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Cubital Tunnel Release

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Paggaling pagkatapos ng surgical decompression ng ulnar nerve sa siko, na sumasaklaw sa parehong in-situ (simple) release at anterior transposition.

Ilustrasyon ng loob ng siko na nagpapakita ng ulnar nerve na dumadaan sa likod ng bony bump (medial epicondyle) sa pamamagitan ng cubital tunnel.
Ang ulnar nerve na dumadaan sa cubital tunnel sa loob ng siko, na pinalaya sa pamamagitan ng surgical decompression. Mcstrother / Wikimedia Commons, CC BY 3.0

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

Ang protocol na ito ay nagsisilbing gabay sa iyong paggaling pagkatapos ng surgical release ng ulnar nerve sa siko (cubital tunnel release) kasama si Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Ipinapaliwanag nito ang mga dapat asahan, ang mga pag-iingat para sa mga unang linggo, at ang mga ehersisyo upang mapanatiling malayang nakaka-glide ang nerve habang naghihilom ang lahat. Dalhin ang pahinang ito o ang PDF nito sa iyong physiotherapist o hand therapist upang manatiling coordinated ang iyong rehabilitasyon. Maaaring i-adjust ng iyong therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga rooms. Kadalasang nakakatulong ang pagkuha ng larawan ng sugat at pag-email nito para masuri.

Dalawang magkaibang operasyon, dalawang bahagyang magkaibang paggaling. Ang ulnar nerve ay maaaring palayain sa dalawang pangunahing paraan, at ang paraang ginamit sa iyo ay nagbabago sa iyong mga unang pag-iingat:

  • In-situ (simple) decompression: ang nerve ay pinalalaya kung saan ito nakalagay, nang hindi ito ginagalaw. Ito ang standard na operasyon na ginagawa ni Dr Hirpara, at mabilis ang paggaling: nagsisimula nang maaga ang banayad at full movement ng siko. Walang ginagamit na rigid brace.
  • Anterior (submuscular) transposition (ang nerve ay itinaas at inilipat sa isang mas protektadong posisyon sa harap ng siko): ginagawa lamang sa hindi gaanong karaniwang sitwasyon kung saan ang nerve ay nag-su-sublux o nadidislokate sa ibabaw ng bony bump (medial epicondyle) kapag ibinabaluktot ang siko. Nangangailangan ito ng mas maingat na early phase, pag-iwas sa end-range na pagbaluktot at pagtuwid ng siko sa unang ilang linggo habang ang nerve at soft tissues ay nananatili sa kanilang bagong posisyon. Maaaring gumamit ng simpleng sling para sa comfort lamang.

Sundin ang gabay sa ibaba para sa operasyong ginawa sa iyo: in-situ sa karamihan ng mga kaso, transposition kung ang iyong nerve ay unstable.

Ano ang dapat asahan

Para sa pamamahala ng sugat, pamamaga, at peklat, tingnan ang gabay ng klinika para sa wound care.

Ang layunin ng operasyon ay alisin ang pressure sa ulnar nerve (ang nerve na nagbibigay ng pakiramdam sa iyong kalingkingan at ring finger at nagpapatakbo sa marami sa maliliit na kalamnan ng kamay). Kapag nawala na ang pressure, magsisimulang bumawi ang nerve, ngunit mabagal gumaling ang mga nerve.

Ang bilis ng pagbuti ng iyong mga sintomas ay nakadepende nang malaki sa kung gaano katagal na-compress ang nerve at kung gaano ito nairita bago ang operasyon. Ang pangingilig (tingling) at pins-and-needles ay madalas na unang nababawasan, kung minsan sa loob ng ilang araw o linggo. Ang pamamanhid (numbness) at lakas ng kamay ay mas matagal (madalas ay mga buwan) at ang pinal na resulta ay maaaring patuloy na bumuti hanggang isang taon o higit pa pagkatapos ng operasyon. Sa mga kaso kung saan ang nerve ay sobrang nairita sa loob ng mahabang panahon bago ang operasyon, ang ilang pamamanhid o panghihina ay maaaring hindi na ganap na bumalik; ang operasyon ay naglalayong pigilan ang paglala ng kondisyon at bigyan ang nerve ng pinakamagandang pagkakataon.

