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Paggamot sa Daliri

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Post-operative exercises and precautions after finger surgery, including joint blocking and tendon glides.

Updated Jun 2026
Illustrasyon ng isang kamay na may dalawang daliri na dahan-dahang nakabalot ng tape habang yumuyuko.
Maagang paggalaw na protektado, tulad ng buddy taping, pagkatapos ng operasyon sa daliri. 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 protocol na ito ay gabay sa iyong paggaling pagkatapos ng operasyon sa daliri kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton. Ipinapaliwanag nito ang inaasahan mo sa mga linggo pagkatapos ng iyong operasyon at inilalarawan ang programa ng ehersisyo na tumutulong sa pagbawi ng galaw at function sa iyong daliri at kamay. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa pisyoterapiya o hand therapy upang manatiling koordinado ang iyong rehabilitasyon; maaaring baguhin ng iyong terapeuta ang plano depende sa iyong operasyon at sa kung paano ang iyong paggaling.

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

Ano ang inaasahan

Ang pag-aalaga sa iyong sugat ay ipinaliwanag sa handout tungkol sa pag-aalaga sa sugat ng aming klinika. Ang mga ehersisyo sa ibaba ay sentral sa pagbawi ng galaw at pagpapanumbalik ng function sa iyong daliri at kamay.

Kapag gumaling na ang iyong sugat, maglagay ng init sa iyong kamay sa loob ng 15 minuto bago gawin ang mga ehersisyong ito. Pagkatapos makumpleto ang mga ehersisyo, maglagay ng yelo upang mapanatili ang anumang pamamaga o pamamaga.

Kapag lubos nang gumaling ang sugat, simulan ang masahe ng peklat: mahigpit na bilog sa ibabaw ng incision. Mangyaring tumukoy sa handout tungkol sa pag-aalaga sa sugat para sa karagdagang impormasyon tungkol sa pamamahala ng peklat.

Mangyaring monitorin ang pamamaga, at tumawag sa aming opisina o makipag-usap sa isang hand therapist kung mayroon kang mga alalahanin.

Tatlong prinsipyo ang nagpapatibay sa paggaling mula sa karamihan ng mga operasyon sa daliri, at ang mga ehersisyong nasa ibaba ay naglalapat ng bawat isa sa praktikal. Ang una ay pagkontrol sa pamamaga: ang patuloy na pamamaga sa kamay ay nagpapatigas sa mga malambot na tisyu at nagbabawas sa kung gaano kagaling ang mga tendon at kasukasuan na gumalaw, kaya ang pagtaas, banayad na paggalaw, at (kung kinakailangan) retrograde na masahe at compression ay mga prioridad sa mga unang linggo [1]. Ang pangalawa ay maagang, banayad na paggalaw: mabilis na tumitigas ang mga daliri, kaya ang paggalaw sa mga ito sa loob ng mga limitasyong itinakda para sa iyong partikular na operasyon (nagsisimula sa lalong madaling panahon na pinapayagan ng iyong sugat at operasyon) ay pinapanatiling malambot ang mga maliit na kasukasuan at tumutulong sa mga tendon na dumudulas imbes na dumikit sa mga nakakalingkod na tisyu sa paligid nila. Ang pangatlo ay pagdudulas ng tendon. Ang iba't ibang posisyon ng daliri sa iyong handout (tuwid, hook, tabletop, at buong fist) ay hindi random: ang bawat posisyon ay gumagalaw sa malalim at superficial na mga tendon ng daliri sa magkakaibang dami sa relasyon sa isa't isa at sa tendon sheath, na nagpapanatili sa kanilang malayang pagdudulas [2]. Ang mga ehersisyong pang-blocking ng DIP at PIP ay naglalayon sa parehong pagdudulas ng kasukasuan isa-isa. Ang maraming beses at kaunti ang bawat beses ang patakaran: ang matatag, madalas, at banayad na pagsasanay sa loob ng araw ay mas nakakatulong sa iyong paggaling kaysa sa obahang pagsisikap sa pagkakataon.

Mga Precautions at limitasyon

Ang magaan na functional na paggamit ng iyong kamay ay inirerekomenda para sa mga gawain pang-araw-araw tulad ng self-care, pagkain, pagdadausan, pagsusulat, at pag-type (maliban kung may ibang payo). Karaniwang hihilingin sa iyo na iwasan ang pag-angat, pagkupit, pagdala ng bigat, at pagtama ng impact hanggang sa 6 linggo pagkatapos ng operasyon, depende sa sugat at sa ginawang operasyon. Makakatanggap ka ng karagdagang gabay tungkol sa iyong mga precautions at limitasyon sa iyong post-operative review.

