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Patient-facing topic on os acromiale — failed fusion of an acromial ossification centre that may cause shoulder pain and contribute to subacromial impingement.

Updated Aug 2026
Uma ilustração desenhada à mão de um desenho anatômico de um os acromiale, o acrômio com um fragmento ósseo separado e não fundido.
Os acromiais: a porção anterior do acrômio não se fundiu com o restante do acrômio durante a maturação esquelética. 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.

O que você está sentindo

Você pode notar dor na parte superior do ombro. Essa área fica logo acima da articulação principal do tipo bola e soquete. O desconforto geralmente parece profundo e latejante. Também pode parecer agudo quando você move o braço de certas maneiras. Muitas pessoas descrevem uma sensação de instabilidade ou estalo nesse local. Isso acontece porque o pequeno fragmento ósseo não se conecta totalmente ao restante da escápula.

Seus sintomas frequentemente pioram com atividades acima da cabeça. Alcançar para pegar algo de uma prateleira alta ou levantar objetos acima da cabeça pode desencadear dor. Você também pode sentir desconforto ao alcançar atrás das costas, como ao fechar um sutiã ou guardar uma camisa. Esses movimentos comprimem a área onde o fragmento ósseo encontra o restante do ombro. Se você tiver uma ruptura do manguito rotador, que é comum com essa condição, a dor pode ser mais intensa. O movimento anormal no local da conexão pode irritar os tecidos circundantes, levando à inflamação e a mais desconforto.

A dor noturna é outra queixa frequente. Você pode achar difícil dormir do lado afetado. A pressão de deitar sobre o ombro pode agravar a área inflamada. Algumas pessoas acordam com o ombro rígido pela manhã. A dor pode aliviar conforme você se move ao longo do dia, mas frequentemente retorna após atividade prolongada. Se você for um tenista profissional, seu cirurgião pode aconselhar contra a cirurgia, pois o repouso e a terapia frequentemente ajudam a gerenciar os sintomas. No entanto, se os tratamentos conservadores não ajudarem, opções cirúrgicas, como remover parte do fragmento ou fixá-lo no lugar, podem ser consideradas para reduzir sua dor e melhorar a função.

O que está realmente acontecendo

Seu ombro é uma articulação complexa do tipo bola e soquete. O acrômio é um arco ósseo na parte superior da sua escápula. Na maioria das pessoas, esse osso se forma como uma peça única durante a infância. Em alguns casos, um pequeno fragmento ósseo separado, chamado os acromial, permanece não fundido. Isso ocorre em cerca de 2,13% dos pacientes com problemas no ombro que realizam uma ressonância magnética.

Pense nesse fragmento não fundido como uma pedra solta dentro de um sapato. Ele fica onde deveria fazer parte do osso principal, mas se move ligeiramente mais do que deveria. Esse movimento extra pode irritar os tecidos ao seu redor. A sincôndrose é a conexão fibrosa entre o fragmento e o osso principal. Embora essa conexão seja geralmente estável, ela pode raramente ser lesionada por trauma.

Esse movimento anormal frequentemente leva a um problema secundário: impingement (impacto). O impingement ocorre quando ossos ou tecidos esfregam uns contra os outros em um espaço apertado. Ao mover o braço, o fragmento solto pode pinçar os tecidos moles abaixo dele. Esse pinçamento é uma causa comum de dor e inflamação no ombro.

O manguito rotador é um grupo de tendões que estabilizam a articulação do ombro. Esses tendões atuam como cordas que mantêm a bola do osso do braço encaixada no soquete. Como o os acromial fica diretamente acima desses tendões, o movimento anormal pode desgastá-los. Estudos mostram que o os acromial está frequentemente associado a lesões do manguito rotador. O pinçamento causado pelo fragmento solto pode contribuir para rupturas nessas fibras tendíneas críticas.

Se você tem essa condição, pode sentir dor ao levantar o braço acima da cabeça. O desconforto vem do atrito e da pressão nesse espaço apertado acima da sua articulação do ombro. Compreender essa questão mecânica ajuda a explicar por que o simples repouso às vezes não é suficiente. A irritação física causada pelo fragmento ósseo móvel frequentemente requer tratamento direcionado para resolver os sintomas.

O que podemos fazer a respeito

A abordagem utilizada pelo Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, reflete como gerenciamos essa condição em nossa clínica. Os pacientes chegam aos nossos cuidados por meio de encaminhamento de um clínico geral ou fisioterapeuta. Iniciamos com uma avaliação minuciosa, incluindo anamnese, exame físico e exames de imagem, se necessário, para confirmar o diagnóstico. Para problemas crônicos ou degenerativos, geralmente começamos com tratamento não cirúrgico. Isso inclui modificação das atividades, fisioterapia ou terapia manual, uso de órteses e injeções. Consideramos a cirurgia apenas se essas medidas não proporcionarem melhora suficiente. Para problemas estruturais agudos, a cirurgia pode ser recomendada imediatamente.

