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Paglilinis ng Radial Tunnel

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Post-operative exercises and precautions after radial tunnel release, including radial nerve glides.

Updated Jun 2026
Ilustrasyon ng isang hand therapist na humihila ng forearms at wrist ng isang tao sa isang treatment table.
Banayad na pag-stretch at trabaho sa nerve-gliding pagkatapos ng radial tunnel release. 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 radial tunnel release kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton. Ipinapaliwanag nito ang inaasahan mo sa mga linggo pagkatapos ng operasyon at inilalarawan ang programa ng ehersisyo mula sa iyong post-operative handout. 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 pag-unlad ng iyong paggaling.

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

Maaaring inaasahan

Ang pag-aalaga sa iyong sugat ay ipinaliwanag sa payo sa pag-aalaga ng sugat ng kumpanya. Habang gumagaling ang iyong sugat, maaaring dumikit ang inilabas na nerbiyo sa kalapit na tisyu; napakahalaga ng mga ehersisyong pagdudulas sa ibaba upang panatilihin itong malayang gumagalaw at pigilan itong maging nakatali.

Minsan, maaaring maging sensitibo ang sugat. Ito ay normal, at maaari itong pigilan o bawasan sa pamamagitan ng pagsisimula ng araw-araw na desensitisation: banayad na pagtapat at pagpukpok sa ibabaw ng sugat (o ng panapos), nagsisimula agad pagkatapos ng iyong operasyon. Ang uri ng "sensory feedback" na ito ay nagpapahintulot sa nerbiyo na normalisihin ang pakiramdam ng hawak at tekstura.

Kapag lubos nang gumaling ang sugat, simulan ang masahe ng peklat: matibay na bilog sa ibabaw ng incision. Tingnan ang payo sa pag-aalaga ng sugat para sa karagdagang impormasyon sa pamamahala ng peklat.

Mahalagang magkaroon ng makatotohanang inaasahan sa paggaling. Kailangang maglakbay at umunat ng sukatan na halaga ang radial nerve habang ginagawa ang karaniwang galaw ng braso, kaya ang pagpapanatili nito na gumagalaw nang maaga ang humahadlang sa pagdikit nito sa mga gumagaling na tisyu [1]. Gayunpaman, ang pagpapagaan ng sakit pagkatapos ng radial tunnel release ay madalas na unti-unti imbes na agad, at para sa ilang tao, ito ay bahagya lamang. Ang operasyong ito, tapos na, ay mas hindi predictable kaysa sa ilang iba pang mga prosedura ng paglabas ng nerbiyo: ang radial tunnel syndrome ay maaaring mahirap i-diagnose nang tiyak at madalas itong mag-overlap sa tennis elbow, na bahagi ng dahilan kung bakit nag-iiba ang mga resulta. Ang mga nakalathalang pangmatagalang pag-aaral ay nag-uulat ng magagandang resulta sa humigit-kumulang dalawang-katlo ng mga pasyente sa kabuuan, na may pinakamagandang resulta sa mga taong may mga sintomas ng radial tunnel lamang [2][3]. Ang paggaling ay karaniwang mas mabagal at hindi kumpleto kapag may kasamang tennis elbow (lateral epicondylitis), higit sa isang compression ng nerbiyo sa parehong braso, o isang claim para sa kompensasyon ng trabaho [2][4]. Ang iyong programa ng pagdudulas ng nerbiyo at graded desensitisation ang mga bahagi ng rehabilitation na pinakamaliwanag sa iyong kontrol, at ang matatag na araw-araw na pagsasanay ay nagbibigay sa nerbiyo ng pinakamagandang pagkakataon na manatili.

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, pagsusuot ng damit, pagsulat, at pag-type. Bukod dito, ang mga limitasyon ay simple: walang pag-angat, pagkapit, pagdadala ng bigat, o paggamit ng mga makina na may vibration (halimbawa, power tools o lawn mower) sa loob ng hanggang 6 linggo pagkatapos ng operasyon, at limitado ang pagmamaneho sa unang 1–2 linggo.

