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Suprascapular Nerve Decompression

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Rehabilitation after isolated arthroscopic suprascapular nerve decompression, with honest framing of nerve recovery.

Updated Jun 2026
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Pagpapakilala ng mga kalamnan ng balikat pagkatapos ng decompression ng suprascapular nerve. 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 sumasaklaw sa rehabilitasyon pagkatapos ng iisang arthroscopic na decompression ng suprascapular nerve kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton: ang pag-release ng nerve sa suprascapular notch at/o sa spinoglenoid notch, nang walang ibang repair. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa physiotherapy upang manatiling koordinado ang iyong rehabilitasyon. Ang iyong rehabilitasyon ay unti-unting pinapahusay ng iyong physiotherapist sa pamamagitan ng mga yugto sa ibaba, depende sa kung paano gumagaling ang iyong balikat.

Mahalaga: pakibasa muna. Ang decompression ng suprascapular nerve ay madalas na ginagkasama ng rotator cuff repair. Ang protocol na ito ay para sa iisang decompression lamang. Kung ang iyong operasyon ay kasama rin ang rotator cuff repair, sundin ang rotator cuff repair protocol sa halip: ang repaired tendon ang nagtatakda ng mas mabagal na tempo, at ang protocol na iyon ang may mas mataas na prioridad kaysa sa isa ito. Kung hindi ka sigurado kung anong operasyon ang iyong ginawa, tanungin ang mga kwarto bago ka magsimula.

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

Ano ang inaasahan

Kapag ang nerbiyo ay napalaya nang sarili, walang pag-aayos ng tendon na kailangang protektahan, kaya mabilis ang rehabilitasyon. Ang sling ay isinusuot lamang para sa kaginhawaan at sa maikling panahon (karaniwan ay para sa unang linggo lamang, at hindi hihigit sa dalawang linggo), at ito ay tinatanggal nang maramihan kapag nakapag-set na ang balikat. Ang banayad na galaw ay nagsisimula nang maaga, ayon sa kaginhawaan, at karamihan sa mga tao ay bumabalik sa kanilang karaniwang pang-araw-araw na gawain sa loob ng ilang linggo.

Ang paggaling ng nerbiyo mismo ay sumusunod sa sarili nitong timeline, hiwalay sa galaw ng balikat. Ang operasyon ay nagpapagaan ng presyon sa nerbiyo; ang sakit dulot ng presyon na iyon ay madalas ay nagpapagaan nang relativong mabilis. Ang paggaling ng lakas ng kalamnan at dami ng kalamnan sa mga kalamnan na iniaambag ng nerbiyo (ang supraspinatus at infraspinatus, na nasa ibabaw ng balikat) ay mas mabagal at sumusukat sa scale ng mga buwan. Ang antas ng pagbabalik ng lakas at dami ng kalamnan ay nag-iiba-iba sa bawat tao: sa ilang tao, kumpleto ang paggaling; sa iba, bahagya lamang; at ang matagal nang problema sa nerbiyo ay maaaring hindi ganap na gumaling. Kasama sa iyong pisikal na terapiya ang partikular na trabaho upang muling i-activate ang mga kalamnang iyon habang gumagaling ang nerbiyo. Ang iyong pisikal na terapeuta at ang klinika ang gabay sa iyo kung ano ang inaasahan sa iyong kaso.

Yugto I — Maagang paggalaw (Linggo 0–2)

Ang unang layunin ay kaginhawaan at banayad, maagang paggalaw. Ang sling ay para lamang sa kaginhawaan at dapat itong alisin hangga’t maaari kapag nakapagpaikot na ang balikat; hindi na kailangang matulog gamit ito. Huwag magmaneho habang nagsusuot ng sling. Kumain ng gamot sa sakit nang regular sa mga unang araw upang makapagsimula ng paggalaw ng braso. Panatilihin ang paggalaw ng kamay, pulso, at siko mula pa sa simula, at magsimula ng banayad na paggalaw ng balikat sa loob ng komportableng saklaw ayon sa payo.

