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Calcific Tendinitis

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Recovery after arthroscopic excision of a calcific deposit, from early movement to full activity.

Updated Jun 2026
Illustrasyon ng isang pisioterapeuta na sumusuporta sa braso ng isang tao habang ito ay dahan-dahang tinataas sa gilid.
Pagpapatibay ng komportableng galaw pagkatapos ng paggamot para sa calcific tendinitis. 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 protokol na ito ay sumasaklaw sa rehabilitasyon pagkatapos ng arthroscopic excision ng calcific deposit kay Dr Kieran Hirpara sa Mater Private Hospital Rockhampton: keyhole surgery upang alisin ang depositong calcium mula sa tendon ng rotator cuff, minsan ay pinagsama ng subacromial decompression upang magkaroon ng mas maraming espasyo para sa tendon. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa physiotherapy upang manatiling koordinado ang iyong rehabilitasyon. Ang iyong rehabilitasyon ay unti-unting pinapahusay ng iyong physiotherapist sa pamamagitan ng mga yugto sa ibaba, depende sa kung paano ang pag-unlad ng iyong balikat.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Madalas ay nakakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Kung ang pag-alis ng depositong kailangan ng rotator cuff repair (ang depositong minsan ay nag-iwan ng defect sa tendon na kailangang tahiin), ang iyong paggaling ay sumusunod sa mga alituntunin ng rotator cuff repair, at ang rotator cuff repair protocol ang may prioridad kaysa sa pahinang ito. Ipapaliwanag ni Dr Hirpara sa iyo pagkatapos ng operasyon kung ito ay aplikable sa iyo.

Ano ang inaasahan

Ang dalawang paraan ay nasa ilalim ng mga landas ng maagang paggalaw. Maliban na lamang kung kinakailangan ang pagkukumpuni ng rotator cuff, walang tahi na nangangailangan ng buwan-buwan na proteksyon; ang layunin ng paggamot ay alisin ang pinagmumulan ng sakit, at ang layunin ng rehabilitasyon ay paiti ang paglala pagkatapos ng paggamot, panatilihin ang paggalaw ng balikat upang hindi ito mahigpit, at pagkatapos ay muling itayo ang lakas.

  • Pagkatapos ng arthroscopic excision ibinibigay ang sling para sa kaginhawahan lamang. Ito ay isinasuot nang maikli, karaniwang mga araw at bihira pang higit sa dalawang linggo, at dapat itong tanggalin hangga’t maaari. Hindi mo kailangang matulog dito. Ang pagbawi sa buong, walang limitasyong aktibidad ay karaniwang tumatagal ng humigit-kumulang tatlong buwan.

Huwag magmaneho ng hindi bababa sa anim na linggo pagkatapos ng anumang operasyon sa balikat, kahit na matapos nang alisin ang sling; i-aalis ng iyong doktor ang pagbabawal sa pagmamaneho, karaniwan sa pagsusuri sa anim na linggo.

Sa parehong paggamot, maaaring kailanganin ng balikat ng oras upang ganap na matayo. Karaniwang umuunlad ang hindi komportableng pakiramdam sa mga yugto kaysa sabay-sabay, at pagkatapos ng operasyon ay maaaring kailanganin ng ilang buwan (minsan hanggang siyam) upang ganap na mawala ang mga sintomas bago ang paggamot. Ang patuloy na pag-unlad, hindi agad na kaginhawahan, ang inaasahang pattern.

Ito ay day surgery gamit ang keyhole sa pamamagitan ng ilang maliliit na hiwa. Ang depositong calcific ay matatagpuan sa loob ng tendon ng rotator cuff at tinatanggal, at madalas na isinasagawa ang subacromial decompression sa parehong oras upang bigyan ang tendon ng mas maraming espasyo. Ang mga panligo ay waterproof — maaari kang mag-shower sa itaas nito mula araw 1 — at nananatili hanggang sa masuri ang iyong mga sugat sa iyung unang post-operative appointment tungkol sa isang linggo hanggang sampung araw pagkatapos ng operasyon.