Para sa iyong physiotherapist:

Mga Layunin

  • Iwasan ang pagdikit ng inilabas na nerbiyo sa gumagaling na sugat (nerve gliding program)
  • Pababain ang sensitivity ng sugat sa pamamagitan ng graded desensitisation
  • Panatilihin ang range of motion ng pulso, forearm, at siko
  • Suportahan ang magaan na functional na paggamit ng kamay para sa mga aktibidad pang-araw-araw

Pamamahala

  • Araw-araw na desensitisation: banayad na pagtapat / pagpukpok sa ibabaw ng sugat (dressing), nagsisimula agad pagkatapos ng operasyon
  • Scar massage (matitibay na bilog na galaw sa ibabaw ng incision) kapag lubos nang gumaling ang sugat
  • Home exercise program ayon sa mga card sa ibaba: wrist flexion / extension stretch; wrist supination / pronation stretch; elbow flexion / extension; radial nerve glides
  • Mas mainam ang banayad na sliding-type ("slider") nerve glides kaysa sa agresibong pagtensyon sa dulo ng range: ang mga sliding techniques ay nakakamit ng mas malaking nerve excursion sa mas mababang nerve strain, na mas mahihigpit na tinatanggap sa paligid ng kamakailang decompressed na nerbiyo [1][5]
  • Ang nerve mobilisation ay maaaring isaalang-alang bilang isang karagdagan sa program; ang basehan ng ebidensya para sa neural mobilisation sa mga kondisyong may kinalaman sa nerbiyo ay sumusuporta ngunit may magkakaibang antas ng katiyakan, kaya ang pag-unlad ay dapat gabay sa sintomas [6]

Mga Precautions

  • Magaan na functional na paggamit ng kamay lamang (self-care, pagkain, pagsusuot ng damit, pagsulat, pag-type)
  • Walang pag-angat, pagkapit, pagdadala ng bigat, o paggamit ng mga makina na may vibration (hal. power tools, lawn mower) sa loob ng hanggang 6 linggo pagkatapos ng operasyon
  • Limitado ang pagmamaneho sa unang 1–2 linggo
  • Ang mga nerve glides at stretches ay dapat banayad at sa pangkalahatan ay walang sakit; iwasan ang pagpilit sa isang range na nagpapaulit ng pre-operative na sakit ng nerbiyo

Ito ang mga ehersisyo mula sa iyong post-operative handout, nagsisimula pagkatapos ng operasyon at patuloy sa bahay ayon sa gabay ng iyong physiotherapist o hand therapist. Ang mga repetitions, hold times, at frequency ay nakalista sa bawat card.

Mga ehersisyo mo

Ang programang ito sa ehersisyo ay isinulat kasama si Sarah Farrell, Bachelor of Occupational Therapy (BOccThy), Accredited Hand Therapist (AHT).

Pagkatapos ng iyong protocol

Ang protocol na ito ay nagtatrabaho kasama ng pangkalahatang payo 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 operasyon mismo at sa kondisyong ito ay ginagamot, tingnan ang radial tunnel release at radial tunnel syndrome.

Mga Sanggunian

[1] Wright TW, Glowczewskie F, Cowin D, Wheeler DL. Radial nerve excursion and strain at the elbow and wrist associated with upper-extremity motion. J Hand Surg Am. 2005;30(5):990–996. https://pubmed.ncbi.nlm.nih.gov/16182056/ [2] Lee JT, Azari K, Jones NF. Long term results of radial tunnel release — the effect of co-existing tennis elbow, multiple compression syndromes and workers' compensation. J Plast Reconstr Aesthet Surg. 2008;61(9):1095–1099. https://www.sciencedirect.com/science/article/abs/pii/S1748681507004044 [3] Sotereanos DG, Varitimidis SE, Giannakopoulos PN, Westkaemper JG. Results of surgical treatment for radial tunnel syndrome. J Hand Surg Am. 1999;24(3):566–570. https://pubmed.ncbi.nlm.nih.gov/10357537/ [4] Naam NH, Nemani S. Radial tunnel syndrome. Orthop Clin North Am. 2012;43(4):529–536. (Radial Tunnel Syndrome, StatPearls.) https://www.ncbi.nlm.nih.gov/books/NBK555937/ [5] Coppieters MW, Butler DS. Do "sliders" slide and "tensioners" tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008;13(3):213–221. https://pubmed.ncbi.nlm.nih.gov/17398140/ [6] Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(9):593–615. https://pubmed.ncbi.nlm.nih.gov/28704626/

Reviewed by Dr Kieran Hirpara · 10 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

Radial Tunnel Release — Evidence Brief & Post-operative Rehabilitation

Topic scope: post-operative rehabilitation after surgical decompression / neurolysis of the posterior interosseous nerve (deep branch of the radial nerve) in the radial tunnel of the proximal forearm, performed for radial tunnel syndrome (RTS). This is an elbow / proximal-forearm topic — anatomically and clinically distinct from carpal-tunnel and cubital-tunnel decompression. Like other nerve decompressions it is an early-motion pathway (early elbow/forearm/wrist motion, radial-nerve glides, oedema and scar care). The scope deliberately foregrounds the diagnostic controversy and the more variable, lower success rates that distinguish RTS release from the better-validated carpal-tunnel and cubital-tunnel operations.

