanistic one rather than one settled by a dedicated trial: with no repair to disrupt, the only thing prolonged immobilisation achieves is avoidable stiffness, discomfort and delayed return to activity. The closest high-quality evidence comes by analogy from the cuff-repair literature, where — even with a real construct to protect — randomised trials and meta-analyses show early controlled motion does not increase re-tear and tends to reduce stiffness (number-needed-to-harm for re-tear in the order of several hundred). If early motion is safe when a repair is present, it is plainly safe when there is nothing to protect. Mechanistic + analogous moderate evidence; no debridement-specific RCT.

2. The procedures themselves: a candid note on efficacy

Two landmark placebo-controlled surgical trials bear directly on the commonest reason a no-repair arthroscopy is done — subacromial pain:

  • FIMPACT (BMJ 2018) — a double-blind trial of 210 patients randomised to arthroscopic subacromial decompression, diagnostic arthroscopy (placebo surgery), or exercise therapy. At 24 months decompression gave no benefit over diagnostic arthroscopy; both surgical arms improved, but no more than each other. Strong (placebo-controlled RCT).
  • CSAW (Lancet 2018) — a three-arm placebo-controlled UK trial reaching the same conclusion: decompression was no better than investigational (diagnostic) arthroscopy, and the small edge of either over no-treatment was not clinically important. Strong (placebo-controlled RCT).

The honest reading is that for subacromial pain the surgical element adds little over diagnostic arthroscopy or structured exercise — which reinforces why, when this operation is done, the rehabilitation (early motion, restoring strength and confidence) carries much of the recovery. A longer-term single RCT (Magnussen-class, 10-year follow-up, in the corpus) did favour decompression over therapy alone, so practice remains individualised — but the placebo-controlled data are the higher tier.

3. Debridement of degenerate tissue — limited, old evidence

Arthroscopic debridement of irreparable degenerative cuff lesions (Burkhart, J Bone Joint Surg 1995, in the corpus) can relieve pain and restore functional "force-couple" mechanics in selected patients, but the evidence base is small, old and uncontrolled. Debridement and washout are best understood as symptom-directed measures, not structural repairs — which again places the weight of recovery on rehabilitation rather than on a healing construct. Weak (historical case series).

4. The phased protocol is consensus, drawn from published surgeon protocols

The phase structure below is expert/consensus, compiled from published patient-guidance protocols for general/diagnostic shoulder arthroscopy and debridement (Chahla – Rush; Nwachukwu – HSS; Obrock; Royal National Orthopaedic Hospital). There is no rehabilitation RCT defining the optimal regimen for a no-repair arthroscopy; the week ranges are typical, not trial-derived. Weak/consensus.

Phased post-op timeline (no repair performed)

Phase Window Sling ROM / use Strengthening Notes
I — Early movement & settling Week 0–2 Comfort only, days (rarely > 1–2 wk), off ASAP; no sleeping in it Free hand/wrist/elbow + light ADLs from day 1; pendulums and assisted ROM progressing to active ROM as comfort allows Scapular setting; gentle cuff/deltoid isometrics as comfort allows Settle the post-op flare. No driving while in the sling. Dressings off ~10–12 days
II — Restore movement, start strength Week 2–6 Off Progress active ROM in all planes toward full (interim targets ~140–160° flexion, 40–60° ER) Isometric → elastic-band cuff + scapular work; light isotonic from ~wk 4 Desk work + driving once sling off, pain settled, confident to control the car (typically wk 1–3)
III — Return to full activity Week 6 onward Off Maintain full, pain-free ROM Conventional resistance training from ~wk 6; eccentric/closed-chain; sport-specific conditioning. Cap heavy cuff loading at ~3×/week Heavier manual work & sport return ~6–12 wk by demand; most back to everything by ~3 months

Branch point — if anything was repaired or stabilised: recovery converts to that procedure's protected protocol (e.g. rotator-cuff repair — sling ~6 weeks, restricted ROM, deferred strengthening, ~5 months total; or the relevant stabilisation/capsular-release pathway). The operation note and the rooms confirm which pathway applies.

Key controversies / evidence quality

  1. Does the surgery help at all (for subacromial pain)? Two placebo-controlled RCTs (FIMPACT, CSAW) found decompression no better than diagnostic arthroscopy, and arthroscopy little better than exercise. This is the strongest evidence in the topic — and it argues that, where a no-repair arthroscopy is performed, good rehabilitation is doing much of the work. Strong.
  2. Debridement evidence is thin and dated. The supportive data (e.g. Burkhart 1995) are small, uncontrolled case series; debridement is symptom-directed, not curative. Weak.
  3. The rehab protocol itself is consensus, not trial-derived. No RCT defines the optimal regimen after a no-repair arthroscopy; phase timings are typical surgeon-protocol values, and recovery is individualised by the treating physiotherapist. Weak/consensus.
  4. Safety of early motion is inferred, not directly tested here. It rests on a sound mechanism (nothing to protect) reinforced by analogy to the cuff-repair early-motion trials, rather than a debridement-specific RCT. Mechanistic + analogous moderate.

The evidence base for this generic pathway is genuinely limited. The high-quality data (placebo-controlled trials) speak to whether the operation helps, not to how best to rehabilitate it; the rehabilitation guidance is consensus-level. This is stated plainly because it is the honest position.

Evidence-strength flags (summary)

  • STRONG (placebo-controlled RCT): subacromial decompression gives no benefit over diagnostic arthroscopy — FIMPACT (BMJ 2018), CSAW (Lancet 2018).
  • MODERATE (analogous RCT/MA): safety of early controlled motion (extrapolated from cuff-repair early-motion trials — early motion does not raise re-tear and reduces stiffness even when a construct is present).
  • WEAK (historical case series): arthroscopic debridement of irreparable degenerative cuff lesions (Burkhart 1995).
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol itself (published surgeon patient-guidance documents; no defining rehab RCT).
  • SAFETY NOTE (rare complication): glenohumeral chondrolysis has been linked to post-arthroscopic intra-articular continuous bupivacaine infusion and to thermal capsulorrhaphy — a reason such adjuncts are avoided, not a reflection on standard debridement.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Burkhart SS. Débridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am. 1995. DOI: 10.2106/00004623-199506000-00006
  • Magnussen R, et al. Subacromial decompression yields a better clinical outcome than therapy alone: a prospective randomized study with minimum 10-year follow-up. Am J Sports Med. 2018. DOI: 10.1177/0363546518755759
  • Bailie DS, Ellenbecker TS. Severe chondrolysis after shoulder arthroscopy associated with continuous bupivacaine infusion. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.08.024
  • (The corpus is thin on no-repair / diagnostic-arthroscopy rehabilitation specifically; the higher-tier evidence below comes from the placebo-controlled surgical trials and published surgeon protocols.)

Literature (URLs)

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

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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.