Para sa iyong pisioterapeuta:

Mga Layunin

  • Kaginhawaan at proteksyon sa sugat
  • Maagang banayad na saklaw ng galaw sa loob ng mga limitasyong walang sakit
  • Panatilihin ang paggalaw ng kamay, pulso, at siko

Pamamahala

  • Sling para lamang sa kaginhawaan, karaniwang hanggang ika-7 araw pagkatapos ng operasyon (hanggang dalawang linggo kung kinakailangan para sa kaginhawaan), unti-unting binabawasan ayon sa pagpapabuti ng mga sintomas
  • Maagang banayad na saklaw ng galaw ayon sa kaginhawaan: pendulums, pasibo at aktibo-inaasistang pagtaas, panlabas at panloob na pag-ikot, at pagtuko/pagtuwid ng siko
  • Isometric na pagtatakda ng deltoid at scapula ayon sa kaginhawaan
  • Analgesya bago ang ehersisyo; cryotherapy para sa pagpapagaan ng sakit kung kinakailangan

Mga Paalala

  • Panatilihin ang maagang paggalaw sa loob ng komportableng saklaw na walang sakit
  • Walang mabibigat na pagbuhat, malakas na pagtulak o paghila
  • Walang pagmaneho habang nagsusuot ng sling

Mga Kriteryo para sa Pag-usad

  • Komportableng, nakapagpaikot na sakit
  • Sapat na paggaling ng sugat
  • Toleradong maagang saklaw ng galaw

Yugong II — Pagbubukas ng saklaw ng galaw at pagpapakilala ng kalamnan (Linggo 2–6)

Kapag inalis na ang sling, ang yugong ito ay nagbabalik ng buong galaw at nagsisimula ng magaan na pagpapalakas, kasama ang partikular na trabaho upang ipakilala muli ang supraspinatus at infraspinatus habang bumabawi ang nerbiyos. Karamihan sa mga tao ay bumabalik sa kanilang karaniwang mga gawain sa araw-araw sa yugong ito. Ang pag-unlad ay pinamumunuan ng kaginhawaan, hindi ng kalendaryo.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Buong aktibong saklaw ng galaw sa lahat ng mga patlang
  • Magsimula ng magaan na pagpapalakas at pagpapakilala muli ng rotator cuff (supraspinatus/infraspinatus)
  • Kalayaan sa mga gawain sa araw-araw

Pamamahala

  • Magpatuloy sa buong aktibong saklaw ng galaw sa lahat ng direksyon
  • Magsimula ng magaan na pagpapalakas mula sa humigit-kumulang linggo 2: mga isometrik na ehersisyo na nagtatapos sa paggamit ng elastic band para sa rotator cuff, deltoid, at mga scapular stabilisers, mabigat na load at mas mataas na paulit-ulit
  • Partikular na pag-aalala sa walang sakit na external rotation at sa pagpapakilala muli ng supraspinatus at infraspinatus habang bumabawi ang nerbiyos
  • Unahan-unahang pagbabalik sa karaniwang mga gawain sa araw-araw, karaniwan ay sa humigit-kumulang apat na linggo

Mga Paalala

  • Ang pagpapalakas ay mananatili sa loob ng isang kumportablong saklaw at hindi dapat magdulot ng sakit na tumatagal
  • Iwasan ang makapangyarihang pagtulak, paghila, at mabibigat na pag-angat habang bumabawi ang lakas
  • Inaasahan ang unahan-unahang pagbabalik ng lakas: ang trabaho sa pagpapakilala muli ay inayos ayon sa pagbawi ng nerbiyos, hindi pinipilit

Mga Kriteryo para magpatuloy

  • Buong, o halos buong, walang sakit na aktibong saklaw ng galaw
  • Tinatanggap ang magaan na pagpapalakas nang walang pagtaas ng sintomas

Yugong III — Pagpapalakas at pagbabalik sa aktibidad (Linggo 6–12 at higit pa)

Mula sa humigit-kumulang anim na linggo, ang pagpapalakas ay patuloy nang walang partikular na pagbabawal, na naglalayong bumalik sa mga gawaing pang-ibabaw ng ulo, mas mabigat na trabaho, at isport. Ang nakahiwalay na pagpapalakas ng supraspinatus at infraspinatus ay pinapahusay habang patuloy ang paggaling ng nerbiyo, na karaniwang tumatagal ng ilang buwan.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Buong pagpapalakas nang walang pagbabawal
  • Unahan-unahang pagbabalik sa mga gawaing pang-ibabaw ng ulo, mas mabigat na trabaho, at isport
  • Patuloy na paggaling ng lakas ng rotator cuff habang gumagaling ang nerbiyo