Defining principle of the rehab here: a decompressed nerve does not create a healing construct that needs months of protection — it needs early, gentle movement to stop it adhering to the operative bed and to restore its glide. So the rehab is an early-motion programme: light functional hand use from day 1, radial-nerve sliders, graded desensitisation and (once healed) scar massage; heavier loading deferred to ~6 weeks. But two honesty caveats sit over the whole topic. First, RTS is a contested diagnosis — there is no confirmatory imaging or electrodiagnostic test, it is a diagnosis of exclusion, and a substantial body of opinion regards it as a variant of recalcitrant lateral epicondylitis. Second, outcomes after release are more variable and on average lower than carpal- or cubital-tunnel release — good results cluster around two-thirds overall, and fall further with co-existing tennis elbow, multiple compression sites, or a workers'-compensation context. Patient expectations should be set accordingly.

A. THE DIAGNOSTIC CONTROVERSY (read first — it frames everything)

RTS is among the most contested entities in upper-limb surgery, and the rehab brief is incomplete without it:

  • No confirmatory test. Electromyography and nerve-conduction studies are characteristically normal in RTS (compression is intermittent/dynamic and predominantly of a motor nerve carrying few pain fibres), and MRI is frequently negative — denervation oedema in supinator/extensors is suggestive but inconsistent, and a normal scan does not exclude the diagnosis. RTS is therefore a clinical diagnosis of exclusion, resting on point tenderness ~4 cm distal to the lateral epicondyle (over the radial tunnel rather than the epicondyle), pain on resisted supination / resisted long-finger extension, and — for some surgeons — temporary relief from a diagnostic local-anaesthetic block at the radial tunnel.
  • Overlap with lateral epicondylitis (tennis elbow). The two coexist frequently and share the lateral-elbow pain territory. A recognised school of thought holds that "RTS" is often severe, recalcitrant lateral epicondylitis rather than a discrete compression neuropathy. Importantly, routine PIN release added to lateral-epicondylitis surgery has not been shown to improve outcomes, so the diagnosis should be secure before a decompression is planned.
  • Practical consequence. Surgery is a last resort after prolonged failed conservative care (activity modification, splinting, anti-inflammatories, sometimes a steroid injection), and is best reserved for patients with proximal-forearm pain and no better explanation. This uncertainty is the single most important reason post-operative expectations must be framed honestly.

B. RELEASE OUTCOMES (variable — and why)

  • Headline success ~two-thirds. Across the older long-term series, roughly 67% good, 15% fair, 18% poor after radial tunnel decompression — markedly more variable than carpal- or cubital-tunnel release. A 2008 long-term series (Lee, Azari, Jones) and a 1999 series (Sotereanos et al.) both document this spread; the Sotereanos cohort reported good/excellent results in only ~39% by objective assessment (though ~64% by patient self-rating), underscoring how outcome depends on the metric used.
  • Co-existing lateral epicondylitis lowers success. Success falls to roughly 40% when tennis elbow coexists, versus far higher with isolated RTS.
  • Multiple compression sites and workers'-compensation context lower success — reported ~58% success in compensation cases vs ~73% without. These are the same modifiers named in the patient protocol.
  • 2025 systematic review (Raymond et al., HAND). 11 studies, 401 limbs (381 patients). Outcomes were heterogeneous; a dorsal approach between ECRB and EDC was associated with the most favourable Roles-and-Maudsley scores and satisfaction. The review's central message is that the overall evidence is low-grade (observational), the diagnosis non-standardised, and the effectiveness of conservative treatment essentially untested — a "tendency" toward benefit rather than proof.
  • Resorption-style "spontaneous improvement" does not apply here — unlike calcific tendinitis, RTS does not self-resolve through a biological cycle; conservative care manages symptoms rather than curing a deposit.

C. SURGICAL APPROACH (shapes the early rehab)

  • What is done. Complete neurolysis of the radial nerve at its bifurcation, decompressing the deep branch (PIN) and superficial sensory branch, releasing the arcade of Frohse (the proximal supinator edge), the leash of Henry (radial recurrent vessels), the ECRB fascial edge, and the distal supinator border. Any constrictive bands or vessels are divided.
  • Approaches. Dorsal (Thompson, between ECRB/EDC or the brachioradialis–ECRL interval), volar/anterior (Henry), or transmuscular. Anatomical studies map the trade-offs; the dorsal ECRB–EDC interval performed best in the 2025 review. The superficial radial branch matters — it is a recognised source of post-operative dysaesthesia if irritated.
  • Rehab implication. A muscle-splitting/dorsal exposure through the extensor mass means early gentle forearm rotation and wrist motion are encouraged but heavy resisted supination/extension is deferred; the incision sits over a mobile, frequently sensitive area, so desensitisation and scar care carry real weight here.

