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Mga ehersisyo bilang inpatient — shoulder replacement

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Early in-hospital exercises after a shoulder replacement (total, reverse, or for fracture) — gentle hand, elbow and shoulder movement, with sleep-in-sling precautions for the first six weeks.

Updated Jun 2026
Ilustrasyon ng isang reverse shoulder replacement implant.
Maagang mga ehersisyo sa ospital pagkatapos ng shoulder replacement. Kieran Hirpara 4.0

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

Ito ang mga marahang ehersisyo na sisimulan sa ospital pagkatapos ng iyong shoulder replacement (total, reverse, o replacement para sa isang bali). Pinapanatili nitong gumagalaw ang kamay, siko at balikat habang naghihilom ang repair.

Your exercises

Iyuko ang pulso pasulong, paurong at patagilid.

Kieran Hirpara 4.0

Paggalaw ng pulso

Panatilihing gumagalaw ang iyong kamay sa pamamagitan ng pagyuko ng iyong pulso pasulong, paurong at patagilid.

10 beses, 3 beses bawat araw

Kumuyom, pagkatapos ay ibuka nang buo ang kamay.

Kieran Hirpara 4.0

Pagbukas at pagsara ng kamay

Panatilihing gumagalaw ang iyong kamay at mga daliri sa pamamagitan ng pagbukas at pagsara ng mga ito, o sa pamamagitan ng pagpiga ng isang stress ball.

10 beses, 3 beses bawat araw

Baluktutin at ituwid ang siko.

Kieran Hirpara 4.0

Pagbaluktot ng siko

Baluktutin at ituwid ang iyong siko.

10 beses, 3 beses bawat araw

Yumuko pasulong, hayaang lumaylay ang braso at iikot ito sa pamamagitan ng pag-uga ng katawan.

Kieran Hirpara 4.0

Mga pendulum

Ito ay isang passive na ehersisyo. Yumuko pasulong at hayaang lumuwag pababa ang iyong braso. Gamitin ang iyong katawan upang marahang igalaw ang braso nang pakanan o pakaliwang paikot, kasabay ng pasulong, paurong at patagilid.

Mga 30 segundo bawat direksyon, 3 beses bawat araw

Kalungin ang inoperahang braso gamit ang kabilang braso at itaas ito pasulong.

Kieran Hirpara 4.0

Assisted forward flexion

Habang nakaupo sa upuan at nakayuko pasulong, kalungin ang iyong inoperahang braso gamit ang kabilang braso at marahang igalaw ito paitaas sa harap mo. Ibaba ito muli sa tulong ng iyong hindi inoperahang braso. Maaari mo ring higaan ang iyong likod sa kama at tulungan ang braso paitaas kung mas gusto mo.

10 beses, 3 beses bawat araw

Kalungin ang inoperahang braso at tulungan itong ilabas patagilid.

Kieran Hirpara 4.0

Assisted abduction

Habang nakaupo sa upuan at nakayuko pasulong, kalungin muli ang braso at tulungan itong ilabas patagilid (tulad ng pag-uga sa isang sanggol).

10 beses, 3 beses bawat araw

Igalaw ang braso mula sa posisyon sa sling patungo sa pagtuturo nang diretso sa harap, huwag nang lumagpas.

Kieran Hirpara 4.0

External rotation

Habang nakaupo sa upuan, igalaw lang ang iyong braso mula sa kinalalagyan nito sa sling patungo sa pagtuturo nang diretso sa harap mo. Huwag nang lumagpas palabas.

10 beses, 3 beses bawat araw

Pilipitin ang mga balikat pababa at magkalapit.

Kieran Hirpara 4.0

Lower trapezius setting

Pilipitin ang iyong mga balikat pababa at magkalapit.

Hawakan nang 5 segundo, 5 beses, 3 beses bawat araw

Ilapit ang tainga sa balikat, palayo mula sa inoperahang panig.

Kieran Hirpara 4.0

Upper trapezius stretch

Gamitin ang iyong hindi inoperahang braso upang ilapit ang iyong tainga sa iyong balikat, palayo mula sa inoperahang panig.

Hawakan nang 10 segundo, 3 beses, 3 beses bawat araw

Ilapit ang ilong pababa patungo sa kilikili, palayo mula sa inoperahang panig.

Kieran Hirpara 4.0

Levator scapulae stretch

Gamitin ang iyong hindi inoperahang braso upang ilapit ang iyong ilong sa bahagi ng iyong kilikili, palayo mula sa inoperahang panig.