Para sa iyong physiotherapist:

Pamamahala

  • Pag-aalaga sa sugat at peklat ayon sa handout ng pag-aalaga sa sugat ng klinika; simulan ang masahe sa peklat (matigas na bilog sa ibabaw ng incision) kapag ang sugat ay ganap na nalagda na
  • Kapag ang sugat ay nalagda na, maglagay ng init sa kamay sa loob ng 15 minuto bago ang exercise program; maglagay ng yelo pagkatapos ng mga ehersisyo upang bawasan ang pamamaga at pamamaga
  • Subaybayan ang pamamaga; i-escalate sa silid o sa hand therapist kung may mga alalahanin
  • Ang kontrol sa oedema ay isang prioridad kung ang pamamaga ay sobra o mabagal na lumala: ang elevation at aktibong paggalaw ang unang linya, kasama ang retrograde massage, compression, at manual oedema mobilization bilang mga adjuncts kasabay ng standard na therapy [1]
  • Home exercise program ayon sa mga cards sa ibaba: wrist flexion/extension; distal interphalangeal (DIP) at proximal interphalangeal (PIP) joint blocking; tendon glides (Series A at Series B)
  • Ang mga sequence ng tendon glide at joint-blocking ay dinisenyo upang maksimizehin ang differential excursion ng mga flexor tendons kumpara sa isa't isa at sa sheath: baguhin ang mga posisyon (tuwid, hook, tabletop, fist) imbes na ulitin ang iisang posisyon [2]

Mga Precautions

  • Ang magaan na functional na paggamit ng kamay ay inirerekomenda para sa mga gawain pang-araw-araw (self-care, pagkain, pagdadausan, pagsusulat, pag-type) maliban kung may ibang payo
  • Walang pag-angat, pagkupit, pagdala ng bigat o impact hanggang sa 6 linggo pagkatapos ng operasyon (depende sa sugat / ginawang operasyon)
  • Ang mga partikular na precautions at limitasyon ay kumpirmado sa post-operative review
  • Ito ay isang pangkalahatang post-operative finger program; kung ang partikular na operasyon ay may sariling protektadong range, mga limitasyon sa motion o splinting (halimbawa, pagkatapos ng tendon repair), ang mga instruksyon na partikular sa operasyon ang may higit na kapangyarihan

Ito ang mga ehersisyo mula sa iyong handout, ipagpatuloy sa bahay ayon sa gabay ng iyong physiotherapist o hand therapist.

Mga ehersisyo mo

Pagkatapos ng iyong protocol

Ang protocol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan ang pamamahala ng post-operative na sakit, pag-aalaga sa sugat at mga pangunahing kaalaman sa hand therapy. Para sa mga operasyon kung saan karaniwang ginagamit ang programang ito, tingnan ang trigger finger release at Dupuytren's fasciectomy.

Ang programang pang-ehersisyong ito ay isinulat kasama si Sarah Farrell, BOccThy, Accredited Hand Therapist.

Mga Sanggunian

[1] Miller LK, Jerosch-Herold C, Shepstone L. Epekto ng mga teknik sa pamamahala ng pamamaga para sa subacute na pamamaga ng kamay: isang sistematikong pagsusuri. J Hand Ther. 2017;30(4):432–446. https://pubmed.ncbi.nlm.nih.gov/28807598/ [2] Wehbé MA, Hunter JM. Paggalaw ng flexor tendon sa kamay. Bahagi II. Iba't ibang paggalaw. J Hand Surg Am. 1985;10(4):575–579. https://pubmed.ncbi.nlm.nih.gov/4020073/

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

Finger Surgery — General Post-operative Hand-Therapy Rehabilitation

Topic scope: This is a general post-operative finger rehabilitation program, not a single-procedure protocol. It applies as the default hand-therapy pathway after common finger operations where the repaired or released structure does not mandate its own protected range — most typically trigger finger (A1 pulley) release and Dupuytren's fasciectomy, and as a baseline mobility/oedema program after finger fracture fixation (proximal/middle phalanx ORIF or K-wire), PIP joint and volar-plate / collateral-ligament procedures, and minor soft-tissue work. The program rests on three levers the patient handout puts into practice — (1) oedema control, (2) early gentle protected movement, and (3) tendon gliding / joint-blocking to preserve differential excursion. It explicitly defers to the operation-specific protocol whenever the surgery carries a defined protected arc, motion limit or splinting regime (most importantly flexor or extensor tendon repair), which this general program does not attempt to reproduce.