Pamamahala

  • Mula sa humigit-kumulang linggo 6, umunlad sa buong pagpapalakas, kabilang ang closed-chain at progressive resistance work
  • Mula sa humigit-kumulang linggo 12, ituloy ang pagpapalakas ng supraspinatus at infraspinatus nang hiwalay
  • I-stage ang pagbabalik sa mga gawaing pang-ibabaw ng ulo at isport; ang buong pagbabalik sa mga gawaing pang-ibabaw ng ulo ay madalas na nakamit sa loob ng humigit-kumulang apat hanggang anim na linggo para sa mas magaan na mga gawain, na may unahan-unahang pagbabalik sa isport sa mga sumusunod na linggo at buwan habang pinapayagan ng lakas at kapag walang sakit na
  • Patuloyin ang maintenance programme habang patuloy ang paggaling ng nerbiyo at mga kalamnan

Mga Paalala

  • Ang pag-unlad ay nananatiling nakabatay sa sintomas
  • Ang lakas at dami ng kalamnan sa apektadang mga kalamnan ay maaaring patuloy na gumaling sa loob ng ilang buwan, at maaaring bahagya lamang ang paggaling: ayusin ang mga inaasahan ayon dito at iwasan ang sobrang pagpiga habang hindi pa kumpleto ang lakas

Pagkatapos ng iyong protocol

Ang mga yugto sa itaas ay naangkop mula sa mga nakapublikasyon na papel sa teknika at mga klinikal na pag-aaral tungkol sa arthroscopic decompression ng suprascapular na nerbiyos. Ang mga saklaw ng linggo ay karaniwan kaysa sa nakatakda, at ang iyong patuloy na rehabilitasyon ay indibidwal na pinamumunuan ng iyong pisyoterapeuta, na nagtatrabaho kasama ang klinika, batay sa kung paano gumagaling ang iyong balikat at ang nerbiyos. Ang pahinang ito ay nagtataglay kasama ng pangkalahatang payo sa paggaling ng klinika; tingnan ang pamamahala ng post-operative na sakit at pag-aalaga sa sugat. Para sa operasyon mismo at sa kondisyon na pinapagaling nito, tingnan ang decompression ng suprascapular na nerbiyos. Ang ebidensya sa likod ng protocol na ito (literatura sa pagpapagaan ng sakit at paggaling ng lakas sa decompression ng nerbiyos) ay buod sa seksyon ng ebidensya, na magagamit bilang PDF mula sa itaas ng pahinang ito.

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

Suprascapular Nerve Decompression — Post-operative Rehabilitation (Arthroscopic Release)

Topic scope: Post-operative rehabilitation after an isolated arthroscopic suprascapular nerve decompression / release — release of the nerve at the suprascapular notch (division of the transverse/superior scapular ligament) and/or the spinoglenoid notch, performed for nerve entrapment, often with excision of an associated paralabral / spinoglenoid ganglion cyst. This page covers the isolated decompression only; when the procedure is combined with a rotator cuff repair the slower, protected rotator-cuff-repair pathway takes precedence.

Defining principle of the rehab here: decompression relieves pressure on a nerve and creates no construct that needs months of protection — there is no tendon repair or capsular reconstruction to safeguard. So (like a debridement/decompression, and unlike a cuff repair or labral repair) this is an early-movement pathway: a short sling for comfort only (about the first week, two at most), early range of motion as comfort allows, and return to daily activities within a few weeks. The crucial separate timeline is the nerve itself: the compression pain often settles relatively quickly, but recovery of strength and bulk in the muscles the nerve supplies (supraspinatus and infraspinatus) is paced over weeks to months and is frequently only partial — functional recovery follows the nerve, not the calendar. The single branch point is whether a rotator cuff repair was also performed — if so, the recovery converts to the protected rotator-cuff-repair pathway.

The procedure

The suprascapular nerve can be entrapped at two fibro-osseous tunnels as it crosses the scapula: the suprascapular notch (under the superior transverse scapular ligament — entrapment here affects both supraspinatus and infraspinatus) and the spinoglenoid notch (under the spinoglenoid ligament — entrapment here is more selective for the infraspinatus). A paralabral ganglion cyst, often arising from a posterosuperior labral tear, is a common space-occupying cause at the spinoglenoid notch.

Arthroscopic decompression releases the offending ligament (and decompresses/excises any cyst); where the cyst arises from a labral tear, the labral source may be addressed at the same sitting. Because the operation removes a compressive lesion rather than creating a repair, there is no healing construct that dictates a protected immobilisation period — the rehab is governed by comfort and by the nerve's own recovery.

