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Liberação de De Quervain

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Um plano de recuperação com mobilização precoce após a liberação cirúrgica do primeiro compartimento dorsal na tenossinovite de De Quervain, com suporte de conforto breve, movimentos suaves do polegar e do pulso desde o início para prevenir rigidez, cuidados com a cicatriz e retorno gradual à força de preensão e pinça por volta de quatro a seis semanas.

Ilustração do lado radial do punho mostrando o túnel do primeiro compartimento dorsal sobre os dois tendões do polegar (abductor pollicis longus e extensor pollicis brevis), que é aberto durante a liberação de De Quervain.
A liberação de De Quervain abre o túnel apertado (o primeiro compartimento dorsal) sobre os dois tendões do lado do polegar no pulso, proporcionando espaço para que deslizem livremente. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

Este protocolo orienta a sua recuperação após a liberação de De Quervain, uma pequena cirurgia que abre o túnel apertado sobre os tendões do lado do polegar do seu pulso, com o Dr. Kieran Hirpara no Mater Private Hospital Rockhampton. Ele começa com o seu programa de exercícios em casa, seguido pelo protocolo clínico estruturado escrito para o seu terapeuta da mão; leve esta página ou o seu PDF à sua primeira sessão de terapia para que a sua reabilitação permaneça coordenada. O seu terapeuta da mão pode ajustar o plano dependendo de como a sua recuperação avança.

Se tiver alguma preocupação sobre a sua ferida após a cirurgia, entre em contato com a clínica. Muitas vezes, é útil tirar uma foto da ferida e enviá-la por e-mail para avaliação.

O que esperar

A tenossinovite de De Quervain é uma irritação dos dois tendões que vão para o seu polegar (o abdutor longo do polegar e o extensor curto do polegar) onde eles passam por um túnel justo (o primeiro compartimento dorsal) no lado do polegar do pulso. A liberação é uma pequena operação que abre esse túnel para que os tendões tenham espaço para deslizar livremente, aliviando a dor e o travamento.

Como nada é costurado de volta ou apertado (o túnel é simplesmente aberto e deve permanecer aberto), esta é uma recuperação de movimento precoce, não uma de longa proteção. Não há nenhuma estrutura que precise de meses para cicatrizar. O objetivo inteiro da reabilitação é manter os tendões em movimento através do leito cirúrgico em cicatrização para que eles não se fixem, enquanto a pequena ferida e os nervos da pele sobre ela se estabilizam.

Portanto, o plano é simples: um curativo macio (por vezes uma tala leve para o polegar apenas para conforto) durante os primeiros dias até cerca de uma ou duas semanas, movimentos suaves do polegar e do pulso iniciados precocemente, cuidados com a cicatriz após a cicatrização da ferida e um aumento gradual da força de preensão e pinça. A maioria das pessoas retorna a atividades normais confortáveis por volta de quatro a seis semanas.

Duas coisas são observadas após esta operação específica. A primeira é um pequeno nervo da pele, o nervo sensitivo radial, cujos ramos correm por toda a frente do local cirúrgico; ele pode ficar formigando ou sensível por um tempo, e o trabalho inicial de estabilização nervosa visa esse nervo. A segunda é a posição dos tendões: abrir o túnel demais em direção ao lado da palma pode ocasionalmente permitir que um tendão deslize para a frente (subluxação) quando você move o polegar. Ambos são incomuns, e seu terapeuta da mão ficará de olho nisso.

Precauções e limitações

  • Mantenha o polegar e o pulso em movimento desde o início: o movimento suave é o tratamento aqui, não o repouso. A rigidez causada pela falta de movimento é o principal problema que procuramos evitar.
  • Utilize qualquer tala de conforto apenas conforme indicado e apenas nos primeiros dias até uma ou duas semanas: ela serve para conforto, não para proteção, e deve ser removida para os seus exercícios.
  • Mantenha a ferida limpa e seca até que esteja cicatrizada; não inicie a massagem cicatricial até que as curativos sejam removidos e a pele esteja fechada.
  • Evite preensão forte, pinçamento vigoroso, levantamento e torção (torcer um pano, abrir potes apertados, ferramentas pesadas) até cerca de três a quatro semanas, depois retome gradualmente.
  • Informe o seu terapeuta ou a clínica se notar formigamento, dormência ou uma sensação aguda e irradiante na parte dorsal do polegar e do pulso, ou se um tendão estalar ou deslizar quando mover o polegar.