Hawakan nang 10 segundo, 3 beses, 3 beses bawat araw

Ang braso ay suportado sa harap sa taas ng balikat habang maliliit na salitang pagtulak ay nilalabanan upang sanayin ang kontrol.

Kieran Hirpara 4.0

Rhythmic stabilisation

Habang suportado ang iyong braso sa harap mo sa mga taas ng balikat, hayaan ang iyong physiotherapist (o ang iyong magaling na kamay) na maglapat ng maliliit, marahang pagtulak mula sa iba't ibang direksyon habang pinapanatili mong nakatigil at matatag ang braso — huwag itong hayaang gumalaw. Sinasanay nito ang mga nagpapatatag na kalamnan ng balikat na tumugon. Panatilihing marahan ang lahat ng pagsisikap.

Ayon sa gabay ng iyong physiotherapist

Simulan ang mga marahang ehersisyong ito sa ospital at ipagpatuloy ang mga ito sa bahay. Dapat itong maging komportable; bumawi kung tumitindi ang sakit.

Kung nagkaroon ka ng reverse replacement, maaari mong simulang igalaw ang balikat nang maaga; magsimula sa mga assisted at gravity-assisted na paggalaw (pinakamadali kapag nakahiga sa iyong likod, hayaang tumulong ang gravity), pagkatapos ay magdagdag ng marahang aktibong paggalaw ayon sa kaya ng iyong kaginhawaan, na nananatili sa loob ng nararamdamang komportable. Iwasan lamang ang mga posisyong nakalista sa "Wearing your sling."

Kung nagkaroon ka ng total (anatomic) replacement o isang replacement para sa isang bali, panatilihing assisted at marahan ang iyong maagang mga paggalaw gaya ng ipinakita; hayaang ang iyong kabilang braso ang gumawa ng trabaho, at huwag itulak ang inoperahang braso palabas nang lampas sa hinihingi ng mga ehersisyo, upang maprotektahan ang naghihilom na repair sa harap ng balikat.

Wearing your sling

Ang tagal ng iyong pagsuot ng sling ay nakadepende sa kung anong replacement ang naganap sa iyo; mangyaring sundin ang panuntunan para sa iyong operasyon.

Kung nagkaroon ka ng reverse replacement:

  • Ang sling ay pangunahin para sa kaginhawaan at suporta, at isusuot mo ito nang mga 2 linggo sa halip na buong panahon nang 6 na linggo.
  • Maaari mong ilabas ang iyong braso mula sa sling para sa iyong mga ehersisyo at para sa pagligo.
  • Maaari kang magsimula ng marahang mga paggalaw ng balikat kaagad (tingnan ang iyong mga ehersisyo); hindi na kailangang panatilihing ganap na nakatigil ang braso.
  • May ilang posisyong dapat iwasan sa mga unang linggo habang nag-aayos ang lahat: huwag iabot ang iyong braso sa likod ng iyong katawan o sa likod ng iyong likuran, huwag pagsamahin ang pag-abot paurong sa pagbaling ng braso papasok, huwag magbuhat ng anuman, at huwag magtulak paitaas gamit ang iyong mga kamay (halimbawa, ang pagtulak ng iyong sarili paitaas palabas ng upuan). Tatalakayin ng iyong physiotherapist ang mga ito sa iyo.

Kung nagkaroon ka ng total (anatomic) replacement, o isang replacement para sa isang bali:

  • Kailangan mong matulog nang naka-sling.
  • Pinapayagan kang ilabas ang iyong braso mula sa sling para sa iyong mga ehersisyo at para sa pagligo.
  • Kailangan mong isuot ang iyong sling nang 6 na linggo, lalo na kapag nasa labas ng bahay.
  • Ang isang repair sa harap ng iyong balikat ay nangangailangan ng panahon upang maghilom, kaya ang iyong maagang mga paggalaw ay mas marahan at mas iniingatan; manatili sa mga assisted na ehersisyong ipinakita at huwag pilitin ang braso palabas nang lampas sa hinihingi ng mga ehersisyo.

Para sa lahat:

  • Gumamit ng yelo para sa ginhawa sa sakit kung kinakailangan.
  • Kapag nakasuot ng iyong sling, i-relax ang iyong balikat at hayaang ang sling ang bumuhat sa bigat ng iyong braso.
  • Inumin ang iyong mga gamot sa sakit bago mo gawin ang iyong mga ehersisyo, at bago ang iyong mga appointment sa physiotherapy.
  • Maliban kung ikaw mismo ang nag-ayos ng iyong sariling physiotherapy, may appointment nang ginawa para sa iyo at nakadetalye ito sa iyong discharge pack.
  • Kung mayroon kang anumang problema, makipag-ugnayan sa mga rooms o ipaalam sa iyong physiotherapist.