Sa paghahambing ng dalawang operasyon, natuklasan ng malalaking review ng mga nailathalang trial na ang simple in-situ decompression at anterior transposition ay nagbibigay ng magkatulad na pangkalahatang resulta, kung saan ang simple decompression ay may tendensiyang magkaroon ng mas kaunting komplikasyon sa sugat at soft-tissue [1][2]. Ang pagpili sa pagitan ng mga ito ay ginagawa ng iyong surgeon base sa iyong nerve at iyong siko.

Mga pag-iingat at limitasyon

Hinihikayat ang magaan na functional na paggamit ng iyong kamay para sa mga pang-araw-araw na gawain tulad ng pag-aalaga sa sarili, pagkain, pagbibihis, pagsusulat, at pag-type mula sa simula, hangga't komportable.

Ang mga maagang limitasyon ay nakadepende sa operasyong iyong ginawa:

  • Pagkatapos ng in-situ (simple) decompression (ang karaniwang operasyon): hinihikayat ang banayad at buong paggalaw ng siko, forearm, pulso, at kamay nang maaga upang mapanatili ang pag-glide ng nerve. Walang brace na ginagamit. Panatilihing magaan ang pagbuhat, paghawak, at pagdadala ng bigat gamit ang braso sa loob ng unang anim na linggo, pagkatapos ay unti-unting dagdagan.
  • Pagkatapos ng anterior transposition (kung ang iyong nerve ay unstable lamang): protektado ang siko sa unang ilang linggo; iwasang pilitin itong itiklop nang husto o ituwid nang husto, at iwasang panatilihin itong nakatiklop sa mahabang panahon, habang ang nerve ay nananatili sa bago nitong posisyon. Maaaring gumamit ng simpleng sling para lamang sa komportable. Ang mga nerve glide ay magsisimula nang mas huli kaysa sa simple release (karaniwan ay mga dalawa hanggang tatlong linggo). Tulad ng sa in-situ release, panatilihing magaan ang pagbuhat at resistance sa loob ng unang anim na linggo, pagkatapos ay unti-unting dagdagan.

Bilang pangkalahatang gabay, ang pagbuhat at resistance strengthening ay pinapanatiling magaan hanggang mga anim na linggo, pagkatapos ay unti-unting dadagdagan [3][4].

Ang pagsandal sa siko (pagpapahinga ng iyong siko sa isang matigas na ibabaw) ay nagbibigay ng pressure mismo sa ibabaw ng nerve at dapat iwasan habang ito ay nagpapagaling.

Kapag magaling na ang iyong sugat, ang scar massage ay nakatutulong upang mapanatiling malambot ang balat at mga tissue sa ibabaw ng nerve. Ang pahinang wound care ay may higit pang impormasyon tungkol sa scar management.

Ito ang mga ehersisyo mula sa iyong handout, na isinasagawa ayon sa inilarawan sa bawat card. Simulan ang mga ito ayon sa gabay ni Dr Hirpara at ng iyong therapist: ang petsa ng pagsisimula para sa mga nerve glide, at anumang limitasyon sa range ng siko, ay nakadepende sa operasyong iyong ginawa.

Iyong mga ehersisyo

Isang pagkakasunod-sunod ng mga posisyon ng braso na ginagabayan ang siko, pulso, at mga daliri sa mga paggalaw na dahan-dahang nagpapausod (slide) sa ulnar nerve.