Para o manejo da ferida, edema e cicatriz, consulte as orientações da clínica sobre cuidados com a ferida.

Seus exercícios

Estes são os exercícios do seu material didático. Inicie-os conforme orientado pelo Dr. Hirpara e pelo seu terapeuta da mão. Os exercícios iniciais (movimento do polegar, movimento do punho e deslizes tendíneos) mantêm tudo em movimento e deslizando, para que os tendões liberados não aderam; estes começam nos primeiros dias, dentro do conforto. A massagem cicatricial inicia-se após a cicatrização da ferida. O fortalecimento do preensão e da pinça é uma adição posterior, geralmente a partir de três a quatro semanas. O deslize nervoso é adicionado apenas se a pele sobre o punho sentir formigamento ou sensibilidade. Interrompa qualquer coisa que cause dor aguda ou irradiante no lado do polegar do punho.

O seu protocolo clínico

O restante desta página é o protocolo clínico faseado para a reabilitação após a libertação da de Quervain (primeiro compartimento dorsal). Esta secção deve ser fornecida ao seu terapeuta da mão, e cada fase inicia-se com uma explicação em linguagem simples do que está a acontecer. Trata-se de uma descompressão, não de uma reparação: o primeiro compartimento dorsal é dividido e deve permanecer dividido, pelo que não existe nenhuma estrutura a proteger. O programa segue, portanto, uma via de movimento precoce, baseada no deslizamento: manter os tendões do APL/EPB a deslizar através do leito cirúrgico para prevenir a formação de aderências, controlar o edema, gerir a cicatriz e o nervo sensitivo radial, e restaurar a força de preensão e a pinça.

Antes do início do tratamento, verifique o relatório operatório do paciente e entre em contacto com o cirurgião assistente relativamente à libertação (incisão longitudinal/dorsal, se foi encontrado e libertado um sub-sheath/septo separado do EPB), ao posicionamento dorsal da libertação para prevenir a subluxação volar dos tendões, e a qualquer manuseamento do nervo sensitivo radial. O Dr. Hirpara realiza uma libertação aberta através de uma abordagem dorsal/longitudinal, protegendo os ramos do nervo sensitivo radial e mantendo a libertação dorsal para evitar a subluxação volar; a imobilização é apenas para conforto (curativo macio ± tala curta para o polegar durante alguns dias até ~1–2 semanas), e o movimento precoce do polegar e do pulso é a norma.

Fase I — mobilização precoce, controlo do edema e cuidados com a ferida (semana 0 a ~2)

A primeira ou segunda semana visa proteger a ferida e reduzir o inchaço, enquanto a mobilização é iniciada imediatamente. Não existe um arco protegido a respeitar: o objetivo é permitir que os tendões libertados deslizem logo de imediato. Qualquer talabarte é apenas para conforto e deve ser removido para os exercícios.

Para o seu terapeuta da mão:

Educação e precauções - Trata-se de uma descompressão: não há estrutura a proteger; a mobilização ativa precoce é a norma prevista - Suporte apenas para conforto: curativo macio ± talabarte para o polegar curto durante os primeiros dias até ~1–2 semanas; remover para os exercícios e lavagem - Manter a ferida limpa e seca até à cicatrização; adiar o trabalho sobre a cicatriz até que a pele esteja fechada - Evitar preensão vigorosa, pinça, levantamento de peso e rotação do pulso nesta fase - Avaliar a distribuição do nervo sensitivo radial (polegar/pulso dorso-radial) quanto a parestesias, hipersensibilidade ou sinal de Tinel; avaliar subluxação do APL/EPB na extensão-abdução do polegar resistida/ativa

Gestão - Ferida: curativos cirúrgicos conforme indicado; monitorizar infeção - Edema: elevação, massagem retrograde suave, gelo conforme necessário - Exercícios: amplitude de movimento (ROM) ativa do polegar (flexão/extensão, abdução palmar + radial, oposição), amplitude de movimento ativa do pulso, deslizamentos dos tendões APL/EPB, amplitude de movimento ativa completa dos dedos; utilização funcional ligeira da mão dentro dos limites do conforto

Critérios para progressão - Ferida cicatrizada/em resolução; edema controlado; mobilização ativa confortável do polegar e do pulso

Fase II — recuperação da amplitude de movimento e manejo da cicatriz (semanas ~2 a 4)

Uma vez que a ferida esteja cicatrizada, a tala de conforto é descontinuada e o foco muda para a amplitude de movimento completa e confortável, além da dessensibilização ativa da cicatriz e dos nervos. O fortalecimento leve começa no final deste período.