Defining principle: fingers stiffen faster than almost any other joint complex in the body. The small interphalangeal joints, the gliding flexor/extensor tendons within their sheaths, and the dense soft-tissue envelope are all exquisitely sensitive to swelling and immobility — adhesions and joint contracture establish within days, not weeks. Rehabilitation is therefore a constant balancing act: protect the repaired structure for exactly the window it needs, and not one day longer, while restoring controlled glide and range early to outrun the stiffness. When in doubt, the default after finger surgery is controlled motion, not rest.

A. WHY EARLY CONTROLLED MOTION (THE CORE RATIONALE)

The unifying problem after any finger operation is the stiff finger: persistent oedema and immobility drive scar between the gliding planes, contract the joint capsule and collateral ligaments, and convert a mechanically sound repair into a functionally poor hand. The hand-surgery literature treats the stiff finger as a largely preventable complication of inadequate early rehabilitation rather than an inevitable consequence of surgery [The Stiff Finger; Stiff Digit, JAAOS].

  • Immobilisation has a cost. Reduced range of motion after immobilisation arises from increased swelling, scarring between tendons and surrounding structures, and joint/ligament contracture — the exact mechanisms early motion is designed to defeat (BSSH early-mobilisation guidance).
  • Adhesions establish early. The rationale for getting the patient moving — ideally with instructions given pre-operatively — and for a first therapy review at 5–7 days is to begin glide before adhesions become established (BSSH). The synthesis mirrors this: the home program starts as soon as the wound and operation allow, not at an arbitrary late milestone.
  • Time to active exercise predicts the end result. In hand-fracture rehabilitation, earlier commencement of active exercise predicts greater total active range of motion at 6 weeks — a direct, measurable dose-response between early motion and outcome [Time to commencement of active exercise predicts TAM, Hand Therapy 2016].

B. EVIDENCE BY PROCEDURE GROUP

Finger fracture fixation (phalangeal ORIF / K-wire)

  • The modern standard is stable fixation that permits early protected motion. Wide-awake surgery with early protected movement and pain-guided progression yields better finger ROM than rigid immobilisation (Saint John / pain-guided protocols; "better results with wide-awake surgery and early protected motion"). A systematic review and meta-analysis of mobilisation after ORIF of hand fractures supports earlier mobilisation over prolonged immobilisation for range without compromising union (ScienceDirect 2025 SR).
  • Stable construct is the prerequisite. The whole early-motion strategy is contingent on the surgeon's judgement that the fixation will tolerate movement — which is why the synthesis hands the precaution set (load limits, the up-to-6-week no-lift window) back to the post-operative review. Surgeon to confirm per case.
  • Minimally invasive fixation techniques are explicitly framed around preserving the soft-tissue envelope to reduce stiffness and allow early motion [Minimally Invasive Finger Fracture Management, Hand Clin].

PIP joint, volar-plate and collateral-ligament injuries

  • These are stiffness-prone injuries where the management trade-off (stability vs early motion) is sharpest. The literature on PIP dislocations, fracture-dislocations and volar-plate injuries consistently favours early protected/active motion, often with buddy-strapping or a dorsal blocking approach, over static immobilisation, precisely because the PIP joint contracts so readily [PIP dislocations in athletes, Hand Clin; PIP fracture-dislocations, JBJS Rev; finger joint dislocations, Clin Sports Med].
  • Buddy taping — depicted in the handout's hero image — is the canonical low-tech "protected early movement" tool here: it shares load with the neighbouring digit while permitting active glide.

Trigger finger (A1 pulley) release

  • Release of the A1 pulley is a high-yield day procedure with reliably good patient-perceived recovery [Patient-Perceived Outcomes of Recovery After Trigger Digit Release, JHS 2023].
  • Formal supervised therapy is usually NOT required for an uncomplicated release. A prospective randomised controlled trial found no significant difference in DASH, grip strength, ROM or pain between a structured post-operative occupational-therapy arm and a simple home-advice/ROM arm at final follow-up (RCT, PMC10671987). This validates the synthesis framing this as a home program with therapy escalation reserved for those who are slow to settle, stiff or swollen — not mandated for everyone.

Dupuytren's fasciectomy

  • Therapy after fasciectomy centres on oedema and wound management, a home exercise program, and night extension splinting — a typical "brief" protocol runs 4 sessions (days 0-3, 2 wk, 4 wk, 8 wk) with a night extension orthosis to ~3 months (post-fasciectomy rehab trials).
  • Routine night-splinting for all is contested. The SCoRD-type trials and subsequent work show static night splinting does not clearly improve ROM over hand therapy alone for unselected patients — splinting is best targeted at those losing extension, not applied universally [SCoRD protocol; Dutch Multidisciplinary Guideline on Dupuytren Disease].
  • For established post-fasciectomy or post-fracture flexion stiffness, casting motion to mobilise stiffness (CMMS) is an evidence-supported salvage technique to regain digital flexion [Casting motion to mobilise stiffness, Hand Therapy 2010].

