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Lumps and Bumps on the Hand and Wrist

Found a lump on your hand or wrist? The common causes — ganglion cysts, tendon-sheath swellings and other masses — how they are assessed, and when to worry.

37 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Ganglions represent the most common soft-tissue mass of the hand and wrist, with dorsal wrist lesions being particularly prevalent. Management strategies vary by age and location; in children under 10 years, volar wrist ganglions are frequently managed expectantly, as 69% to 79% display spontaneous regression within 12-18 months [7]. Pediatric hand ganglions generally exhibit a greater rate of resolution than wrist ganglions [5]. For dorsal wrist ganglions, performing at least one aspiration before surgical excision improves cost-effectiveness [1]. While open surgery is considered ineffective for dorsal wrist cystic soft tumours due to high recurrence rates [6], routine midcarpal joint exploration during arthroscopic excision appears to reduce recurrence at 1 year without negatively impacting patient outcomes [3]. Hand surgeons remain divided regarding the need for wrist immobilization following dorsal excision [2].

Clinical assessment requires distinguishing flexor sheath ganglions from trigger digits and Dupuytren’s disease via detailed physical examination of the metacarpophalangeal region [4]. Anatomic awareness is critical, as variations such as a persistent median artery with reversed palmaris longus can complicate volar ganglion surgery [12]. Specific complications arise in arthroscopic volar ganglionectomy when the lesion is distal to the radial artery bifurcation and penetrated to the superficial fascia [19]. Postoperative pain intensity is associated with recurrence, dominant hand treatment, higher baseline pain, lower treatment credibility, and longer symptom duration [8].

Rare variants and adjacent pathologies require distinct surgical approaches. Giant cell tumors of the distal phalanx necessitate extensive en bloc excision to prevent local recurrence, as digit-sparing operations may fail to eradicate all tumor foci [9]. Parosteal lipomas of the phalanges yield good outcomes with no recurrence at short- to medium-term follow-up following marginal excision [10]. Giant spindle cell lipomas and large angiolipomas causing carpal tunnel syndrome are successfully treated via surgical excision [11, 13]. For extensive distal radius resection, wrist arthrodesis with iliac crest bone graft serves as a long-term feasible reconstructive alternative, though one-third of patients experience complications at minimum 10-year follow-up [14, 17]. Isolation of Streptococcus species in pyogenic flexor tenosynovitis is associated with a significantly increased number of operations [22]. Clinicians are recommended to conduct more research to confirm anthropometric measurements as risk factors for carpal tunnel syndrome, particularly shape index and wrist to palm ratio, and to consider additional factors like occupation when determining cut-off values for BMI and wrist ratio [25]. Commonalities in how Australian hand therapists implemented scar massage were found, with participants relying primarily on clinical experience to inform their practice [16].

Background & Causes

Diagnostic Evaluation

A careful history suggests the correct diagnosis in approximately 90% of patients with hand problems [29]. Preoperative imaging is critical for risk stratification, as the anatomical location of a volar wrist ganglion on preoperative MRI serves as a risk factor for operation-related complications following arthroscopic ganglionectomy [19]. Specifically, complications after arthroscopic volar wrist ganglionectomy are associated with the ganglion being distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer [19].

Pediatric Ganglions

No specific evidence is provided for this subsection in the current evidence base.

Histology and Pathology

Cystic soft tissue tumours of the dorsal aspect of the wrist present as two distinct histological subtypes [6]. Intraosseous ganglions can lead to structural failure, such as a pathological fracture of the trapezoid [22]. Giant cell tumour of bone in the hand is a rare condition where both curettage and resection/amputation are acceptable treatment options, requiring individualized decisions based on site and extent of disease to minimize morbidity while maximizing disease control [15].

Risk Factors and Prognostic Indicators

Prognostic indicators vary by pathology. Higher postoperative pain intensity following dorsal wrist ganglion excision was associated with recurrence following previous surgery, treatment of the dominant hand, higher baseline pain intensity, lower credibility the patient attributes to the treatment, and longer symptom duration [8]. For tendon sheath giant cell tumours, the high-risk group exhibited a higher incidence of recurrence [31].

