Skip to content

Patients › General-Health

Kompleks na Sindrome ng Rehiyonal na Sakit (CRPS)

PDF Evidence

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 Aug 2026
Isang kamay na may malambot na halo na nagpapahiwatig ng mataas na sensitibidad.
Sa CRPS, ang isang limb ay maaaring maging napakasakit, pamamaga, at sensitibo nang hindi katumbas ng orihinal na sugat. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang nararamdaman mo

Maaari mong mapansin ang sakit na may ibang pakiramdam kumpara sa karaniwang pananakit. Karaniwang nagsisimula ito sa isang kamay, braso, paa, o binti. Maaaring magpakita ang sakit bilang pakiramdam ng pagsunog, pagpulso, o tusok. Maaari kang maging sensitibo sa paghawak o sa mga pagbabago ng temperatura. Kahit ang magaan na damit o mahinahong hangin ay maaaring magdulot ng hindi komportableng pakiramdam. Nangyayari ito dahil ang iyong mga nerbiyos ay nagpapadala ng halo-halong mga signal sa iyong utak.

Karaniwang lumalala ang sakit sa gabi. Maaari rin itong magpalakas pagkatapos ng aktibidad sa loob ng araw. Kapag gising ka pa lang, maaaring magpakita ang iyong limbong bilang matigas o pamamaga. Ang katigasan na ito ay maaaring magdulot ng hirap sa mga simpleng gawain. Maaari kang mahirap umabot sa likod upang isara ang bra. Ang pagtatakip ng damit o pagsisiksik ng jacket ay maaaring maging hindi komportable at masakit. Ang pag-angat ng mga bagay o pagkapit ay maaaring maging mahirang gawin.

Karaniwang hindi posible ang pagtulog sa apektadong gilid. Maaari kang magbago ng posisyon nang madalas upang makahanap ng ginhawa. Ang hindi komportableng pakiramdam ay maaaring makagambala sa iyong pang-araw-araw na gawain at pahinga. Habang ang maagang paggamot ay tumutulong upang bawasan ang panganib ng permanenteng pagkawala ng kakayahan, may ilang tao pa rin na nakakaranas ng pangmatagalang pagbabago. Ang iyong surgeon ay magtatrabaho sa iyo upang pamahalaan ang mga sintomas na ito. Ang pag-unawa sa kung ano ang nararamdaman mo ay ang unang hakbang patungo sa mas mahusay na pag-aalaga.

Ano ang nangyayari talaga

Ang CRPS ay isang kumplikadong kondisyon kung saan nakakabit sa posisyong "naka-on" ang mga signal ng sakit ng iyong katawan. Hindi ito simpl sugat lamang. Sa halip, ito ay isang multifactorial na isyu na kinasasangkutan ng iyong mga nerbiyos, immune system, at kahit ang iyong mga gene. Ang iyong surgeon ay nagdi-diagnose nito batay sa iyong history at physical exam, sa paghahanap ng mga partikular na senyales na nagpapakita kung ano ang nagkakamali sa loob ng iyong mga tissue.

Isipin ang iyong mga nerbiyos bilang mga electrical wire na may short-circuit. Ang mga test ay nagpapakita na ang paraan ng iyong pakiramdam ng sakit ay pundamental na nabago kumpara sa mga taong walang kondisyong ito. Ang iyong utak at mga nerbiyos ay maling nag-iinterpret ng mga normal na signal bilang matinding sakit. Ito ang dahilan kung bakit madalas hindi sapat ang epekto ng karaniwang gamot pang-alis ng sakit kapag ginamit mag-isa.

Dahil ang problema ay kinasasangkutan ng maraming iba't ibang sistema, walang iisang solusyon. Mahalaga ang maagang pagkilala. Kung maagang makakakuha tayo nito, maaari nating gamitin ang mga aktibong paggamot upang bawasan ang risk na maging isyu sa pangmatagalan. Gayunpaman, kahit may mabilisang paggamot, may ilang mga pasyente pa rin na maaaring maranasan ang permanenteng pagbabago sa paraan ng pagganap ng kanilang limb.