Yugong I — Maagang paggalaw (linggo 0–2)

Gising ka mula sa operasyon na may braso sa sling, ngunit ang sling ay para lamang sa kaginhawaan: subukang gumamit nito nang hindi kailangan, at karamihan sa mga tao ay nakakalabas nito sa loob ng ilang araw. Maaari mong gamitin ang braso nang walang limitasyon sa ilalim ng taas ng balikat mula sa simula. Pinapayagan at ligtas ang pagtaas ng braso sa itaas ng taas ng balikat, bagama’t magkakaroon ng hindi komportable sa unang panahon; ilang beses sa isang araw, gamitin ang iyong magandang braso upang tulungan ang operadong braso na itaas sa itaas ng taas ng balikat bilang banayad na pag-unat, upang hindi mahigpit ang balikat. Iwasan ang pagdadala ng anumang bagay na mas mabigat sa humigit-kumulang dalawang kilo gamit ang operadong braso sa mga unang linggong ito, dahil ito ay magdudulot ng sakit. Simulan ang iyong mga ehersisyo sa pinakamaagang pagkakataon, na may layuning gawin ang sampung ulit ng bawat isa, tatlong beses sa isang araw. Kumain ng gamot pang-alis ng sakit bago ang iyong mga ehersisyo, at gumamit ng yelo para sa kaginhawaan. Huwag magmaneho: ang pagmamaneho ay muling sisimulan lamang pagkatapos ikaw ay bigyan ng pahintulot ng iyong doktor, karaniwan ay sa pagsusuri sa ikaanim na linggo.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Pagpapahina ng post-operative na sakit at pamamaga
  • Maagang pagbawi ng saklaw ng galaw: ang prioridad ay ang pag-iwas sa pagiging mahigpit, kung saan karaniwang madaling mahigpit ang mga pasyente na may calcific tendinitis
  • Normal na paggamit ng braso sa ilalim ng taas ng balikat

Pamamahala

  • Sling para lamang sa kaginhawaan; bawasan ang paggamit nito sa pinakamabilis na paraang pinapayagan ng kaginhawaan, karaniwan sa loob ng ilang araw
  • Walang limitasyong aktibong paggamit ng braso sa ilalim ng taas ng balikat mula sa ika-1 na araw
  • Aktibong pagtaas sa itaas ng taas ng balikat ayon sa kakayahang tanggapin
  • Pasibo at aktibo-tulong na pagtaas sa itaas ng taas ng balikat ilang beses sa isang araw (gamit ang kabilang braso) upang maiwasan ang pagiging mahigpit
  • Programang ehersisyo sa bahay: sampung ulit ng bawat isa, tatlong beses sa isang araw
  • Analgesia bago ang mga ehersisyo; cryotherapy para sa pagpapagaan ng sakit kung kinakailangan

Mga Paalala

  • Walang pagdadala o pagtaas na higit sa humigit-kumulang dalawang kilo gamit ang operadong braso
  • Walang pagmamaneho sa loob ng anim na linggo (ito ay nag-aaplay sa anumang operasyon sa balikat)

Mga Kriterya para sa Pag-usad

  • Sapat na pagsusuri ng sugat sa unang post-operative na pagpupulong
  • Nakalabas na sa sling at gumagamit ng braso nang komportable sa ilalim ng taas ng balikat

Yugong II — Pagbawi ng saklaw ng galaw (linggo 2–8)

Maaari kang ma-review sa mga silid sa loob ng dalawa hanggang tatlong linggo, kung saan sinusuri ang sugat at ang passive range of motion. Ang pangunahing layunin ng yugong na ito ay ang saklaw ng galaw: pag-usad sa mga stretch para sa forward elevation at pagdaragdag ng mga galaw palabas sa gilid, na gabay ng physiotherapy ang pag-usad. Ang karaniwang layunin ay ang pagtaas ng braso nang aktibo hanggang horizontal sa loob ng anim na linggo, at ang assisted (passive) range (forward, palabas sa gilid, at sa pag-ikot) ay babalik sa normal sa loob ng anim na linggo. Maaari kang magmaneho mula sa anim na linggo, pagkatapos ipahintulot ng iyong surgeon at kung kayang gawin nang ligtas ang emergency stop.