Symptoms & Presentation

Patients who received steroids at the time of aspiration perceived lower rates of recurrence [18]. Regarding surgical complications, operation-related issues following arthroscopic volar wrist ganglionectomy are associated with the anatomical location of the procedure, specifically when distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer [19].

Management

Ganglions of the Hand and Wrist

Dorsal wrist ganglions can be confused with carpal bosses, which are osteoarthritic spurs or prominences developing at the base of the second or third carpometacarpal joints [35]. Every effort should be made to treat the carpal boss nonoperatively with splinting, nonsteroidal antiinflammatory medications, and ultrasound-guided cortisone injections prior to proceeding with surgery [35]. The potential for persistent symptoms following surgery for a carpal boss must be emphasized [35]. For dorsal wrist ganglions, performing at least 1 aspiration before surgical excision improves cost-effectiveness, as patient preferences may preclude routinely performing 2 aspirations [1].

The main cyst of a dorsal wrist ganglion is usually located directly over the scapholunate ligament [44]. A small, mucin-filled duct is invariably seen piercing the transverse fibers of the scapholunate ligament, connecting the underlying scapholunate joint with the main cyst [44]. Failure to identify and excise the pedicle attachment to the scapholunate ligament increases the likelihood of recurrence for dorsal wrist ganglions [44]. Arthroscopic resection is an effective treatment strategy for intra-articular synovial ganglions refractory to conservative measures, providing complete resolution of symptoms and functional recovery with minimal soft tissue damage [47].

Bone Tumors and Lesions

Both curettage and resection/amputation are acceptable treatment options for giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control [15]. Wrist reconstruction using a free vascularized fibular head graft after intralesional excision can help prevent local tumor recurrence, restore the articular surface, and maintain movements of the wrist joint in patients with Campanacci grade 3 giant cell tumors involving the articular surface of the distal radius [21]. The management decision for unicameral bone cysts should be individually guided within the patient’s context [26].

Osteoid osteoma in the hand or carpus has been treated with surgical excision with either curettage of the nidus or en bloc excision [43]. Persistence of an osteoid osteoma lesion has been reported if the nidus is not completely excised [43]. Successful use of percutaneous CT-guided laser photoagulation has been reported for osteoid osteoma in the hand or carpus [43]. Radiofrequency ablation may be considered for carefully selected osteoid osteoma lesions that are not subcutaneous or near major nerves [43]. Prolonged use of NSAIDs may be an alternative to surgical treatment for osteoid osteoma if the clinical and radiographic findings are strongly supportive of a diagnosis and excision or biopsy might produce excessive morbidity [43].

Soft Tissue Tumors

With surgical excision, all symptoms were treated leading to a successful outcome for a large angiolipoma of the hand causing carpal tunnel syndrome [13]. The tumor was treated with excision and showed no sign of recurrence at the 1-year postoperative examination for an osteochondrolipoma of the hand [28]. Complete excision is recommended for atypical pleomorphic lipomatous tumors; in one case, it required ray amputation and complex reconstruction due to infiltrative growth, resulting in excellent hand function and no recurrence at 14 months [30].

Rheumatoid Arthritis and Tenosynovitis

The indications for surgical treatment of the rheumatoid wrist are based on pain, functional disability, deformation including its esthetic aspect, and possible future development of the disease [32]. Key risk factors for complications in the rheumatoid wrist include long-standing disease (>5 years), persistent synovitis (>1 year), and a LDE stage 4 or higher wrist [32]. Surgical intervention should be considered if the carpus is subluxated with a prominent ulna associated with local synovitis of the ulnar tendons and/or distal radioulnar joint [32]. Three-dimensional CT scans can help improve the ability to predict the risk of extensor tendon rupture around the ulnar side of the wrist in rheumatoid arthritis [32]. When relevant risk factors for future deterioration are present, the indication for wrist stabilization should be given precedence even for oligosymptomatic patients with rheumatoid arthritis [32].