Kieran Hirpara 4.0

Mga ulnar nerve glide

Ang mga banayad na paggalaw na ito ay pinapanatiling malayang dumudulas ang ulnar nerve upang hindi ito dumikit sa naghihilom na tissue. Gumalaw nang swabe sa bawat posisyon hanggang sa kung ano lamang ang komportable — ang bahagyang paghila o pangingilig ay normal, ngunit huminto bago makaramdam ng anumang matalas o matinding pins-and-needles. Huwag kailanman pilitin ang stretch. Magsimula lamang kapag sinabi ng iyong surgeon o therapist (karaniwang mas huli ito kung ikaw ay sumailalim sa transposition — tingnan ang mga pag-iingat sa ibaba).

5 mabagal na pag-uulit, 2–3 beses araw-araw

Isang braso na tumitiklop sa siko upang ilapit ang kamay sa balikat, pagkatapos ay itutuwid.

Kieran Hirpara 4.0

Pagbaluktot ng siko (flexion)

Habang suportado ang iyong itaas na bahagi ng braso, dahan-dahang itiklop ang iyong siko upang ilapit ang iyong kamay sa iyong balikat, pagkatapos ay ibaba itong muli. Gumalaw sa loob ng komportableng range. Kung ikaw ay sumailalim sa isang transposition, maaaring hilingin ng iyong surgeon na iwasan ang pagtiklop ng siko nang sagad sa unang ilang linggo — sundin ang limitasyong ibinigay sa iyo.

10 repetitions, 3–4 beses araw-araw, sa loob ng iyong pinapayagang range

Isang braso na itinutuwid sa siko mula sa nakabaluktot na posisyon.

Kieran Hirpara 4.0

Pagtuwid ng siko (extension)

Mula sa nakabaluktot na posisyon, dahan-dahang ituwid ang iyong siko hanggang sa kung saan ito komportable, pagkatapos ay ibalik ito. Kung ikaw ay sumailalim sa isang transposition, iwasang piliting ituwid nang husto ang siko sa mga unang linggo kung ito ay ipinagbilin sa iyo — manatili sa komportableng range na itinakda ng iyong surgeon.

10 repetitions, 3–4 beses araw-araw, sa loob ng iyong pinapayagang range

Habang ang siko ay nasa gilid, ang forearm ay umiikot ang palad paitaas pagkatapos ay palad paibaba.

Kieran Hirpara 4.0

Rotasyon ng forearm

Habang ang iyong siko ay nakadikit sa iyong tagiliran at nakabaluktot sa isang right angle, dahan-dahang ituon ang iyong palad paitaas sa kisame, pagkatapos ay paibaba sa sahig. Panatilihing nakadikit ang iyong siko sa iyong katawan sa buong proseso.

10 beses sa bawat direksyon, 3–4 beses araw-araw

Isang kamay na ibinabaluktot ang pulso pataas at pababa at ibinubukas at isinasara ang mga daliri.

Kieran Hirpara 4.0

Paggalaw ng pulso at daliri

Dahan-dahang itiklop ang iyong pulso pataas at pababa, at buksan at isara nang lubos ang iyong mga daliri, gumawa ng maluwag na kamao at pagkatapos ay iunat ang mga daliri. Pinapanatili nito ang paggalaw ng buong braso at tumutulong na mabawasan ang pamamaga at paninigas habang nagpapagaling ang siko.

10 ng bawat isa, ilang beses sa isang araw

Simulan lamang ang mga ehersisyo sa ibaba ayon sa gabay ni Dr Hirpara at ng iyong hand therapist, at manatili sa anumang range at limitasyong ibinigay sa iyo. Ang mga ulnar nerve glide ang mga mahalaga — pinapanatili ng mga ito ang pagdausdos ng nerve sa bago nitong posisyon sa halip na magkaroon ng scarring, at nagsisimula ang mga ito nang maaga. Ang pagbaluktot, pagtuwid ng siko, at pag-ikot ng forearm ay pumipigil sa paninigas ng siko, at ang mga galaw ng wrist at daliri ay pinapanatili ang paggana ng lahat ng iba pa. Iwasang magpahinga nang matagal na nakabaluktot nang husto ang siko, dahil ito ang nag-iirita sa nerve sa simula pa lamang. Itigil ang anumang nagdudulot ng matalas o parang kuryenteng sakit pababa ng forearm patungo sa kalingkingan at ring finger.