Para sa iyong physiotherapist:

Mga Layunin

  • Aktibong forward flexion at abduction hanggang horizontal sa loob ng anim na linggo
  • Passive flexion, abduction, at external rotation hanggang normal sa loob ng anim na linggo
  • Kalayaan sa mga araw-araw na gawain

Pamamahala

  • Pag-usad ang passive at active-assisted forward flexion; ipakilala at pag-usad ang abduction
  • Pag-usad sa active range of motion sa lahat ng planes ayon sa kaginhawaan
  • Magpatuloy sa scapular setting at postural work
  • Magpatuloy sa analgesia bago ang mga sesyon, at init o yelo sa paligid ng pag-stretch ayon sa kagustuhan

Mga Paalala

  • Panatilihin ang magaan na pag-angat habang binabawi ang saklaw ng galaw; ang pag-usad ay nananatiling gabay ng sintomas
  • Ang pag-stretch hanggang sa matigas na hindi komportable ay tanggap; ang pilit at sobrang sakit na pag-stretch ay hindi tanggap

Mga Kriteryo para sa Pag-usad

  • Passive range of motion na nasa normal o malapit na sa normal
  • Aktibong elevation hanggang horizontal o higit pa, na may pagpapahina ng sakit

Yugong III — Pagpapalakas at pagbabalik sa buong gawain (linggo 8–16)

Karaniwang susuriin ka muli sa mga walong linggo. Sa pagbabalik ng iyong saklaw ng galaw, ang rehabilitasyon ay naglalayong palakasin ang rotator cuff, kadalasan sa ilalim ng supervisyon ng iyong physiotherapist, at gamitin ang braso nang malaya sa itaas ng taas ng balikat. Ang layunin ay ang buong aktibong pagtaas pasulong (forward elevation) at pag-abduksyon sa mga labindalawang linggo. Ang paggaling mula sa pag-alis lamang ng deposit ay karaniwang tumatagal ng mga tatlong buwan, pagkatapos ay walang limitasyon; kung kailangan ng pagkumpuni ang rotator cuff, mas matagal ang paggaling (karaniwang mga limang buwan) at sumusunod sa protocol ng pagkumpuni ng rotator cuff. Huwag mag-alala kung may natitirang pananakit sa higit pa sa puntong ito: pagkatapos ng operasyong ito, maaaring tumagal ng hanggang siyam na buwan bago lubos na matanggal ang mga sintomas bago-operasyon, habang ang trend ay patuloy na nasa tamang direksyon.

Para sa iyong physiotherapist:

Mga Layunin

  • Buong aktibong pagtaas pasulong (forward flexion) at pag-abduksyon sa mga labindalawang linggo
  • Unahan-unahang pagbabalik ng lakas at tibay ng rotator cuff at scapula
  • Pagbabalik sa buong, walang limitasyong gawain sa mga tatlong buwan

Pamamahala

  • Unahan-unahang pagpapalakas ng rotator cuff mula walong linggo: isometrics na nag-uusad patungo sa elastic-band at magaan na timbang na ehersisyo, mababang load at mas mataas na paulit-ulit
  • Pag-unlad ng aktibong paggamit ng braso sa itaas ng taas ng balikat
  • Pagpapalawak ng gym-, trabaho-, at espesipikong pagkarga sa isport ayon sa kakayahang matolerahan sa mga labindalawa hanggang animnapung linggo

Mga Paalala

  • Ang pagpapalakas ay hindi dapat manghina sa saklaw ng galaw; patuloy na gawin ang mga ehersisyo para sa mobility sa buong yugong ito
  • Unahan-unahang pagbuo ng mabigat at overhead na pagkarga; ang pagtaas ng pananakit ay nangangahulugang pagbaba ng antas ng ehersisyo

Mga Kriteryo para sa Pag-unlad

  • Buong aktibong saklaw ng galaw na may pagbabalik ng lakas at patuloy na pagbaba ng mga sintomas
  • Paglabas sa karaniwang follow-up kapag magaling ang pag-unlad, karaniwang mula sa mga walong hanggang animnapung linggo