Você pode começar modificando suas atividades diárias para evitar movimentos que causem dor. A fisioterapia visa fortalecer os músculos ao redor do ombro para reduzir a tensão no os acromial. Este é um fragmento ósseo adicional na sua escápula que pode causar irritação. Geralmente, aconselhamos que você faça uma tentativa razoável desta abordagem conservadora antes de considerar outras opções. Se a dor persistir, podemos discutir o manejo clínico. Isso pode incluir medicamentos para dor e anti-inflamatórios para ajudar a controlar os sintomas. Injeções, como cortisona, podem ser oferecidas para reduzir a inflamação e proporcionar alívio temporário. Esses tratamentos ajudam a gerenciar o desconforto, mas não alteram a estrutura óssea subjacente.

A cirurgia é considerada quando o tratamento conservativo atingiu seu limite e seus sintomas permanecem significativos. Discutimos isso como uma decisão compartilhada, ponderando os benefícios potenciais contra os riscos. O objetivo é aliviar a dor e restaurar a função quando os métodos não cirúrgicos não são mais eficazes. Nossa equipe irá guiá-lo nas próximas etapas com base em suas necessidades específicas e nas descobertas da sua avaliação.

O que esperar

O os acromiale é um fragmento ósseo extra na sua escápula. Afeta cerca de 1 em cada 50 pessoas com problemas no ombro. Você pode ter dor em ambos os lados, pois é bilateral em 62% dos casos. Esse fragmento pode atritar contra outros ossos, causando irritação ou lesões no manguito rotador.

Se você tiver sintomas, seu cirurgião provavelmente começará com tratamento não cirúrgico. Isso inclui repouso e medicação anti-inflamatória. Para a maioria das pessoas, essa abordagem ajuda a controlar a dor. Se essas medidas não funcionarem, a cirurgia pode ser considerada para remover ou corrigir o fragmento. Isso geralmente leva à diminuição dos sintomas e à melhora da função do ombro.

A recuperação da cirurgia envolve um período de sensibilidade local no local. Um em cada quatro pacientes experimenta isso. A boa notícia é que essa sensibilidade desaparece por conta própria ao longo do tempo para a maioria dos pacientes. Você deve esperar um retorno gradual às atividades normais à medida que a área cicatriza.

Se você tiver uma prótese de ombro reversa, a presença de os acromiale não impacta negativamente seus resultados. Esse procedimento continua sendo uma opção segura e eficaz para você. Seu cirurgião garantirá que a substituição articular funcione bem apesar do fragmento ósseo extra.

Para tenistas profissionais, a cirurgia geralmente não é recomendada. As exigências do esporte podem superar os benefícios de corrigir o fragmento. Nesses casos, o manejo dos sintomas sem operação é frequentemente o caminho preferido.

No geral, o prognóstico é positivo para aqueles que precisam de tratamento. A maioria das pessoas encontra alívio da dor e melhora do movimento. Seu cirurgião irá guiá-lo pela melhor opção para sua situação específica. Você pode esperar uma melhora constante no conforto do ombro ao longo de semanas a meses.

Quando procurar ajuda médica

Consulte o seu médico de família se tiver dor persistente no ombro que não melhora com o repouso. Solicite uma avaliação por um especialista se notar fraqueza, instabilidade ou uma sensação de bloqueio ou cedência. Os sintomas que interferem com o seu sono ou trabalho também merecem atenção. A piora súbita da dor deve ser avaliada prontamente.

Os acromiale é um fragmento ósseo adicional no ombro. Ocorre em cerca de 2% das pessoas com problemas no ombro. Está frequentemente associado a lesões do manguito rotador, que são rupturas nos músculos do ombro. Estas rupturas podem ocorrer porque o osso adicional causa movimento anormal e irritação. A avaliação precoce ajuda a confirmar o diagnóstico e a orientar o seu plano de tratamento.

Reviewed by Dr Kieran Hirpara · 7 August 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

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • In Thai patients with shoulder problems requiring MRI evaluation, the prevalence of os acromiale was 2.13% [1].
  • Os acromiale is associated with rotator cuff injuries [5].
  • A multicenter study aimed to determine the prevalence of and factors associated with os acromiale in the Japanese population [6].
  • Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes [2].
  • Surgical options for symptomatic os acromiale include arthroscopic sub-total excision [16].
  • Surgical options for symptomatic os acromiale include arthroscopic subacromial decompression of stable fragments [16].
  • Surgical options for symptomatic os acromiale include open reduction and internal fixation of unstable fragments [16].
  • Surgical treatment is usually not indicated for os acromiale in the professional tennis player [7].
  • Ipsilateral os acromiale may be a relative contraindication to the clavicle hook plate [12].
  • Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients after reverse total shoulder arthroplasty [3].
  • Postoperative local tenderness at the os acromiale resolves spontaneously over time in the majority of patients after reverse total shoulder arthroplasty [3].
  • The presence of os acromiale does not appear to have a negative impact on clinical outcomes after reverse total shoulder arthroplasty [4].
  • The outcome of reverse total shoulder arthroplasty does not seem to be negatively affected by the presence of an os acromiale [9].