Pagbabalik sa trabaho at aktibidad

Karamihan sa mga tao ay bumabalik sa desk-based o magaan na trabaho sa loob ng isa hanggang dalawang linggo, habang ang mas mabibigat, paulit-ulit, o manwal na mga tungkulin ay karaniwang tumatagal ng apat hanggang walong linggo. Handa ka na para sa isang partikular na gawain kapag ang iyong sugat ay nakakayanan na ang kontak at presyur na kasama nito, at kaya mo itong gawin nang komportable sa loob ng mga pag-iingat sa itaas. Kung ang iyong trabaho ay mabigat, kinapapalooban ng paglean sa siko, o gumagamit ng mga vibrating tool, banggitin ito sa iyong post-operative review upang makagawa ng plano (kabilang ang anumang modified duties).

Ang pagmamaneho ay karaniwang nagpapatuloy sa loob ng dalawa hanggang tatlong linggo, kapag wala ka na sa anumang sling at kaya mo nang kontrolin ang sasakyan at rumesponde sa emergency nang walang sakit. Ang pagbabalik sa sports at overhead activity ay karaniwang nasa anim hanggang labindalawang linggo.

Ang paggaling ng nerve ay may sariling mas mabagal na timeline. Ang pangingilig (tingling) ay madalas na nawawala muna, sa loob ng mga araw hanggang linggo, habang ang pamamanhid (numbness) at lakas ay patuloy na bumubuti sa loob ng maraming buwan at maaaring patuloy na gumaling hanggang sa loob ng halos isang taon. Sa mga bahagi kung saan ang nerve ay matagal na sobrang na-compress, ang ilang pamamanhid o panghihina ay maaaring hindi na lubos na gumaling, at ang operasyon ay naglalayong pigilan ang paglala nito.

Pagkatapos ng iyong protocol

Ang protocol na ito ay kasabay ng pangkalahatang payo sa paggaling ng klinika: tingnan ang pamamahala ng sakit pagkatapos ng operasyon, pag-aalaga ng sugat at mga pangunahing kaalaman sa hand therapy. Ang phased plan sa itaas ay naaayon sa nailathalang ebidensya tungkol sa decompression ng ulnar nerve sa siko, at ang iyong patuloy na paggaling ay ginagabayan nang indibidwal ng iyong physiotherapist o hand therapist ayon sa pag-unlad ng iyong nerve at siko.

Mga Sanggunian

[1] Said J, Van Nest D, Foltz C, et al. Ulnar nerve in situ decompression versus transposition for idiopathic cubital tunnel syndrome: an updated meta-analysis. J Hand Microsurg. 2019;11(1):18–27. https://pmc.ncbi.nlm.nih.gov/articles/PMC6431285/ [2] Macadam SA, Gandhi R, Bezuhly M, Lefaivre KA. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am. 2008;33(8):1314.e1–12. https://pubmed.ncbi.nlm.nih.gov/18929194/ [3] Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016;11:CD006839. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006839.pub4/full [4] Andrews K, Rowland A, Pranjal A, Ebraheim N. Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop. 2018;15(3):832–836. https://pmc.ncbi.nlm.nih.gov/articles/PMC6082832/

Reviewed by Dr Kieran Hirpara · 18 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.

Cubital Tunnel Release — Post-operative Rehabilitation (In-situ Decompression vs Anterior Transposition)

Topic scope: post-operative rehabilitation after surgical decompression of the ulnar nerve at the elbow. The single defining branch point is the operative technique: (A) in-situ (simple) decompression — an early-full-motion pathway; versus (B) anterior transposition (subcutaneous or submuscular) — a protected early phase that avoids end-range elbow flexion/extension for the first few weeks to protect the transposed nerve and its soft-tissue bed.