Pagkatapos ng iyong protokol

Ang mga yugto sa itaas ay naangkop mula sa mga nakapublikasyon na gabay para sa pasyente at mga protokol ng rehabilitasyon para sa pamamaraang ito: ang protokol ng rehabilitasyon para sa pag-aalis ng depositong kalisyum ng London Shoulder Partnership, gabay para sa pasyente mula sa ShoulderDoc (UK) tungkol sa operasyon para sa kalisyum na tendinitis, at gabay para sa pasyente ni Dr. Kevin Ko para sa arthroscopic na pag-aalis. Ang mga saklaw ng linggo ay karaniwan lamang at hindi eksakto, at ang iyong patuloy na rehabilitasyon ay indibidwal na pinamumunuan ng iyong pisioterapeuta, na nagtatrabaho kasama ang klinikang medikal, batay sa kung paano ang iyong balikat na gumagaling. Ang pahinang ito ay nagtataglay kasama ng pangkalahatang payo sa paggaling ng klinikang medikal: tingnan ang pamamahala ng sakit pagkatapos ng operasyon at pag-aalaga sa sugat. Para sa kondisyon mismo at kung paano gumagana ang mga tratamientong ito, tingnan ang kalisyum na tendinitis. Ang ebidensya sa likod ng protokol na ito (natural na kasaysayan, barbotage, at literatura sa pagsasagawa ng operasyon) ay buod sa seksyon ng ebidensya, na magagamit bilang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

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.

Calcific Tendinitis of the Rotator Cuff — Staged Management & Post-operative Rehabilitation (Arthroscopic Excision)

Topic scope: (A) the natural history and stepped non-operative management of rotator-cuff calcific tendinitis (rest/analgesia → barbotage ± subacromial steroid → ESWT), and (B) post-operative rehabilitation after arthroscopic excision of the calcific deposit (± subacromial decompression; the cuff-repair pathway defers to the rotator-cuff-repair protocol).

Defining principle of the surgical rehab here: arthroscopic excision removes the source of pain and does not, by itself, create a construct that needs months of protection — provided the rotator cuff is left intact. So (like a debridement/decompression, and unlike a cuff repair) the rehab is an early-movement pathway: short sling for comfort only, unrestricted use below shoulder height from day one, assisted elevation to prevent stiffness, strengthening from ~8 weeks. The single branch point is whether removing the deposit left a tendon defect that needed repair — if so, the recovery converts to the slower, protected rotator-cuff-repair pathway.

A. NATURAL HISTORY & NON-OPERATIVE MANAGEMENT

Natural history (self-limiting in most)

Rotator-cuff calcific tendinitis is self-limiting in the majority: after a variable quiescent period the deposit enters a resorptive phase (peripheral vascularisation + phagocytosis), and spontaneous resorption occurs in roughly two-thirds of cases within 1–2 years [Uhthoff & Loehr; Chianca 2018 review]. This underpins a non-operative-first approach and explains why post-operative residual calcium that "dissolves spontaneously" does not harm the outcome.

Stepped non-operative interventions

  1. Analgesia / activity modification / physiotherapy — first line; many settle as the deposit resorbs. Consensus.
  2. Ultrasound-guided barbotage (needling + lavage), usually + subacromial corticosteroid — the best-supported interventional option. A systematic review of 908 patients and subsequent meta-analyses favour barbotage for medium-term pain/function; barbotage + subacromial steroid improves Constant–Murley score and reduces deposit size vs steroid alone. Notably, clinical improvement is NOT dependent on how much calcium is aspirated — perforating the deposit to trigger resorption is the active mechanism. Moderate–strong (SR/RCT).
  3. Extracorporeal shock-wave therapy (ESWT) — reduces deposit size and pain; broadly comparable to barbotage in several comparisons. Moderate (RCT).

B. POST-OPERATIVE REHABILITATION (arthroscopic excision ± subacromial decompression)

Surgery is reserved for deposits recalcitrant to adequate non-operative care. The operation locates and removes the deposit from within the cuff tendon, often with a subacromial decompression for room. Key surgical-outcome facts that shape the rehab:

  • Preserving cuff integrity while removing as much deposit as possible gives good-to-excellent results in ~90% and avoids iatrogenic tendon defects [arthroscopic excision series].
  • Complete vs near-complete removal gives equivalent outcomes — residual calcium resorbs spontaneously afterwards; the surgeon need not chase every fleck at the cost of the tendon.
  • Arthroscopic decompression WITHOUT cuff repair is a validated strategy with good outcomes where the residual defect is not repaired [Bone & Joint 2023].
  • Symptom settling is gradual — significant pain relief and ROM gains are the norm, but the pre-operative symptoms can take up to ~9 months to fade fully; recovery to unrestricted activity after excision alone is ~3 months.