Conservative management in rheumatoid tenosynovitis of the hand and wrist requires rheumatologic support for systemic pharmacologic management [33]. Splinting has an adjunctive role to relieve pain in rheumatoid tenosynovitis [33]. Targeted injection into the tenosynovial inflammation is more effective than the administration of systemic corticosteroids for isolated tenosynovitis [33]. Surgical treatment for tenosynovitis is to remove the inflamed tenosynovium while preserving normal structures [33]. Tenosynovectomy has been shown to decrease pain and improve disease outcomes in rheumatoid arthritis [33].

Painful dorsal wrist swelling may be the presenting symptom in rheumatoid arthritis, where tenosynovial swelling may contribute to de Quervain disease, trigger finger, or carpal tunnel syndrome [39]. If synovitis is only moderate and bone changes are absent but pain is significant, dorsal synovectomy of the wrist may be of lasting benefit [39]. Persistent swelling at the dorsum of the wrist that continues for 6 weeks or longer despite adequate medical treatment may be an indication for a dorsal synovectomy [39]. Dorsal synovectomy may be considered a prophylactic measure to avoid extensor tendon rupture in rheumatoid arthritis [39]. Compression of the median nerve in rheumatoid arthritis should be relieved surgically if conservative treatment with splinting and corticosteroid injections has been unsuccessful [39]. A palmar (flexor) tenosynovectomy may be useful in relieving pain and preventing rupture of tendons if hypertrophy of the volar wrist tenosynovium is obvious clinically [39].

Other Conditions

Scar massage implementation by hand therapists relies primarily on clinical experience to inform practice [16]. Awareness of anatomic variations such as a persistent median artery with a reversed palmaris longus is valuable for surgeons operating on the upper extremity [12].

Surgery of a distal radius fracture is indicated in active patients when satisfactory reduction cannot be achieved or maintained by closed manipulation and casting [38]. The goal of distal radius fracture treatment is to end up with a pain-free wrist at the functional level the patient requires [38]. General health, age, pain reaction patterns, and socioeconomic factors influence the outcome of distal radius fracture treatment regardless of conservative or invasive methods [38].

Nonsurgical treatment for primary osteoarthritis of the thumb CMC joint is indicated for all stages initially and consists of splinting, NSAIDs, and steroid injections [45]. For mucous cysts associated with DIP joint osteoarthritis, open excision of the cyst followed by débridement of the distal phalangeal osteophytes is indicated to prevent recurrence [45]. Joint arthrodesis in 10° to 20° of flexion is indicated for DIP joint arthrosis, with headless screw fixation having the highest fusion rate [45]. For PIP joint osteoarthritis in long and ring fingers with intact bone stock and no angulation or rotational deformity, arthroplasty is an option [45]. For PIP joint osteoarthritis in border digits (index and small fingers), arthrodesis is indicated, with headless screw fixation having the highest fusion rate [45]. Nonsurgical treatment for STT joint osteoarthritis (rest, NSAIDs, splinting) is indicated initially [45]. Pisiform excision is indicated in refractory cases of pisotriquetral joint arthritis [45].

In early stages, wrist joint synovitis in juvenile arthritis is manifested clinically as a relatively subtle fusiform swelling that does not move with finger flexion and extension [46]. When joint synovitis is active and not controlled with systemic medications, direct injection of the radiocarpal, midcarpal, and distal radioulnar joints is a very useful clinical tool [46].

Key Considerations

Dorsal Wrist Ganglions

Performing at least one aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglion treatment [1].

Giant Cell Tumors

Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand. Treatment decisions must be individualized based on the site and extent of disease to minimize treatment morbidity while maximizing disease control [15].

Other Soft Tissue Tumors

Surgical excision resolves symptoms and leads to successful outcomes for large angiolipoma of the hand presenting as a cause for carpal tunnel syndrome [13]. Excision of osteochondrolipoma of the hand shows no sign of recurrence at the 1-year postoperative examination [28].

Anatomy and Post-operative Care

Commonalities in how respondents implemented scar massage were found, with participants relying primarily on clinical experience to inform their practice [16].