Ang mga sintomas na nararamdaman mo—tulad ng pamamaga, pagbabago ng kulay, o sobrang sensitivity—ay resulta ng kalituhan ng mga nerbiyos na ito. Ang iyong katawan ay tumutugon sa isang kinilingang banta na wala naman talaga. Ito ang dahilan kung bakit gumagamit tayo ng mga tool tulad ng Hamilton Inventory upang subaybayan hindi lamang ang iyong sakit, kundi pati na rin kung paano nito naaapektuhan ang iyong pang-araw-araw na buhay at mental na kalusugan.

Habang ang eksaktong sanay ay nananatiling kasalukuyang pinag-aaralan, alam natin na ang pag-iwas dito ay maaaring magdulot ng permanenteng pagkawala ng function. Ito ang dahilan kung bakit gumagamit tayo ng komprehensibong approach. Maaari nating gamitin ang mga gamot tulad ng ketamine o prednisolone upang payain ang mga nerbiyos. Maaari rin nating gamitin ang high-intensity laser therapy upang bawasan ang sakit direkta sa site. Ang mga paggamot na ito ay layuning putulin ang siklo ng sakit bago ito maging permanent.

Ano ang inaasahan

Ang iyong doktor na espesyalista sa buntis (surgeon) ay magdiyagnosis ng kondisyong ito batay sa iyong kasaysayan at isang pisikal na pagsusuri. Mahalaga ang maagang pagkilala at agarang paggamot upang bawasan ang permanenteng pagkawala ng kakayahan. Gayunpaman, kahit may tamang alaga, maaari pa ring maranasan ng iyo ang permanenteng kapansanan at kawalan ng kakayahan. Ang kondisyong ito ay multifactorial, ibig sabihin maraming salik ang kabilang, at patuloy pa ring pinag-aaralan ng mga mananaliksik kung paano ito eksaktong nabubuo.

Kung iiwan itong walang ginagawa, ang tanawin (outlook) ay hindi tiyak. Isang aktibong pamamaraan ng paggamot ang tila nagbabawas ng panganib ng pag-unlad ng pinakakaraniwang anyo ng sindromang ito. Para sa mga mayroon nang kroniko o mahirap gamutin na mga sintomas, malakas na dapat isaalang-alang ang paggamit ng ketamine. Iba pang mga pagpipilian ay kinabibilangan ng prednisolone, na maaaring gamitin sa mga sitwasyon kung saan wala nang espesyalisadong mga interbensyon. Ang high-intensity laser therapy ay nagbibigay din ng konklusibong ebidensya ng pagbaba ng sakit, kahit pagkatapos lamang ng ikatlong sesyon ng paggamot.

Ang paggaling ay nararamdaman nang iba-iba ng bawat isa. Maaari mong mapansin ang mga pagbabago sa sakit sa loob ng ilang linggo pagkatapos magsimula ng mga terapiya tulad ng laser treatment. Ang quantitative sensory testing ay nagpapakita na ang iyong mga mekanismo ng sakit ay nabago kumpara sa mga healthy controls, na tumutulong sa pagpapaliwanag kung bakit ang mga karaniwang pagsusuri ay maaaring hindi ganap na maipakikita ang iyong karanasan. Ang mga kasangkapan tulad ng Hamilton Inventory ay tumutulong sa pagsubaybay sa iyong mga sintomas, mga limitasyon sa pagganap, at kung paano nakakaapekto ang kondisyong ito sa iyong pang-araw-araw na buhay.

Habang ang ilang kaso ay nalulutas, ang iba ay nananatili. Ang insidensya ng sindromang ito pagkatapos ng isolated cubital tunnel surgery ay napakababa, na may kabuuang insidensya sa loob ng isang taon na humigit-kumulang 0.33%. Para sa mga fracture ng pulso, ang ulat na insidensya sa loob ng apat na buwan ay nag-iiba-iba depende sa mga pamantayan sa diyagnosis at kung paano pinamahalaan ang fracture. Dahil ang kalidad ng metodolohiya ng mga non-drug treatments para sa mga kaso ng upper limb ay madalas ay mahina, ang iyong doktor na espesyalista sa buntis ay magtatakda ng plano batay sa kung ano ang gumagana para sa iyo. Maging tapat tungkol sa iyong progreso. Ang mga realistickong inaasahan ay tumutulong sa iyo na pamahalaan ang kondisyong ito nang walang maling pangako.