Evidence by theme

Pain relief is the most reliable benefit

Across cohorts and a systematic review, decompression gives good pain relief and functional improvement in the majority. In a retrospective series of 112 arthroscopic decompressions, VAS pain fell from a mean of 6.5 to 2.9 (p < 0.0001) at a mean follow-up of ~9 months, with no neurovascular injuries, infections or fractures [112-patient series, PMC6994808]. A 2018 systematic review of decompression outcomes reported broad improvements in patient-reported scores and high rates of return to sport/duty [systematic review, JSES 2018, DOI 10.1016/j.jse.2017.09.025]. A volleyball-player cohort and a spinoglenoid-notch technique series likewise report reliable return of arm function [Brzoska 2023; Plancher 2021]. Moderate (cohorts + SR of level III–IV studies).

Strength recovery follows the nerve — slower, and often incomplete

This is the key counselling point. The same 112-patient series showed measurable strength gains (supraspinatus 3.3 → 4.9; infraspinatus 3.3 → 4.8 on the 0–5 scale) but over months, not weeks [PMC6994808]. A systematic review of motor recovery after notch decompression found that full strength was NOT regained in the majority (~60%) of reported cases, and that established fatty (structural) muscle degeneration generally did not reverse — "patients should be informed about this" [motor-recovery SR, PubMed 32392599]. Open spinoglenoid-notch series report better external- rotation strength figures (e.g. ~66% regaining full ER strength) for cyst-related entrapment, where the lesion is discrete and recovery potential higher [open decompression, PubMed 23664748]. Earlier diagnosis and decompression, and a discrete compressive cause (cyst) rather than chronic idiopathic entrapment, predict more complete muscular recovery. Moderate–weak; consistent direction across studies.

Ganglion-cyst vs idiopathic entrapment

Cyst-related entrapment (a removable, space-occupying cause) tends to do well — decompression removes the cause and electrodiagnostic recovery of the nerve has been documented post- decompression [Feinberg 2019, Muscle Nerve]. Chronic idiopathic entrapment, longstanding denervation, and established fatty infiltration carry a more guarded prognosis for strength return. This distinction underlies the variable, partly-incomplete recovery seen in the pooled literature. Weak (case series / mechanistic).

The rehabilitation protocol itself is consensus/expert

The phased post-op programme below is drawn from published technique papers and patient-guidance protocols, not from a rehabilitation RCT — there is no trial defining the optimal post- decompression regimen. Phase timings are typical, not trial-derived. Weak/consensus.

Phased post-op timeline (isolated decompression — no cuff repair)

Phase Window Sling ROM / use Strengthening Notes
I — Early movement Week 0–2 Comfort only, ~first week (up to 2 wk), off ASAP; not worn to sleep Early gentle ROM as comfort allows — pendulums, passive/active-assisted elevation, ER/IR, elbow flexion/extension; keep hand/wrist/elbow moving from day 1 Isometric deltoid + scapular setting as comfortable Settle post-op flare; no driving while in sling; no heavy lifting/forceful push-pull
II — Range & muscle reactivation Week 2–6 Off Progress to full active ROM in all planes Light strengthening from ~wk 2 (isometric → band), low-load/high-rep cuff, deltoid, scapular stabilisers; particular attention to pain-free ER and to reactivating supraspinatus/infraspinatus as the nerve recovers Most return to normal daily activities (~wk 4); progress guided by comfort, not calendar
III — Strengthening / return Week 6–12 and beyond Off Full ROM maintained Full strengthening without restriction from ~wk 6; isolated supraspinatus/infraspinatus strengthening advanced from ~wk 12; staged return to overhead work and sport Strength + muscle bulk may keep recovering over several months and may be only partial — pace expectations to the nerve

Branch point — if a rotator cuff repair was also performed: recovery converts to the protected rotator-cuff-repair pathway (sling ~6 weeks, ROM restrictions, strengthening deferred). The surgeon confirms which pathway applies.

Key controversies / evidence quality

  1. Strength recovery is the honest weak point. Decompression reliably relieves pain but does not reliably restore full strength — a systematic review found ~60% of cases fell short of full strength recovery, and fatty muscle degeneration generally did not reverse [PubMed 32392599]. This is the single most important thing to counsel before surgery. Moderate (SR of level III–IV).
  2. Evidence is small cohorts and case series. The largest single series is ~112 patients; most are < 30; the systematic reviews pool level III–IV studies. There is no RCT for isolated decompression rehab, and no rehab trial at all. Weak overall evidence base — stated honestly.
  3. Indication / patient selection. When to decompress (especially for asymptomatic or mildly symptomatic cysts, or chronic idiopathic entrapment with established atrophy) remains debated — reflected in editorial commentary in the corpus ("should you have the nerve to do it?", Arthroscopy 2021, DOI 10.1016/j.arthro.2020.12.192). Consensus/expert.
  4. The rehab protocol is consensus, drawn from technique papers and surgeon patient-guidance documents rather than a rehab trial — phase timings are typical, not trial-derived.