Key Evidence

  • [L2] As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. [1] (10.1016/j.jhsa.2022.09.002)
  • [L2] The systematic review and survey of Canadian hand surgeons reveal that hand surgeons are divided regarding the need to immobilize the wrist after dorsal wrist ganglion excision. [2] (10.1177/15589447211014631)
  • [L3] Routine midcarpal joint exploration during arthroscopic excision of dorsal wrist ganglions appeared to reduce recurrence at 1 year without negatively impacting patient outcomes. [3] (10.1177/17531934251405730)
  • [L4] Distinguishing between a flexor sheath ganglion, trigger digit, and Dupuytren's may be accomplished with a detailed physical examination of the MCP region of the affected digit. [4] (10.1177/15589447221109644)
  • [L4] Pediatric ganglions of the hand have a greater rate of resolution than ganglions of the wrist. [5] (10.1016/j.jhsa.2023.07.002)
  • [L4] The authors suggest that open surgery continues to be an ineffective way of managing cystic soft tumours of the dorsal aspect of the wrist due to high recurrence rates. [6] (10.1177/17531934241251721)
  • [L4] In children aged <10 years, ganglions mainly occur on the volar wrist and can be treated expectantly, with 69% to 79% displaying spontaneous regression within a span of 12-18 months. [7] (10.1016/j.jhsa.2021.12.015)
  • [L2] Higher postoperative pain intensity was associated with recurrence following previous surgery, treatment of the dominant hand, higher baseline pain intensity, lower credibility the patient attributes to the treatment and longer symptom duration. [8] (10.1177/17531934231153029)
  • [L4] Giant cell tumors of the distal phalanx are extremely rare and require extensive en bloc excision to prevent local recurrence, as digit-sparing operations may fail to eradicate all tumor foci. [9] (10.1016/j.jhsa.2020.04.005)
  • [L4] Marginal excision appears to result in a good outcome with no recurrence at short- to medium-term follow-up for parosteal lipomas of the phalanges. [10] (10.1016/j.jhsa.2020.10.029)
  • [Case_report] The case is reported due to the unusual location of a rare variant of giant lipoma involving a finger. [11] (10.1055/s-0040-1721879)
  • [L4] Awareness of such anatomic variations is valuable for surgeons operating on the upper extremity. [12] (10.1016/j.jhsg.2022.04.005)
  • [L4] With surgical excision, all symptoms were treated leading to a successful outcome. [13] (10.1016/j.jhsg.2022.05.006)
  • [L2] Resection followed by wrist arthrodesis and structural iliac bone graft achieved satisfactory oncologic and functional results, albeit with one-third of all patients experiencing some complications at a minimum of 10 years of follow-up. [14] (10.1097/corr.0000000000003738)
  • [L4] Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control. [15] (10.1177/17531934211007820)
  • [L4] Commonalities in how respondents implemented scar massage were found, with participants relying primarily on clinical experience to inform their practice. [16] (10.1177/17589983231205666)
  • [Paper] This CORR Insights® is a commentary on a study by Li et al. and does not present original data; it highlights the long-term feasibility and functional acceptability of wrist arthrodesis with iliac crest bone graft as a reconstructive alternative after extensive distal radius resection. [17] (10.1097/corr.0000000000003816)
  • [L3] Patients who received steroids at the time of aspiration perceived lower rates of recurrence. [18] (10.1016/j.jhsg.2023.06.007)
  • [L3] The operation-related complications after arthroscopic volar wrist ganglionectomy are associated with its anatomical location: distal to the bifurcation of the radial artery and concurrently penetrated up to the superficial fascia layer. [19] (10.1186/s12891-025-08766-x)
  • [L4] Wrist reconstruction using a free vascularized fibular head graft after intralesional excision can help prevent local tumor recurrence, restore the articular surface, and maintain movements of the wrist joint in patients with Campanacci grade 3 giant cell tumors involving the articular surface of the distal radius. [21] (10.1016/j.jhsa.2021.09.036)
  • [L4] The study aimed to identify factors affecting the outcome and prognosis of pyogenic flexor tenosynovitis, finding that isolation of Streptococcus species was associated with a significantly increased number of operations. [22] (10.1177/1753193413497867)
  • [L2] Despite general patterns associating BMI, WPR, WR, and SI with CTS, exceptions exist; clinicians are recommended to conduct more research to confirm anthropometric measurements as risk factors, particularly SI and WPR, and to consider additional factors like occupation when determining cut-off values for BMI and WR. [25] (10.1016/j.jht.2022.03.002)
  • [L3] The management decision should be individually guided within the patient’s context. [26] (10.2106/jbjs.rvw.23.00159)
  • [L4] The tumor was treated with excision and showed no sign of recurrence at the 1-year postoperative examination. [28] (10.1016/j.jhsa.2021.05.024)
  • [L4] Complete excision is recommended for atypical pleomorphic lipomatous tumors; in this case, it required ray amputation and complex reconstruction due to infiltrative growth, resulting in excellent hand function and no recurrence at 14 months. [30] (10.1016/j.jhsa.2021.04.015)
  • [L4] The high-risk group exhibited a higher incidence of recurrence. [31] (10.1177/17531934231222401)
  • [L4] Arthroscopic resection is an effective treatment strategy for intra-articular synovial ganglions refractory to conservative measures, providing complete resolution of symptoms and functional recovery with minimal soft tissue damage. [47] (10.1016/j.jhsg.2024.05.007)