Para o seu terapeuta da mão:

Avaliações - Amplitude de movimento (AM) ativa/passiva do polegar e do punho; qualidade da cicatriz; sintomas do nervo sensorial radial; rastreamento de subluxação

Educação e precauções - Descontinuar qualquer tala de conforto; incentivar o uso normal e leve da mão - Continuar a evitar preensão e pinça pesadas/forçadas até ~3–4 semanas

Conduta - Cicatriz: massagem e silicone/hidratante após a cicatrização; dessensibilização se houver hipersensibilidade - Nervo: deslizes/dessensibilização do nervo sensorial radial se irritado; estabilizar antes de iniciar carga - Exercícios: progredir para AM completa do polegar e do punho; continuar os deslizes tendinosos; iniciar preensão/pinça leve (massa terapêutica, bola macia) a partir de ~3–4 semanas

Critérios para progressão - AM completa do polegar e do punho, sem dor; cicatriz cicatrizada e móvel; sintomas nervosos em resolução

Fase III — fortalecimento e retorno às atividades (semanas ~4 a 6 e além)

Com a mobilidade restaurada e a ferida madura, a força de preensão e de pinça é progressivamente aumentada e o paciente é reintegrado às atividades completas. A maioria atinge um uso normal confortável por volta de quatro a seis semanas; demandas manuais mais pesadas exigem um pouco mais de tempo e são baseadas em critérios.

Para o seu terapeuta da mão:

Avaliações - Força de preensão e de pinça em comparação com o lado contralateral; dor com carga; testes funcionais/específicos do trabalho, conforme apropriado

Educação e precauções - Retorno gradual à preensão, pinça, levantamento e torção; atividade completa conforme o conforto e a força permitirem - Dor/dormência dorsorradial persistente ou tendão estalando → encaminhar de volta ao cirurgião assistente (considerar neuroma, liberação incompleta ou subluxação volar)

Conduta - Exercícios: fortalecimento progressivo de preensão e pinça; carga específica de tarefas e do trabalho; continuar qualquer trabalho residual de cicatriz/nerve - Considerar alta quando a força estiver quase simétrica e a função estiver restaurada - Considerar encaminhamento de volta ao médico assistente se a recuperação estagnar ou houver um resultado insatisfatório

Critérios para alta / retorno à atividade completa - Preensão e pinça quase simétricas; uso funcional e específico do trabalho sem dor

Retornar ao trabalho e às atividades

O uso leve das mãos nas atividades diárias (comer, escrever, vestir-se, tarefas leves) é incentivado desde o início, dentro dos limites do conforto. Como a cirurgia é realizada no punho e a mão precisa se mover livremente e realizar preensão com segurança, a direção de veículos é retomada quando a ferida estiver confortável, a tala de conforto for removida e você conseguir segurar e girar o volante com confiança; para a maioria das pessoas, isso ocorre nas primeiras uma a duas semanas, conforme confirmado na consulta de acompanhamento.

A preensão vigorosa, a pinça, o levantamento de peso e a torção devem ser adiados até cerca de três a quatro semanas, sendo progressivamente intensificados. O trabalho de escritório e as atividades leves geralmente são retomados em alguns dias até uma ou duas semanas; o trabalho manual mais pesado, que depende de carga forte e repetida no polegar e no punho, geralmente é retomado por volta de quatro a seis semanas, avaliado pela força e pelo conforto recuperados, e não apenas pelo calendário, conforme determinado pelo Dr. Hirpara e pelo seu terapeuta da mão.

Após o seu protocolo

Este protocolo complementa as orientações gerais de recuperação da clínica: consulte o controlo da dor pós-operatória, os cuidados com a ferida e a gestão da cicatriz. O plano por fases acima descrito reflete as orientações de reabilitação publicadas após a libertação de De Quervain, e a sua recuperação contínua é orientada individualmente pelo Dr. Hirpara e pelo seu terapeuta da mão, de acordo com a evolução da sua mão.