Anatomy & Pathophysiology

  • The prevalence of os acromiale in Thai patients with shoulder problems requiring MRI evaluation is 2.13% [1].
  • A tear of the rotator cuff may often be associated with os acromiale, likely due to impingement from abnormal motion at the fibrous union site [8].
  • Fused os acromiale, which has not been described previously, might be mistaken for a free ossicle in the clinical setting [10].
  • Awareness of the os acromiale in the young athlete is crucial to confirm diagnosis through appropriate clinical examination and image studies [11].
  • The synchondrosis of an os acromiale can be injured following trauma, though rarely [13].
  • Postoperative local tenderness at the os acromiale resolves spontaneously over time in the majority of patients [3].
  • Reverse shoulder arthroplasty improves range of motion, decreases pain, and increases patient satisfaction in patients with os acromiale and cuff tear arthropathy [24].

Classification

  • Awareness of the os acromiale in the young athlete, appropriate clinical examination, and image studies are crucial to confirm diagnosis [11].
  • Meta-os acromiale is the rarest subtype of os acromiale [15].

Clinical Presentation

  • The prevalence of os acromiale in Thai patients with shoulder problems requiring MRI evaluation was 2.13% [1].
  • The presence of os acromiale does not appear to have a negative impact on clinical outcomes after reverse total shoulder arthroplasty (rTSA) [4].
  • The outcome of reverse total shoulder arthroplasty (RTSA) does not seem to be negatively affected by the presence of an os acromiale [9].
  • Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients following rTSA [3].
  • Surgical treatment is usually not indicated for os acromiale in professional tennis players [7].
  • Awareness of the os acromiale, appropriate clinical examination, and image studies are crucial to confirm diagnosis in young athletes [11].
  • Liberson reviewed 1800 shoulder girdles and identified an incidence of os acromiale of 1.4% [14].
  • The lesion of os acromiale is bilateral in 62% of patients according to Liberson's review [14].

Investigations

  • Appropriate radiographic investigation for os acromiale injury includes axillary views [13].

Treatment

  • Surgical options for symptomatic os acromiale include arthroscopic sub-total excision, arthroscopic subacromial decompression of stable fragments, and open reduction and internal fixation of unstable fragments [16].
  • Open reduction and internal fixation using cannulated screws or tension band wiring have superior outcomes in the literature in the treatment of symptomatic os acromiale [19].
  • A new arthroscopic technique of fixation of os acromiale with absorbable screws provides promising clinical, cosmetic, and radiologic results with high patient satisfaction [17].
  • A symptomatic os acromiale in a competitive female fastball pitcher was treated successfully with open reduction and internal fixation [21].
  • Special consideration must be given to the type of tension-band construct used to achieve adequate compression and fixation for meta-os acromiale, the rarest subtype of os acromiale [15].
  • Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients but resolves spontaneously over time in the majority of patients [3].
  • The presence of os acromiale does not appear to have a negative impact on the clinical outcomes after reverse total shoulder arthroplasty (rTSA) [4].

Complications

  • Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients following reverse total shoulder arthroplasty [3].
  • Reverse total shoulder arthroplasty remains a safe and effective treatment option in the presence of os acromiale [4].
  • The incidence of os acromiale identified by Liberson was 1.4% [14].
  • The lesion of os acromiale was bilateral in 62% of patients in Liberson's review [14].

Recovery

  • Reverse total shoulder arthroplasty (rTSA) remains a safe and effective treatment option in patients with os acromiale [4].