Reviewed by Kieran Hirpara · 13 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.

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].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, the study location, and how the fracture is managed [15].
  • A more active treatment approach seems to lower the incidence of CRPS-1 [2].
  • The incidence of CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
  • Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].
  • Strong consideration should be given for the use of ketamine in patients presenting with chronic or refractory CRPS [1].
  • Prednisolone has potential as a treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
  • High-intensity laser therapy (HILT) offers conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
  • The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Background & Causes

  • CRPS is a multifactorial condition requiring further study to understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • Altered pain mechanisms exist in CRPS compared to controls, with a pooled standardized mean difference of -0.41 in quantitative sensory testing outcomes [5].
  • The diagnosis of CRPS is clinical, based on history and physical examination [9].
  • Early recognition and prompt treatment are important to minimize permanent loss of function, although patients may still experience permanent impairment and disability [9].
  • CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
  • Female sex is a significant predictor of developing CRPS following treatment of Dupuytren contracture [11].
  • Release of more than one digit is a significant predictor of developing CRPS following treatment of Dupuytren contracture [11].
  • 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].
  • Elderly patients have a higher risk of developing CRPS after distal radius fracture surgery [13].
  • Females have a higher risk of developing CRPS after distal radius fracture surgery [13].
  • Manual laborers have a higher risk of developing CRPS after distal radius fracture surgery [13].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].
  • Preexisting neuropathic disorders are the strongest predictors of CRPS after distal radius fracture [17].
  • Traumatic nerve injuries are the strongest predictors of CRPS after distal radius fracture [17].
  • Compressive neuropathies are the strongest predictors of CRPS after distal radius fracture [17].
  • Cervical radiculopathy is the strongest predictor of CRPS after distal radius fracture [17].
  • Patients with scaphoid waist fracture may be at higher risk of CRPS type I [19].
  • Women with diabetes mellitus who report severe pain before treatment are at higher risk of CRPS type I following scaphoid waist fracture [19].

Symptoms & Presentation

  • CRPS is a multifactorial condition [3].
  • Quantitative sensory testing indicates altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • Pain is a highly debilitating symptom in CRPS-I [7].
  • The diagnosis of CRPS is based on history and physical examination [9].
  • CRPS should be considered a diagnosis of exclusion [18].
  • Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [18].

Management

  • 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].
  • Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].
  • The incidence of CRPS following isolated cubital tunnel surgery (CuTS) is approximately 0.33% at 1 year [10].
  • Elderly patients have higher risks of developing CRPS after distal radius fracture surgery [13].
  • Female patients have higher risks of developing CRPS after distal radius fracture surgery [13].
  • Manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
  • A patient with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy had a positive outcome with no relapse on subsequent collagenase clostridium histolyticum (CCH) injection and manipulation of the other hand [16].

Key Considerations

  • In patients with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
  • A more active treatment approach appears to lower the incidence of CRPS-1 [2].
  • CRPS is a multifactorial condition requiring further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where specialized interventions may be unavailable [6].
  • High-intensity laser therapy (HILT) provides conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
  • CRPS diagnosis is clinical, based on history and physical examination, with early recognition and prompt treatment important to minimize permanent loss of function [9].
  • Patients with CRPS may still experience permanent impairment and disability despite early intervention [9].
  • Female sex and the release of more than one digit are significant predictors of developing CRPS following Dupuytren contracture treatment [11].
  • A large percentage of patients diagnosed with and treated for CRPS type 1 can achieve full resolution of symptoms with carpal tunnel release [12].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair (ARCR) [14].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and fracture management [15].
  • A patient with bilateral Dupuytren’s contractures developed CRPS-1 after fasciectomy but had a positive outcome with collagenase clostridium histolyticum (CCH) injection and manipulation of the other hand [16].

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)
  • [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. [18] (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. [19] (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] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[19] 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

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

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.