Phased post-op timeline (no cuff repair)

Phase Window Sling ROM / use Strengthening Notes
I — Early movement Week 0–2 Comfort only, days (rarely > 2 wk), off ASAP Unrestricted use below shoulder height from day 1; assisted elevation above shoulder height several × daily to prevent stiffness — Settle post-op flare; calcific patients are stiffness-prone → motion is the priority. ≤ ~2 kg, no driving while in sling
II — Regaining range Week 2–8 Off Progress active elevation; restore full passive + active ROM Begin gentle as pain allows Most regain comfortable range through this window
III — Strengthening / return Week 8–16 Off Full active elevation goal by ~12 wk Cuff + scapular strengthening from ~8 wk, isometric → band/light weight; advance work/sport loading wk 12–16 Full unrestricted activity ~3 months; discharge ~8–16 wk

Branch point — if a rotator cuff repair was required: recovery converts to the protected rotator-cuff-repair pathway (sling ~6 wk, ROM restrictions, strengthening deferred), typically ~5 months total. The surgeon confirms post-operatively which pathway applies.

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Surgery is a last resort — given high spontaneous-resorption rates and effective barbotage/ESWT, excision is reserved for genuinely recalcitrant cases. Strong rationale.
  2. How much to remove / whether to repair the defect. Equivalent outcomes for complete vs partial removal, and viable decompression-without-repair, mean the surgeon balances deposit clearance against tendon integrity intra-operatively — which in turn decides the rehab pathway. Moderate.
  3. The post-op rehab protocol itself is consensus/expert, drawn from surgeon patient-guidance protocols rather than a rehab RCT — phase timings are typical, not trial-derived.

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE–STRONG (SR / RCT): barbotage ± steroid for non-operative calcific tendinitis (908-patient SR; barbotage + steroid > steroid alone); ESWT efficacy.
  • MODERATE (cohorts): arthroscopic excision outcomes (~90% good-excellent; equivalence of complete vs partial removal; decompression without repair, Bone & Joint 2023); spontaneous resorption ~2/3 within 1–2 years.
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol (surgeon patient-guidance documents; no defining rehab RCT).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles) — adjacent rotator-cuff evidence

  • Predictors of failure of non-operative treatment of chronic symptomatic rotator-cuff disease (2013 Neer Award). J Shoulder Elbow Surg. 2016. DOI: 10.1016/j.jse.2016.04.030
  • Arthroscopic rotator cuff repair: scientific rationale, surgical technique, early clinical results. J Shoulder Elbow Surg. 2010. DOI: 10.1016/j.jse.2009.12.012
  • Early versus delayed rehabilitation after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2024. DOI: 10.1002/ksa.12129
  • Speed of recovery after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2017. DOI: 10.1016/j.jse.2016.11.002
  • (The corpus is thin on calcific-tendinitis-specific rehab; the evidence base below is the calcific literature + published surgeon protocols.)

Calcific tendinitis literature (URLs)

  • Ultrasound-guided barbotage for calcific tendonitis of the shoulder: a systematic review including 908 patients (DARE). https://www.ncbi.nlm.nih.gov/books/NBK241935/
  • Determining the efficacy of barbotage for pain relief in calcific tendinitis. JSES Int / ScienceDirect. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11401591/
  • Needling and lavage in rotator-cuff calcific tendinitis: ultrasound-guided technique. PMC. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10805427/
  • Calcific tendinitis of the rotator cuff: a review (natural history, phases, resorption). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC3749672/
  • Recovery pattern after arthroscopic treatment for calcific tendinitis of the shoulder. Orthop Traumatol Surg Res. 2020. https://www.sciencedirect.com/science/article/pii/S1877056820301043
  • Arthroscopic decompression of calcific tendinitis without cuff repair. Bone Joint J. 2023. https://boneandjoint.org.uk/Article/10.1302/0301-620X.105B6.BJJ-2022-1137.R1
  • Arthroscopic treatment of calcific tendonitis (preserve cuff, ~90% good-excellent; residuals resorb). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4044535/

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

  • The London Shoulder Partnership — Calcific Deposit Excision Rehabilitation. http://thelondonshoulderpartnership.co.uk/shoulder/shoulder-rehabilitation/calcific-deposit-excision-rehabilitation/
  • Ko K. Arthroscopic Excision of Calcific Tendonitis — What Can I Expect? (OPA Orthopedics). https://www.kevinkomd.com/pdf/calcific-tendonitis.pdf
  • Funk L. Surgery for Calcific Tendinitis. ShoulderDoc. https://shoulderdoc.co.uk/pages/surgery-for-calcific-tendinitis

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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.