Reviewed by Dr Kieran Hirpara · 21 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

de Quervain's Release — Procedure Outcomes & Post-operative Rehabilitation (First Dorsal Compartment Release)

Topic scope: post-operative rehabilitation after surgical release of the first dorsal compartment of the wrist (abductor pollicis longus, APL, and extensor pollicis brevis, EPB) for refractory de Quervain's tenosynovitis. This is a decompression, not a reconstruction: the fibro-osseous tunnel is opened and is meant to stay open, so the rehabilitation is an early-motion pathway built around tendon gliding, oedema and scar control, and protection of the overlying radial sensory nerve — rather than months of protected healing.

Defining principle of the rehab here: de Quervain's release relieves a tendon entrapment and does not create a construct that needs protection. The divided extensor retinaculum is meant to stay divided. So (unlike a tendon or ligament repair) immediate, gentle active thumb and wrist motion is the default, and the only deliberate restraints are brief comfort support and a short window of heavy-grip/pinch/twist avoidance while the wound heals. The therapy programme exists to keep the APL/EPB tendons gliding through the healing surgical bed so they do not adhere, to settle the radial sensory nerve branches that cross the incision, and to rebuild grip and pinch — not to immobilise. The single branch points are (1) whether a separate EPB sub-sheath/septum was present and released (its retention is a classic cause of failed release) and (2) keeping the release dorsal so the tendons do not subluxate volarly.

A. PROCEDURE OUTCOMES (open release; endoscopic and retinaculum-sparing variants)

Surgical release of the first dorsal compartment is a reliable operation for de Quervain's that has failed non-operative care: the great majority of patients obtain durable symptom relief, and the principal debates are over technique details (incision orientation, completeness of EPB sub-sheath release, whether to preserve/lengthen the retinaculum) rather than whether to decompress.

  • Open release gives durable, high-quality long-term outcomes. A series of 80 cases with a mean 9.5-year follow-up reported sustained relief with a low complication profile, establishing the long-term reliability of open release [Garçon et al., Orthop Traumatol Surg Res 2018]. Moderate (long-term cohort).
  • Functional recovery is good and objectively measurable. A series using DASH scores to evaluate first-extensor-compartment release for refractory disease documented good functional outcomes, and emphasised identifying and releasing a separate EPB sub-compartment (septum) when present [Lee et al., Clin Orthop Surg 2014]. DASH is a validated, widely used outcome instrument across hand and wrist conditions [Baltzer, Novak & McCabe, J Hand Surg Am 2014 — scoping review]. Moderate (cohort) + instrument SR.
  • Endoscopic and open release are broadly comparable. A comparative study of endoscopic versus open release found favourable results for the endoscopic approach with attention to the radial sensory nerve, while open release remains the standard reference technique [Kang et al., Bone Joint J 2013]. Moderate (comparative).
  • The retinaculum can be partly resected, simply divided, or reconstructed. Partial resection of the extensor retinaculum gives good short-term results [Altay et al., Orthop Traumatol Surg Res 2011]; simple release and Z-plasty (retinaculum-lengthening) reconstruction give comparable outcomes, with Z-plasty proposed to reduce subluxation risk at the cost of complexity [Kim, Baek & Lee, J Hand Surg Eur 2019]. A longitudinal-incision technique series likewise reports good functional outcomes [Mangukiya et al., Musculoskelet Surg 2019]. Moderate (comparative/cohort).
  • Dissatisfaction does occur and is worth counselling for. A focused study of dissatisfaction after first dorsal compartment release found that a minority of patients remain dissatisfied, often linked to residual pain, nerve symptoms or incomplete relief — a reminder that outcomes are good but not universal [Rogozinski & Lourie, J Hand Surg Am 2016]. Moderate (cohort).

B. REHABILITATION / THERAPY EVIDENCE

The central rehab questions are (1) whether to immobilise the thumb/wrist afterwards and for how long, and (2) whether formal hand therapy changes the outcome. The published base specific to post-de-Quervain-release rehabilitation is thin and consensus-driven: there are no high-quality trials comparing immobilisation regimens or therapy protocols. Practice converges on brief comfort support and early motion, with hand therapy used selectively.