When you go home

Kapag nasa bahay ka na, nagpapatuloy ang iyong paggaling sa buong rehabilitation protocol para sa iyong operasyon: reverse shoulder replacement; total shoulder replacement; shoulder replacement para sa bali.

Ang ebidensyang nasa likod ng maagang yugtong ito sa loob ng ospital (kung bakit mahalaga ang sling at ang marahang mga paggalaw, kung bakit maaaring gumalaw nang maaga at malaya ang isang reverse replacement na ang pangunahing pag-iingat ay ang paglayo ng braso sa pag-abot sa likod ng katawan, at kung bakit mas iniingatan ang isang total replacement na may limitadong external rotation upang protektahan ang repair sa harap ng balikat) ay nabuod sa seksyon ng ebidensya, na makukuha bilang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 11 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

Inpatient (In-Hospital) Phase After Shoulder Replacement — Early Rehabilitation Evidence

Topic scope: This page covers only the early in-hospital phase of recovery after a shoulder replacement — the first days on the ward and the principles of the first protected weeks — for anatomic total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and shoulder replacement performed for a proximal-humerus fracture. The companion patient page (the synthesis) lists the actual in-hospital exercises and sling rules; this page sets out the evidence behind them. The full course of rehabilitation for each operation lives in its own protocol — follow that one once you are home: total shoulder replacement, reverse shoulder replacement, and shoulder replacement for fracture, each of which carries its own detailed evidence page.

Defining principle of the early phase: the two pathways now differ. A reverse replacement is run on an accelerated, permissive footing, while an anatomic total replacement (and a replacement for a fracture) remains protective. In every case the hand/wrist/elbow are kept active from the start, but what the shoulder itself is allowed to do — and what is being protected — differs by operation:

  • Anatomic TSA protects the subscapularis repair. To put the ball-and-socket implant in, the surgeon detaches and re-attaches the subscapularis tendon (or its bone block) at the front of the shoulder. Early external rotation is limited, active and resisted internal rotation is delayed, and shoulder elevation is kept passive/assisted — because these are the positions that strain the healing repair. This is why the in-hospital ER exercise only moves the arm from the sling position to pointing straight ahead — and no further. The sling is worn full-time for about 6 weeks.
  • Reverse TSA is accelerated. Often there is no subscapularis repair to protect, and the deltoid (not the cuff) powers the arm, so the shoulder can move early. The sling is for comfort and support only (~2 weeks), and active-assisted and active-as-tolerated shoulder motion begins from the start (supine/gravity-assisted first), within comfort. The main early constraint is dislocation precautions, whose at-risk position is hand-behind-the-back (combined extension + adduction + internal rotation): avoid reaching the arm behind the body or behind the back, no lifting, and no pushing up through the hands. This aligns with the accelerated reverse literature (see the reverse protocol's evidence page).
  • Replacement for fracture adds a third constraint: the tuberosities (the bony muscle attachments) must heal, so this pathway follows the protective line (like anatomic TSA) and is usually the most protective of the three.

Common to all three: the hand/wrist/elbow are kept active immediately, and adequate analgesia makes early gentle motion possible. The sling duration and how freely the shoulder moves then differ — permissive for reverse, guarded for anatomic and fracture.

The early in-hospital phase, in brief

Most patients stay in hospital a short time after a shoulder replacement — commonly about one to two nights, and selected patients are now safely discharged the same day. Before discharge the ward physiotherapist fits the sling, teaches independent sling management, and starts the gentle exercises shown in the synthesis: keeping the hand, wrist and elbow active; pendulums; and shoulder elevation — assisted (passive) and limited in external rotation after an anatomic repair, but active-assisted and active-as-tolerated from the start after a reverse replacement. The arm is commonly numb from a nerve block when you wake, with sensation returning over roughly 24 hours. The job of this phase is pain control, swelling reduction, keeping the non-shoulder joints moving, and protecting the new joint while it settles — not building strength, which comes later in the home protocol.