C. OEDEMA, SCAR AND STIFFNESS MANAGEMENT

  • Oedema control is first-line and non-negotiable. Persistent hand oedema stiffens the soft tissues and degrades both ROM and function. The best systematic review of subacute hand oedema management concluded that active exercise enabling tendon gliding and muscular contraction acts as a pump to drive oedema away from the periphery, and supports elevation and active movement as first-line, with retrograde massage, compression and manual oedema mobilisation as adjuncts — there is no single superior modality, so the program layers them [Miller, Jerosch-Herold & Shepstone, J Hand Ther 2017]. This is reference [1] in the synthesis.
  • Tendon gliding works through differential excursion. The straight / hook / tabletop / full-fist positions are not interchangeable repetitions: each moves the FDP relative to the FDS and relative to the sheath by a different amount, and it is this differential glide that keeps the tendons from scarring to one another and to the sheath [Wehbe & Hunter, J Hand Surg Am 1985 — reference [2] in the synthesis]. Joint-by-joint DIP and PIP blocking isolates the same glide at a single joint.
  • Scar management. Once the wound is healed, scar massage and desensitisation reduce adherent scar over the incision — relevant to every open finger procedure and the surgical interval through which the tendons must glide.
  • Heat before, ice after the exercise session is a standard hand-therapy adjunct to improve tissue extensibility for movement and settle the post-exercise inflammatory flare (consensus practice).

Phased timeline (maps to the synthesis sections)

Phase Window Protect Motion / glide Oedema & scar Notes
I — Settle & protect Week 0-~2 Protect per the specific operation (buddy tape / splint / load limits as set at review); light functional use for self-care, dressing, writing, typing Begin gentle active motion within the operation's limits; tendon glides and DIP/PIP blocking as the wound and fixation allow Elevation + active movement first-line for swelling; wound care per handout First therapy review ideally 5-7 days to start glide before adhesions set (BSSH). No lifting/gripping/impact
II — Restore glide & range Week ~2-6 Wean protection as the structure consolidates; precautions confirmed at post-op review Progress active ROM, full tendon-glide series, joint blocking; buddy strapping for PIP/collateral injuries Once healed: commence scar massage (firm circles); heat before / ice after exercises; retrograde massage + compression if oedema persists Most ROM is won in this window — frequent gentle practice beats occasional hard effort
III — Strengthen & return Week ~6-12 Protection generally off (operation-dependent) Restore full ROM; introduce grip and functional strengthening Continue scar work until mature; night extension splint to ~3 mo if losing extension (Dupuytren) Return to lifting/gripping/impact from ~6 weeks per the operation; escalate persistent stiffness to hand therapy / CMMS

Phase windows are typical and consensus-based; the operation-specific protocol and the surgeon's post-operative review override any timing here.

D. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Universal supervised therapy vs home program. For simple procedures (trigger finger release) an RCT shows no benefit of routine formal therapy over good home advice — supporting a targeted therapy model. For complex/stiffness-prone injuries (PIP, fracture-dislocation, fracture ORIF) early supervised hand therapy is far more clearly beneficial. The synthesis correctly pitches a home program with therapist escalation rather than mandating identical input for every operation. Moderate.
  2. Night-splinting after Dupuytren's fasciectomy. Routine static night splinting is not supported for unselected patients (SCoRD, Dutch guideline); reserve it for those demonstrably losing extension. Moderate (RCT/guideline).
  3. How early, and how much, to move a fixed fracture. Early protected motion is favoured, but it is strictly contingent on a stable construct — a judgement only the operating surgeon can make. The "early motion is better" evidence assumes adequate fixation. Moderate (SR), construct-dependent.
  4. The general protocol itself is a consensus scaffold. A single "finger surgery" rehab program necessarily generalises across heterogeneous operations; its three principles (oedema, early motion, glide) are very well supported, but the exact dosing/timing is expert-consensus, individualised by the treating therapist and surgeon.

E. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG: oedema control via elevation + active tendon-gliding exercise as first-line (SR, J Hand Ther 2017); tendon differential-excursion rationale for the varied glide positions (mechanistic, Wehbe & Hunter); early motion reduces stiffness/adhesions after finger surgery (consistent across the stiff-finger and BSSH literature).
  • MODERATE (RCT / SR / guideline): early mobilisation > immobilisation after hand-fracture ORIF (SR + meta-analysis, 2025); time-to-active-exercise predicts 6-week TAM; no added benefit of routine formal therapy after simple trigger-finger release (RCT); selective (not universal) night splinting after Dupuytren's fasciectomy (SCoRD/Dutch guideline).
  • WEAK / CONSENSUS: the precise phase windows and exercise dosing in this general program (expert hand-therapy consensus, individualised); heat-before/ice-after adjunct; the principle that operation-specific protocols override this general scaffold (sound clinical practice, not trial-derived).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Time to commencement of active exercise predicts total active range of motion 6 weeks after hand-fracture fixation. Hand Therapy. 2016. DOI: 10.1177/1758998316679386
  • Hardy MA. The Stiff Finger. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.02.001
  • Etiology, Evaluation, and Management Options for the Stiff Digit. JAAOS. DOI: 10.5435/jaaos-d-18-00310
  • Phalangeal neck fractures of the proximal phalanx of the fingers in adults. Injury. 2010. DOI: 10.1016/j.injury.2010.06.017
  • Minimally Invasive Finger Fracture Management. Hand Clinics. 2013. DOI: 10.1016/j.hcl.2013.08.014
  • Management of Proximal Interphalangeal Joint Dislocations in Athletes. Hand Clinics. 2009. DOI: 10.1016/j.hcl.2009.05.008
  • Treatment of Proximal Interphalangeal Joint Fracture-Dislocations. JBJS Reviews. DOI: 10.2106/jbjs.rvw.o.00019
  • Management of Finger Joint Dislocation and Fracture-Dislocations in Athletes. Clinics in Sports Medicine. 2019. DOI: 10.1016/j.csm.2019.10.006
  • Patient-Perceived Outcomes of Recovery After Trigger Digit Release. J Hand Surg Am. 2023. DOI: 10.1016/j.jhsa.2023.03.016
  • Comparative Study of A1 Pulley Release and Ulnar Superficialis Slip Resection (trigger digit). J Hand Surg Am. 2022. DOI: 10.1016/j.jhsa.2022.04.021
  • Use of casting motion to mobilize stiffness (CMMS) to regain digital flexion. Hand Therapy. 2010. DOI: 10.1258/ht.2010.010008
  • Dutch Multidisciplinary Guideline on Dupuytren Disease. J Hand Surg Glob Online. 2022. DOI: 10.1016/j.jhsg.2022.11.008
  • Factors affecting functional recovery after surgery and hand therapy in Dupuytren's patients. J Hand Ther. 2014. DOI: 10.1016/j.jht.2014.11.006
  • Rehabilitation Regimens Following Surgical Repair of Extensor Tendon Injuries of the hand. DOI: 10.1007/s12593-012-0075-x

Hand-therapy / rehabilitation literature (URLs)

  • Miller LK, Jerosch-Herold C, Shepstone L. Effectiveness of edema management techniques for subacute hand edema: a systematic review. J Hand Ther. 2017;30(4):432-446. https://pubmed.ncbi.nlm.nih.gov/28807598/
  • Wehbe MA, Hunter JM. Flexor tendon gliding in the hand. Part II. Differential gliding. J Hand Surg Am.
  • https://pubmed.ncbi.nlm.nih.gov/4020073/
  • Systematic review and meta-analysis of mobilisation following ORIF of hand fractures. ScienceDirect.
  • https://www.sciencedirect.com/science/article/pii/S1748681525003109
  • Better results of finger fractures with wide-awake surgery and early protected motion. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445035/
  • The effectiveness of rehabilitation after open surgical release for trigger finger: a prospective, randomized, controlled study. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10671987/
  • Splinting after contracture release for Dupuytren's contracture (SCoRD): RCT protocol. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386788/

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

  • The British Society for Surgery of the Hand (BSSH) — Guidelines. https://www.bssh.ac.uk/professionals/guidelines.aspx
  • Pain-Guided Hand Therapy for early protected movement of finger fractures (The Saint John Protocol), ASSH. https://handsurgery.org/multimedia/files/preCourse/Pain%20Guided%20Hand%20Therapy%20for%20early%20protected%20movement%20finger%20fractures.pdf
  • Rehabilitative Strategies Following Hand Fractures. Hand Clinics. https://www.hand.theclinics.com/article/S0749-0712(13)00066-8/fulltext
  • University of Kentucky HealthCare — Hand Rehabilitation Protocols. https://ukhealthcare.uky.edu/sites/default/files/m21-0609_ortho_protocols-final.pdf

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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.