  • Early motion is the rationalised default; prolonged immobilisation is not supported. Because the release is a decompression with no construct to protect, early active thumb and wrist motion is used to keep the APL/EPB tendons gliding and prevent adhesion. Immobilisation, where used, is a soft dressing or short thumb spica for comfort only for days to ~1–2 weeks. The supporting evidence is mechanistic/consensus, mirroring the well-established early-motion rationale after other upper-limb decompressions. Weak–moderate (mechanism strong, outcome data sparse).
  • De Quervain's is not always an isolated problem — therapy assessment matters. A hand-therapy review highlights that de Quervain's syndrome may coexist with other dorsoradial/wrist pathology, so post-operative therapy should reassess rather than assume a single diagnosis — relevant when symptoms persist after release [Redvers-Chubb, Hand Therapy 2015]. Consensus (narrative/therapy review).
  • Hand therapy focus is glide, scar and nerve, then strength. The programme priorities are tendon gliding (adhesion prevention), oedema control, scar management and radial sensory nerve desensitisation, and graded grip/pinch strengthening. The benefit of formal supervised therapy over a home programme is not established by trial data; selective therapy is defensible. Weak / consensus.

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Early motion, oedema & wound care Week 0–~2 Comfort support only (soft dressing ± short thumb spica) Immediate active thumb + wrist motion; APL/EPB tendon glides; elevation/oedema control; screen radial sensory nerve + subluxation Light functional use only No construct to protect; motion is the treatment. Keep wound clean/dry
II — Restore motion & scar/nerve care Week ~2–4 Splint discarded once healed Full thumb + wrist ROM; scar massage once wound healed; radial sensory nerve glides/desensitisation if irritable Begin light grip/pinch (putty, ball) from ~3–4 wk Avoid forceful grip/pinch/twist until ~3–4 wk
III — Strengthening & return Week ~4–6+ Restrictions lifted, graded Progressive grip/pinch and task-specific loading Return to near-symmetrical grip/pinch; full activity as strength allows Light/desk work days–1–2 wk; manual work ~4–6 wk, criterion-based