Evidence-strength flags (summary)

  • MODERATE (cohorts + SR): decompression relieves pain and improves function in the majority (112-patient series VAS 6.5→2.9; 2018 JSES SR; volleyball-player cohort).
  • MODERATE–WEAK (SR of level III–IV): strength recovery is slower and often incomplete (~60% short of full strength; fatty degeneration usually does not reverse — motor-recovery SR).
  • WEAK (case series / mechanistic): cyst-related entrapment outperforms chronic idiopathic entrapment; earlier decompression predicts fuller recovery; documented electrodiagnostic nerve recovery post-release.
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol itself (technique papers + surgeon patient-guidance; no defining rehab RCT).

Citations

RAG corpus (180,000+ Orthopaedic articles)

  • Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg. 2011. DOI: 10.1016/j.jse.2010.10.032
  • Clinical outcomes of suprascapular nerve decompression: a systematic review. J Shoulder Elbow Surg. 2018. DOI: 10.1016/j.jse.2017.09.025
  • Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2008.10.024
  • Arthroscopic suprascapular nerve decompression: indications and surgical technique. J Shoulder Elbow Surg. 2010. DOI: 10.1016/j.jse.2010.01.006
  • Suprascapular neuropathy: what does the literature show? J Shoulder Elbow Surg. 2012. DOI: 10.1016/j.jse.2011.11.033
  • The Evaluation and Management of Suprascapular Neuropathy. J Am Acad Orthop Surg. 2020. DOI: 10.5435/jaaos-d-19-00526
  • Suprascapular Neuropathy. J Bone Joint Surg Am. 2010. DOI: 10.2106/jbjs.i.01743
  • Outcomes of Arthroscopic Nerve Release in Patients Treated for Large or Massive Rotator Cuff Tears and Associated Suprascapular Neuropathy: A Prospective, Randomized, Double-Blinded Clinical Trial. Am J Sports Med. 2021. DOI: 10.1177/03635465211021834
  • Editorial Commentary: Suprascapular Nerve Decompression Can Be Effective, But Should You Have the Nerve to Do It? Arthroscopy. 2021. DOI: 10.1016/j.arthro.2020.12.192
  • Complete Fatty Infiltration of Intact Rotator Cuffs Caused by Suprascapular Neuropathy. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.01.010

Literature (URLs)

  • A retrospective review of 112 patients undergoing arthroscopic suprascapular nerve decompression (VAS 6.5→2.9; supraspinatus/infraspinatus strength gains; no neurovascular/infective/fracture complications). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC6994808/
  • Motor Recovery of the Suprascapular Nerve after Arthroscopic Decompression in the Scapular Notch — a Systematic Review (~60% do not regain full strength; fatty degeneration generally not reversed). PubMed. https://pubmed.ncbi.nlm.nih.gov/32392599/
  • Suprascapular nerve entrapment isolated to the spinoglenoid notch: surgical technique and results of open decompression (~66% regained full ER strength). PubMed. https://pubmed.ncbi.nlm.nih.gov/23664748/
  • Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: technique and preliminary results. PubMed. https://pubmed.ncbi.nlm.nih.gov/17210425/
  • Compression of the suprascapular nerve by a ganglion cyst of the spinoglenoid notch: the arthroscopic solution. PubMed. https://pubmed.ncbi.nlm.nih.gov/14595536/

Published protocols / technique papers (basis for the phase structure)

  • Plancher KD, Evely TB, Brite JE, Briggs KK, Petterson SC. Endoscopic/arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch: indications and surgical technique. JSES Rev Rep Tech. 2021;1(3):198-206. https://www.sciencedirect.com/science/article/pii/S2666639121000250
  • Harkin WE, Kerzner B, Scanaliato J, et al. Open Suprascapular Nerve Decompression at the Spinoglenoid Notch. Arthrosc Tech. 2024;13(9):103051. https://pmc.ncbi.nlm.nih.gov/articles/PMC11411363/
  • Brzoska R, Laprus H, Klaptocz P, et al. Arm Function After Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch in Volleyball Players. Orthop J Sports Med. 2023;11(2):23259671221147892. https://pmc.ncbi.nlm.nih.gov/articles/PMC9974621/
  • Feinberg JH, Mehta P, Gulotta LV, et al. Electrodiagnostic evidence of suprascapular nerve recovery after decompression. Muscle Nerve. 2019;59(2):247-249. https://pubmed.ncbi.nlm.nih.gov/30291636/

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l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.