Evidence by theme

1. Length of stay is short, and same-day discharge appears safe in selected patients

Shoulder replacement has traditionally been an inpatient operation, but length of stay is short and falling. At an orthopaedic specialty hospital the average stay was about 1.3 days versus ~1.85 days at a general centre [RAG corpus — 10.1016/j.jse.2016.01.010]. A large series found same-day discharge was not inferior to a longer in-hospital stay for 90-day readmissions [RAG corpus — 10.1016/j.jse.2019.09.037], and outpatient TSA in an ambulatory centre was reported as a safe alternative to inpatient care in a matched cohort (2016 Neer Award) [RAG corpus — 10.1016/j.jse.2016.07.011]. Same-day discharge appears safe even in patients aged ≥65 with appropriate selection [RAG corpus — 10.1016/j.jse.2021.02.022]. Whether you stay one night or go home the same day is an individual decision; the early-exercise and sling principles are the same either way.

Evidence: MODERATE (cohort / matched-cohort data).

2. Pain control is the patient's and the system's primary early concern

When patients consider shorter stays, perioperative pain control is their primary concern [RAG corpus — 10.1016/j.jse.2022.07.009] — which is why the synthesis emphasises taking analgesia before exercises and physiotherapy. Adequate pain relief is also what makes early gentle motion possible. A regional nerve block is commonly used, explaining the early numbness that recovers over about a day.

Evidence: MODERATE (survey / practice data).

3. Early motion depends on the operation — accelerated for reverse, guarded for anatomic

The ward starts active hand/wrist/elbow motion immediately after every replacement. What the shoulder is allowed to do then splits by operation. For reverse replacement the conservative-versus-early question has been tested directly: randomised trials show that earlier motion and shorter (or even no) immobilisation do not increase dislocation or complications, including a 3-week-versus-no-immobilisation RCT in primary RSA [RAG corpus — 10.1016/j.jse.2025.02.015], and home-based physiotherapy matched formal outpatient therapy after RSA [RAG corpus — 10.1016/j.jse.2023.03.023]. Dr Hirpara's reverse pathway now follows this accelerated line: a short (~2-week) comfort sling, and active-assisted and active-as-tolerated shoulder motion (supine/gravity-assisted first) from the start, within comfort — with dislocation precautions (no arm behind the body, no lifting, no pushing through the hands) the main early constraint. By contrast, anatomic TSA and replacement for fracture keep the protective early line — passive/assisted elevation only, no active shoulder lifting, and the front-of-shoulder repair (or the tuberosities) guarded — because there is a repair that the reverse construct does not have.

Evidence: MODERATE–STRONG for RSA early motion (RCTs), which the reverse pathway now reflects; the specific in-hospital timings are consensus/surgeon preference.

4. Why external rotation is limited after anatomic TSA but freer after reverse

In anatomic TSA the subscapularis must be detached to seat the implant and then repaired, and external rotation (especially with the arm out to the side) puts the greatest strain on that repair — so early ER is restricted while forward elevation and scaption, which do not load the repair, are allowed sooner [literature — Brigham & Women's Faulkner TSA guideline; subscapularis management review]. Typical published protocols cap early external rotation at around 20–30° and release it at about 6 weeks; the synthesis applies this by moving the arm only from the sling position to "pointing straight ahead." After reverse replacement there is usually no subscapularis repair to protect, so ER is more permissive and the dominant precaution is instead the hand-behind-the-back dislocation position [parent reverse protocol — RAG corpus 10.1016/j.jse.2016.12.073; 10.1016/j.jse.2020.05.019].

Evidence: MODERATE (biomechanical + protocol consensus); no single defining rehab RCT for the early in-hospital window.

Phased timeline — the early phase only

This focuses on the in-hospital and immediately-post-discharge window. The complete multi-phase course (intermediate, transitional, advanced strengthening, return to sport) lives in each parent protocol; the rows below are intentionally consistent with the Phase I content of those pages.

Phase Window Sling Shoulder motion Operation-specific note
In hospital Days 0–2 Reverse: comfort/support. Anatomic + fracture: worn incl. overnight Active hand/wrist/elbow (all); pendulums. Reverse: active-assisted + active-as-tolerated from the start (supine/gravity-assisted first). Anatomic + fracture: passive/assisted elevation, limited assisted ER Ward physio fits sling, teaches management, starts the synthesis exercises before discharge
Early protection Weeks 0–3 Reverse: ~2 weeks for comfort. Anatomic + fracture: full-time (worn overnight) Reverse: continue active-assisted/active motion within comfort; dislocation precautions (no arm behind body, no lifting, no pushing through hands). Anatomic TSA: passive/assisted only, no active lifting, ER limited (sling-to-straight-ahead), IR delayed. Fracture: most protective Pain + swelling control; keep adjacent joints moving

After this early window, follow the full protocol for your specific operation (linked above), where the sling is weaned, active motion is progressed, and strengthening begins.