(Phase windows are typical clinical guides, not trial-derived deadlines. Driving resumes once the wound is comfortable, any comfort splint is off, and the patient can grip and steer confidently — commonly within 1–2 weeks.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. The EPB sub-sheath (septum) must be sought and released. A separate EPB sub-compartment is common and, if missed, is a classic cause of persistent symptoms / failed release. Series that emphasise identifying and releasing it report good outcomes [Lee 2014]. Moderate — strong mechanistic consensus.
  2. Volar tendon subluxation if released too volar. Dividing the retinaculum too far towards the palmar side can let the APL/EPB tendons subluxate volarly with thumb motion. Keeping the release dorsal, and retinaculum-lengthening (Z-plasty) reconstructions, are described specifically to mitigate this [Kim 2019; Altay 2011]. Moderate (technique-comparative).
  3. Radial sensory nerve injury is the signature complication. The superficial radial nerve branches cross the operative field; injury or scar entrapment produces dorsoradial numbness, hypersensitivity or painful neuroma and is a leading driver of dissatisfaction [Ilyas et al., J Am Acad Orthop Surg 2007; Rogozinski 2016]. Careful exposure with nerve protection is emphasised across open and endoscopic techniques [Kang 2013]. Moderate.
  4. Immobilise or move early? No trial settles the optimal post-operative regimen; consensus favours brief comfort support and early motion (decompression logic) over prolonged splinting. Weak — consensus, not trial-derived.
  5. Outcomes are good but not universal. A measurable minority remain dissatisfied, usually from residual pain, nerve symptoms or incomplete release — worth explicit pre-operative counselling [Rogozinski 2016]. Moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE (cohort / comparative): durable long-term relief from open release (9.5-yr cohort); good DASH-measured functional outcomes; comparability of endoscopic vs open and of simple release vs Z-plasty / partial retinaculum resection; radial sensory nerve injury as the signature complication; a real, defined dissatisfaction rate.
  • WEAK / CONSENSUS: the early-motion, glide-based rehabilitation programme itself (mechanistically rationalised; no trial comparing immobilisation regimens or therapy protocols after de Quervain's release); the role of formal supervised therapy vs a home programme; exact phase timings and return-to-activity windows (typical guides, not trial-derived). Outcomes and the two signature complications (radial sensory nerve injury; volar subluxation) are better studied than the rehabilitation protocol.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Garçon JJ, Charruau B, Marteau E, et al. Results of surgical treatment of De Quervain's tenosynovitis: 80 cases with a mean follow-up of 9.5 years. Orthop Traumatol Surg Res. 2018. DOI: 10.1016/j.otsr.2018.04.022 (PMID 29909297)
  • Lee HJ, Kim PT, Aminata IW, et al. Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis: Surgical Findings and Functional Evaluation Using DASH Scores. Clin Orthop Surg. 2014. DOI: 10.4055/cios.2014.6.4.405
  • Ilyas AM, Ast M, Schaffer AA, et al. de Quervain Tenosynovitis of the Wrist. J Am Acad Orthop Surg. 2007. DOI: 10.5435/00124635-200712000-00009 (PMID 18063716)
  • Kang HJ, Koh IH, Jang JW, et al. Endoscopic versus open release in patients with de Quervain's tenosynovitis. Bone Joint J. 2013. DOI: 10.1302/0301-620X.95B7.31486 (PMID 23814248)
  • Altay M, Ertürk C, Işıkan UE. De Quervain's disease treatment using partial resection of the extensor retinaculum: A short-term results survey. Orthop Traumatol Surg Res. 2011. DOI: 10.1016/j.otsr.2011.03.015
  • Kim J, Baek J, Lee J. Comparison between simple release and Z-plasty of retinaculum for de Quervain's disease: a retrospective study. J Hand Surg Eur Vol. 2019. DOI: 10.1177/1753193418818341 (PMID 30669923)
  • Mangukiya HJ, Kale A, Mahajan NP, et al. Functional outcome of De Quervain's tenosynovitis with longitudinal incision in surgically treated patients. Musculoskelet Surg. 2019. DOI: 10.1007/s12306-018-0585-1
  • Rogozinski B, Lourie GM. Dissatisfaction After First Dorsal Compartment Release for de Quervain Tendinopathy. J Hand Surg Am. 2016;41(1). DOI: 10.1016/j.jhsa.2015.09.020 (PMID 26481556)
  • Baltzer H, Novak CB, McCabe SJ. A Scoping Review of Disabilities of the Arm, Shoulder, and Hand Scores for Hand and Wrist Conditions. J Hand Surg Am. 2014. DOI: 10.1016/j.jhsa.2014.07.050 (PMID 25227601)
  • Redvers-Chubb K. De Quervain's syndrome: It may not be an isolated pathology. Hand Therapy. 2015. DOI: 10.1177/1758998315599796

de Quervain's release literature (URLs)

  • Lee HJ, et al. Surgical Release of the First Extensor Compartment for Refractory de Quervain's Tenosynovitis (DASH outcomes; EPB septum). Clin Orthop Surg 2014 (open access). https://doi.org/10.4055/cios.2014.6.4.405
  • Garçon JJ, et al. Results of surgical treatment of De Quervain's tenosynovitis: 80 cases, mean 9.5-year follow-up. Orthop Traumatol Surg Res 2018. https://doi.org/10.1016/j.otsr.2018.04.022
  • Ilyas AM, et al. de Quervain Tenosynovitis of the Wrist (review — radial sensory nerve, surgical technique, complications). J Am Acad Orthop Surg 2007. https://doi.org/10.5435/00124635-200712000-00009
  • Rogozinski B, Lourie GM. Dissatisfaction After First Dorsal Compartment Release for de Quervain Tendinopathy. J Hand Surg Am 2016. https://doi.org/10.1016/j.jhsa.2015.09.020

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Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

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

Section 2 -- Scope.

a. License grant.

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

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

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

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

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

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

5. Downstream recipients.

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

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

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

b. Other rights.

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

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

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

Section 3 -- License Conditions.

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

a. Attribution.

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

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

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

ii. a copyright notice;

iii. a notice that refers to this Public License;

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

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

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

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

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

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

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

Section 4 -- Sui Generis Database Rights.

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

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

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

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

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

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

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

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

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

Section 6 -- Term and Termination.

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

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

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

2. upon express reinstatement by the Licensor.

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

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

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

Section 7 -- Other Terms and Conditions.

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

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

Section 8 -- Interpretation.

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

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

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

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

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

Creative Commons may be contacted at creativecommons.org.