Defining principle of the rehab here: decompression relieves pressure on a nerve; it does not, by itself, create a load-bearing repair that needs months of protection. So the rehab is fundamentally an early-motion, nerve-glide pathway aimed at preventing perineural adhesion while the nerve recovers on its own (slow) biological timeline. The one variable that changes the early phase is whether the nerve was transposed — a transposed nerve sits in a new bed and end-range elbow excursion is restricted briefly to protect it, so nerve glides start later and elbow ROM is capped for a few weeks. Phase timings below are typical of published surgeon protocols and institutional consensus rather than trial-derived.

A. PROCEDURE CHOICE & OUTCOME EQUIVALENCE

  • In-situ decompression and anterior transposition give equivalent clinical outcomes. Multiple meta-analyses of RCTs and comparative series find no significant difference in motor nerve conduction velocity or clinical outcome scores between simple decompression and transposition for idiopathic cubital tunnel syndrome. Strong (multiple SR/meta-analyses).
  • Simple decompression carries a lower complication burden (wound, soft-tissue, devascularisation risk), and is often preferred where the nerve is stable and does not subluxate. Moderate–strong.
  • Transposition is selected for nerve instability/subluxation, prior failed in-situ release, bony deformity, or a hostile cubital tunnel floor — surgeon's intra-operative judgement. Consensus.
  • Endoscopic vs open in-situ decompression show comparable outcomes; choice does not change the rehab pathway (both early-motion). Moderate (SR).

B. POST-OPERATIVE REHABILITATION

Common principles (both pathways)

  • Early digital, wrist and shoulder motion from day 1 to prevent stiffness and oedema.
  • Ulnar nerve gliding to prevent perineural adhesion — timing differs by pathway (see below).
  • No elbow leaning / direct pressure over the nerve during recovery.
  • Wound: suture removal ~10–14 days; scar massage and desensitisation once healed.
  • Nerve recovery is slow and graded: paraesthesia often improves first (days–weeks); numbness and intrinsic strength lag (months); final outcome continues to ~12 months. DASH, clinical findings and NCV improve postoperatively, with significant early gains by ~1 month in cohort data. Pre-operative severity/chronicity is the dominant predictor of incomplete recovery.

Phased timeline (typical of published surgeon protocols)

Phase In-situ (simple) decompression Anterior transposition (SC / submuscular)
Week 0–2 Soft dressing; early active full elbow ROM + digit/wrist/shoulder ROM; light ADLs Splint/sling for comfort/protection (often elbow ~semi-flexed early); avoid end-range flexion AND extension, and avoid sustained/prolonged elbow flexion; digit/wrist/shoulder ROM
Week 2–6 Progress to full unrestricted active ROM; scar massage + desensitisation once healed; nerve glides as tolerated Suture out ~10–14d; gradually restore elbow ROM within set limits; scar/desensitisation; introduce nerve glides — typically deferred to this window
Week ~6+ Strengthening / lifting built up as tolerated; return to full activity Restrictions usually lifted ~6 wk; resistance strengthening from ~6 wk; build up gradually

Dr Hirpara's practice parameters:

  1. Default operation = in-situ (simple) decompression; anterior submuscular transposition is reserved for a nerve that subluxates over the medial epicondyle. No rigid brace is used.
  2. Early elbow ROM: full active elbow motion from day 1 after in-situ decompression. After a transposition the elbow is protected from end-range flexion/extension for the first few weeks (a simple sling for comfort only — no rigid brace).
  3. Nerve glides: start early/as-tolerated after in-situ; start around 2–3 weeks after a transposition.
  4. Lifting: kept light (around ≤2 kg) for the first ~6 weeks, then resistance strengthening is built up gradually.
  5. Nerve recovery: paraesthesia settles first (days–weeks); numbness and intrinsic strength recover over months and can keep improving to ~12 months. Pre-operative severity/chronicity is the dominant predictor — long-standing severe compression may not fully recover, and surgery then aims to halt progression.