Key controversies / evidence quality

  1. Inpatient vs same-day discharge. Cohort evidence supports same-day discharge in selected patients, but selection matters and pain control is the limiting factor; whether you stay overnight is a clinical judgement, not a fixed rule. Moderate.
  2. How protective to be early. Randomised data (strongest for reverse) show early motion and shorter immobilisation are safe. The reverse pathway now applies this accelerated approach (short comfort sling, early active-assisted/active motion, dislocation precautions). The anatomic pathway stays protective because it has a subscapularis repair to guard — there the protective early phase is a deliberate surgeon clinical decision, not an oversight relative to the accelerated literature. Moderate–strong evidence; applied per operation.
  3. The in-hospital protocol itself is consensus/expert. The specific early exercises and ROM limits are drawn from published institutional protocols and surgeon guidance, not from a rehab RCT of the in-hospital window. Weak/consensus.

Evidence-strength flags (summary)

  • MODERATE (cohort): short length of stay; same-day discharge non-inferior for readmissions and safe in selected and older patients; pain control as the primary patient concern.
  • MODERATE–STRONG (RCT, mainly reverse): early motion / shorter immobilisation safe after RSA; home-based PT equivalent to formal outpatient PT after RSA.
  • MODERATE (biomechanical + protocol consensus): ER restriction protects the subscapularis repair in anatomic TSA; reverse rehab more permissive in ER but constrained by the dislocation position.
  • WEAK / CONSENSUS: the specific in-hospital exercise set and early-phase timings (institutional protocols + surgeon preference; no defining rehab RCT of the inpatient window).

Citations

  • Length of stay after shoulder arthroplasty — the effect of an orthopedic specialty hospital. J Shoulder Elbow Surg. 2016. DOI: 10.1016/j.jse.2016.01.010
  • Same-day discharge is not inferior to longer length of in-hospital stay for 90-day readmissions following shoulder arthroplasty. J Shoulder Elbow Surg. 2020. DOI: 10.1016/j.jse.2019.09.037
  • Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study (2016 Neer Award). J Shoulder Elbow Surg. 2016. DOI: 10.1016/j.jse.2016.07.011
  • Is outpatient shoulder arthroplasty safe in patients aged ≥65 years? A comparison of readmissions and complications in inpatient and outpatient settings. J Shoulder Elbow Surg. 2021. DOI: 10.1016/j.jse.2021.02.022
  • Perioperative pain control represents the primary concern for patients considering outpatient shoulder arthroplasty: a survey-based study. J Shoulder Elbow Surg. 2022. DOI: 10.1016/j.jse.2022.07.009
  • Three-week immobilization vs. no immobilization in primary reverse total shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg. 2025. DOI: 10.1016/j.jse.2025.02.015
  • Home-based physical therapy results in similar outcomes to formal outpatient physical therapy after reverse total shoulder arthroplasty: a randomized controlled trial. J Shoulder Elbow Surg. 2023. DOI: 10.1016/j.jse.2023.03.023
  • The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation for anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2020. DOI: 10.1016/j.jse.2020.05.019
  • Dislocation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2017. DOI: 10.1016/j.jse.2016.12.073

Literature (URLs)

  • The effect of subscapularis-specific rehabilitation following total shoulder arthroplasty: a prospective, double-blinded, randomized controlled trial. J Hand Ther / ScienceDirect. 2023. https://pubmed.ncbi.nlm.nih.gov/37263480/
  • Management of the subscapularis tendon during total shoulder arthroplasty (early ER strains the repair most). J Hand Ther / ScienceDirect. 2016. https://www.sciencedirect.com/science/article/abs/pii/S1058274616305791

Published rehabilitation protocols (basis for the early-phase structure)

  • Brigham & Women's Faulkner Hospital — Department of Rehabilitation Services: Total Shoulder Arthroplasty Guideline (early ER restriction to protect the subscapularis repair). https://www.brighamandwomensfaulkner.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/total-shoulder-arthroplasty-guideline.pdf
  • Massachusetts General Brigham Sports Medicine — Rehabilitation Protocol for Total Shoulder Arthroplasty and Hemiarthroplasty (Revised December 2018). https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-total-shoulder-arthroplasty-and-hemi.pdf
  • Massachusetts General Brigham Sports Medicine — Rehabilitation Protocol for Reverse Shoulder Arthroplasty (Revised December 2018). https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-reverse-shoulder-arthroplasty.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.