D. POST-OP THERAPY ROLE (nerve/tendon glides, oedema, scar)

The decompressed nerve must glide, not adhere. The mechanical rationale is well quantified: the radial nerve translates and stretches a measurable amount across the elbow and wrist during ordinary arm motion (Wright et al. 2005), so early motion is what keeps it free of the healing bed.

  • Early motion, immediately. Early active elbow, forearm and wrist movement within pain limits from the first post-op days; most protocols use no rigid splinting (or a removable splint for comfort/night only).
  • Radial-nerve glides — favour "sliders" over "tensioners". Sliding (slider) neurodynamic techniques achieve substantially greater nerve excursion at much lower nerve strain than end-range tensioners — preferable around a freshly decompressed nerve. Neural-mobilisation evidence across neuromusculoskeletal conditions is supportive but of variable certainty, so progression is symptom-guided and essentially pain-free; mechanism work (e.g., the MONET protocol) is still maturing.
  • Oedema and desensitisation. Graded desensitisation (tapping/rubbing over the dressing) from day 1 normalises touch and pre-empts a sensitive scar — particularly relevant given superficial- radial-branch proximity.
  • Scar management once healed. Massage, pressure, and silicone are advocated to loosen skin–tissue adhesions and aid remodelling, started once the wound is closed/sutures out.
  • Strengthening deferred. Light functional ADL use throughout; resisted strengthening of wrist/ elbow and fine-motor work introduced from ~6 weeks. Heavy work and vibration tools avoided to ~6–8 weeks.

Phased post-op timeline (maps to the patient protocol phases)

Phase Window Splint Motion / nerve work Load / strengthening Notes
I — Protect & glide Day 0–2 wk None, or removable for comfort/night Early pain-free active elbow/forearm/wrist ROM; radial-nerve sliders; desensitisation from day 1 Light functional ADL use only (self-care, feeding, dressing, writing, typing) Stop the nerve adhering; settle the wound. No lifting/gripping/weight-bearing/vibration tools. Driving limited first 1–2 wk
II — Restore motion 2–6 wk Off Progress full active + gentle assisted ROM; continue sliders; scar massage once healed Still no resisted loading; ADL use continues Sensitivity/dysaesthesia common and usually settles; keep glides gentle
III — Strengthen & return ~6 wk onward Off Full ROM goal; sliders as needed Begin graded wrist/elbow strengthening + fine-motor work from ~6 wk; advance work/heavy tasks thereafter Vibration tools/heavy work resume ~6–8 wk. Pain relief is often gradual and may be partial — counsel accordingly

E. COMPLICATIONS / DOWNSIDES

  • Incomplete or no pain relief — the dominant "complication," tied directly to diagnostic uncertainty; relief is frequently gradual and sometimes partial.
  • Superficial-radial-branch dysaesthesia / scar sensitivity — recognised; desensitisation and careful technique mitigate it.
  • Transient PIN weakness (finger/thumb extension) from retraction — usually recovers.
  • Adhesion/recurrence of symptoms if early glide is neglected.
  • Standard wound risks (infection, haematoma) — uncommon.

F. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Does RTS exist as a discrete entity? Genuinely contested. No confirmatory test; substantial opinion equates much of it with recalcitrant lateral epicondylitis. This is the defining controversy and must shape consent and expectation-setting. Unresolved — expert opinion divided.
  2. Patient selection drives outcome more than technique. Isolated RTS does best; coexisting tennis elbow, multiple compressions, and compensation context predict worse results. Moderate (consistent across cohorts).
  3. Approach choice. A dorsal ECRB–EDC interval was favoured in the 2025 SR, but the evidence is observational and confounded by diagnostic heterogeneity. Weak–moderate.
  4. The rehab protocol itself is consensus/expert — drawn from surgeon and hand-therapy guidance (early motion, sliders, desensitisation, scar care), not from a rehab RCT. Phase timings are typical, not trial-derived. Weak / consensus.
  5. Conservative-treatment efficacy is essentially untested — the 2025 SR notes no usable trials of non-operative care, so "failed conservative management" before surgery rests on practice convention. Weak.

G. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG: the mechanical rationale for early nerve glide — quantified radial-nerve excursion/ strain across elbow and wrist (Wright et al. 2005); slider-vs-tensioner excursion/strain physiology.
  • MODERATE: patient-selection modifiers of outcome (lateral epicondylitis, multiple compressions, workers' compensation lower success); ~two-thirds overall good-result rate from long-term cohorts; dorsal-approach signal from the 2025 systematic review (low-grade studies).
  • WEAK / CONSENSUS: the existence and diagnostic criteria of RTS (no confirmatory test; overlap with lateral epicondylitis); the post-operative rehabilitation protocol (surgeon/ hand-therapy guidance, no rehab RCT); neural-mobilisation certainty (supportive but variable); efficacy of conservative care (essentially untested).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Posterior Interosseous Nerve Compression in the Forearm, AKA Radial Tunnel Syndrome. HAND. 2022. DOI: 10.1177/15589447221122822
  • Radial Tunnel Syndrome: Emphasis on the Superficial Branch of the Radial Nerve. J Hand Surg Eur. 2009. DOI: 10.1177/1753193408099832
  • Anatomical Study of the Surgical Approaches to the Radial Tunnel. J Hand Surg Am. 2015. DOI: 10.1016/j.jhsa.2015.03.009
  • MR Imaging Features of Radial Tunnel Syndrome: Initial Experience. Radiology. 2006. DOI: 10.1148/radiol.2401050028
  • Management of Lateral Epicondylitis: Current Concepts. J Am Acad Orthop Surg (JAAOS). 2008. DOI: 10.5435/00124635-200801000-00004
  • Uncommon Nerve Compression Syndromes of the Upper Extremity. J Am Acad Orthop Surg (JAAOS). 1998. DOI: 10.5435/00124635-199811000-00006
  • Radial Nerve Excursion and Strain at the Elbow and Wrist Associated With Upper-Extremity Motion. J Hand Surg Am. 2005. DOI: 10.1016/j.jhsa.2005.06.008
  • Evidence and Techniques in Rehabilitation Following Nerve Injuries. Hand Clin. 2013. DOI: 10.1016/j.hcl.2013.04.012
  • Preventive Strategies, Exercises and Rehabilitation of Hand Compression Neuropathies. J Hand Ther. 2022. DOI: 10.1016/j.jht.2021.11.003
  • Mechanisms of Neurodynamic Treatments (MONET): a protocol for a mechanistic study. BMC Musculoskelet Disord. 2024. DOI: 10.1186/s12891-024-07713-6

Radial-tunnel literature (URLs)

  • Clinical Outcomes of Operative Management for Radial Tunnel Syndrome According to Surgical Approach: a Systematic Review. HAND. 2025. https://journals.sagepub.com/doi/10.1177/15589447251315761
  • The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis. J Hand Surg Am. 2023. https://www.jhandsurg.org/article/S0363-5023(23)00138-7/abstract
  • Lee JT, Azari K, Jones NF. Long-term results of radial tunnel release — the effect of co-existing tennis elbow, multiple compression syndromes and workers' compensation. J Plast Reconstr Aesthet Surg. 2008. https://www.sciencedirect.com/science/article/abs/pii/S1748681507004044
  • Sotereanos DG, et al. Results of surgical treatment for radial tunnel syndrome. J Hand Surg Am. 1999. https://pubmed.ncbi.nlm.nih.gov/10357537/
  • Interventions for treating the radial tunnel syndrome: a systematic review of observational studies (DARE). https://www.ncbi.nlm.nih.gov/books/NBK75403/
  • Radial Tunnel Syndrome (StatPearls). https://www.ncbi.nlm.nih.gov/books/NBK555937/
  • Orthopedic Management of Radial Tunnel Syndrome: A Diagnostic and Treatment Dilemma. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10081130/
  • Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9896270/

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

  • Radial Tunnel Release post-op protocol (Santa Barbara Orthopedic / Mencias). https://www.sbortho.com/wp-content/uploads/2023/09/radial-tunnel-release-new.pdf
  • Radial Tunnel Syndrome — conservative and post-operative rehabilitation. Physiopedia. https://www.physio-pedia.com/Radial_Tunnel_Syndrome
  • Basson A, et al. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017. https://pubmed.ncbi.nlm.nih.gov/28704626/
  • Coppieters MW, Butler DS. Do "sliders" slide and "tensioners" tension? Man Ther. 2008. https://pubmed.ncbi.nlm.nih.gov/17398140/

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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.