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Procedure equivalence is well supported (multiple meta-analyses); the complication-profile advantage of simple decompression drives the "in-situ first unless unstable" stance. Strong.
  2. The post-op rehab protocol itself is consensus/expert — drawn from surgeon patient-guidance protocols, not a rehab RCT. Phase timings are typical, not trial-derived. Weak/consensus.
  3. Nerve-glide evidence is stronger as a non-operative and adhesion-prevention measure than as a proven post-operative outcome-changer; biomechanical and clinical work supports gliding to reduce excursion-related symptoms. Moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (SR / meta-analysis): clinical-outcome equivalence of in-situ decompression vs anterior transposition; lower complication rate with simple decompression.
  • MODERATE (cohorts / SR): endoscopic vs open in-situ equivalence; post-op DASH/NCV improvement with early gains by ~1 month; nerve-gliding rationale.
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol (surgeon patient-guidance documents; no defining rehab RCT) — including the transposition early-ROM cap, nerve-glide start date, and the ~6-week lifting/strengthening threshold.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Open vs retractor-endoscopic in-situ decompression of the ulnar nerve in cubital tunnel syndrome. Neurosurgery. DOI: 10.1227/neu.0b013e3182846dbd
  • Randomized, prospective study comparing ulnar neurolysis in situ with submuscular transposition. Neurosurgery. DOI: 10.1227/01.neu.0000194847.04143.a1
  • Open versus endoscopic in situ decompression in cubital tunnel syndrome: a systematic review. Int J Surg. 2016. DOI: 10.1016/j.ijsu.2016.09.012
  • Simple decompression vs. subcutaneous anterior transposition of the ulnar nerve (2025). J Hand Surg Glob Online / XRRT. DOI: 10.1016/j.xrrt.2025.100630
  • Cubital tunnel syndrome: current concepts. Curr Rev Musculoskelet Med. 2020. DOI: 10.1007/s12178-020-09650-y
  • Predictors of surgical revision after in situ decompression of the ulnar nerve. J Shoulder Elbow Surg. 2015. DOI: 10.1016/j.jse.2014.12.015
  • Clinical outcomes of ulnar nerve gliding exercise in the nonoperative treatment of cubital tunnel syndrome. JSES Int. 2025. DOI: 10.1016/j.jseint.2025.02.001
  • Biomechanical analysis of ulnar nerve gliding and elongation. Clin Shoulder Elbow. 2024. DOI: 10.5397/cise.2024.00934
  • Postoperative improvement in DASH score, clinical findings and nerve conduction velocity in cubital tunnel syndrome. Sci Rep. 2016. DOI: 10.1038/srep27497

Comparative-effectiveness literature (URLs)

  • Said J, et al. Ulnar nerve in situ decompression versus transposition for idiopathic cubital tunnel syndrome: an updated meta-analysis. J Hand Microsurg. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6431285/
  • Macadam SA, et al. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve: a meta-analysis. J Hand Surg Am. 2008. https://pubmed.ncbi.nlm.nih.gov/18929194/
  • Caliandro P, et al. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016;CD006839. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006839.pub4/full
  • Andrews K, et al. Cubital tunnel syndrome: anatomy, clinical presentation, and management. J Orthop. 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC6082832/

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

  • University of Virginia Orthopaedics — Cubital Tunnel Release, In-situ Rehabilitation Guidelines. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2024/09/Cubital-tunnel-release-in-situ.pdf
  • University of Virginia Orthopaedics — Cubital Tunnel Release, Anterior Subcutaneous Transposition. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2024/09/Cubital-tunnel-release-anterior-subcutaneous-transposition.pdf
  • AAOS OrthoInfo — Cubital Tunnel Release (patient recovery expectations). https://orthoinfo.aaos.org/en/treatment/cubital-tunnel-release/

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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.