Key Evidence

  • [L3] In Thai patients with shoulder problems who required MRI evaluation, the prevalence of os acromiale was 2.13%. [1] (10.1177/23259671221078806)
  • [L4] Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes. [2] (10.1016/j.jse.2019.05.047)
  • [L3] Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients but resolves spontaneously over time in the majority of patients. [3] (10.1177/2325967120965131)
  • [L4] The presence of os acromiale does not appear to have a negative impact on the clinical outcomes after surgery and rTSA remains a safe and effective treatment option. [4] (10.1016/j.xrrt.2025.01.002)
  • [L3] The study supports previous findings that os acromiale is associated with rotator cuff injuries. [5] (10.1016/j.jseint.2025.05.015)
  • [L3] This multicenter study aimed to determine the prevalence of and factors associated with os acromiale in the Japanese population. [6] (10.1016/j.jse.2025.01.008)
  • [L4] Surgical treatment is usually not indicated for os acromiale in the professional tennis player. [7] (10.1177/2325967118773723)
  • [L4] A tear of the rotator cuff may often be associated with os acromiale, likely due to impingement from abnormal motion at the fibrous union site. [8] (10.2106/00004623-198466080-00029)
  • [L4] The outcome of RTSA does not seem to be negatively affected by the presence of an os acromiale. [9] (10.1016/j.jse.2017.02.012)
  • [L4] An anatomical study showed that fused os acromiale, which has not been described previously, might be mistaken for a free ossicle in the clinical setting. [10] (10.2106/00004623-200003000-00010)
  • [L4] Awareness of the os acromiale in the young athlete, appropriate clinical examination, and image studies are crucial to confirm diagnosis. [11] (10.1016/j.jseint.2020.02.008)
  • [L4] Ipsilateral os acromiale may be a relative contraindication to the clavicle hook plate. [12] (10.1186/s12891-021-04841-1)
  • [L4] This case highlights that the synchondrosis of an os acromiale can be injured following trauma, though rarely, and emphasizes the need for appropriate radiographic investigation including axillary views and a flexible surgical approach. [13] (10.1016/j.jse.2008.02.012)
  • [L4] Meta–os acromiale is the rarest subtype of os acromiale, and special consideration must be given to the type of tension-band construct used to achieve adequate compression and fixation. [15] (10.1177/03635465211028238)
  • [L5] Surgical options for symptomatic os acromiale include arthroscopic sub-total excision, arthroscopic subacromial decompression of stable fragments, and open reduction and internal fixation of unstable fragments. [16] (10.5435/jaaos-d-17-00011)
  • [L4] This new arthroscopic technique of fixation of os acromiale with absorbable screws provides promising clinical, cosmetic, and radiologic results with high patient satisfaction. [17] (10.1016/j.jse.2011.12.011)
  • [L4] Open reduction and internal fixation using cannulated screws, or tension band wiring have superior outcomes in the literature in the treatment of symptomatic os acromiale. [19] (10.1302/2058-5241.4.180100)
  • [L4] A symptomatic os acromiale in a competitive female fastball pitcher was treated successfully with open reduction and internal fixation. [21] (10.1177/0363546506288305)
  • [L4] Reverse shoulder arthroplasty improved ROM, decreased pain, and increased patient satisfaction in patients with os acromiale and cuff tear arthropathy. [24] (10.5397/cise.2019.00409)

References

[1] Prevalence of Os Acromiale in Thai Patients With Shoulder Problems: A Magnetic Resonance Imaging Study. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221078806

[2] Os acromiale: systematic review of surgical outcomes. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.05.047

[3] Os Acromiale in Reverse Total Shoulder Arthroplasty: A Cohort Study. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120965131

[4] Clinical implications of reverse total shoulder arthroplasty with an os acromiale: a systematic review. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2025.01.002

[5] Prevalence and factors associated with os acromiale: a multicenter study. JSES International. 2025. DOI: 10.1016/j.jseint.2025.05.015

[6] The prevalence and associated factors of os acromiale: a multicenter study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.008

[7] Os Acromiale in Professional Tennis Players. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118773723

[8] Rotator cuff tears associated with os acromiale.. The Journal of Bone & Joint Surgery. 1984. DOI: 10.2106/00004623-198466080-00029

[9] Reverse shoulder arthroplasty in patients with os acromiale. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.02.012

[10] Os Acromiale: Frequency, Anatomy, and Clinical Implications. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200003000-00010

[11] The unstable os acromiale: a cause of pain in the young athlete. JSES International. 2020. DOI: 10.1016/j.jseint.2020.02.008

[12] Os acromiale may be a contraindication of the clavicle hook plate: case reports and literature review. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04841-1

[13] Fracture of an os acromiale with associated rupture of the coracoclavicular ligaments. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2008.02.012

[14] Types of os acromiale according to Liberson. 2006.

[15] Rare Symptomatic Meta–Os Acromiale in an Athlete. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211028238

[16] Symptomatic, Unstable Os Acromiale. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00011

[17] Arthroscopically assisted internal fixation of the symptomatic unstable os acromiale with absorbable screws. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.12.011

[19] Os acromiale: a review of its incidence, pathophysiology, and clinical management. EFORT Open Reviews. 2019. DOI: 10.1302/2058-5241.4.180100

[21] Surgical Stabilization of Os Acromiale in a Fast-Pitch Softball Pitcher. The American Journal of Sports Medicine. 2006. DOI: 10.1177/0363546506288305

[24] Reverse shoulder arthroplasty with os acromiale. Clinics in Shoulder and Elbow. 2020. DOI: 10.5397/cise.2019.00409

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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.