See Also

  • Osteoarthritis

References

[1] Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.09.002

[2] Immobilization of the Wrist After Dorsal Wrist Ganglion Excision: A Systematic Review and Survey of Current Practice. HAND. 2021. DOI: 10.1177/15589447211014631

[3] Arthroscopic resection of dorsal wrist ganglions with or without midcarpal exploration. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251405730

[4] A Simple Physical Exam Maneuver to Distinguish Trigger Digit, Dupuytren’s Nodule, and Flexor Sheath Ganglion. HAND. 2022. DOI: 10.1177/15589447221109644

[5] Natural History of Pediatric Hand and Wrist Ganglion Cysts: Longitudinal Follow-Up of a Prospective, Dual-Center Cohort. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.07.002

[6] Cystic soft tissue tumours of the dorsal aspect of the wrist have two distinct histological subtypes. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241251721

[7] Pediatric Ganglions of the Hand and Wrist: A Review of Current Literature. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.12.015

[8] Factors associated with self-reported pain and hand function following dorsal wrist ganglion excision. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231153029

[9] Giant Cell Tumor of the Ring Finger Distal Phalanx. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.04.005

[10] Parosteal Lipoma of the Proximal Phalanx of Hand. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.10.029

[11] Giant Spindle Cell Lipoma of Middle Finger: Case Report and Review of Literature. Journal of Hand and Microsurgery. 2024. DOI: 10.1055/s-0040-1721879

[12] Persistent Median Artery With a Reversed Palmaris Longus and Volar Ganglion. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.04.005

[13] Large Angiolipoma of the Hand as a Cause for Carpal Tunnel Syndrome. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.05.006

[14] What Are the Long-term Outcomes of Wrist Arthrodesis Using Structural Iliac Bone Graft After Resection of the Distal Radius for Giant Cell Tumor of Bone? A Minimum 10-year Follow-up. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003738

[15] Giant cell tumour of hand bones: outcomes of treatment. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211007820

[16] Scar massage as an intervention for post-surgical scars: A practice survey of Australian hand therapists. Hand Therapy. 2023. DOI: 10.1177/17589983231205666

[17] CORR Insights®: What Are the Long-term Outcomes of Wrist Arthrodesis Using Structural Iliac Bone Graft After Resection of the Distal Radius for Giant Cell Tumor of Bone? A Minimum 10-year Follow-up. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003816

[18] No Difference in Reintervention at 1-Year Between Ultrasound-Guided versus Blind Dorsal Carpal Ganglion Aspiration. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.06.007

[19] Anatomical location of volar wrist ganglion in preoperative MRI is a risk factor for operation-related complications after arthroscopic ganglionectomy. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08766-x

[21] Wrist Reconstruction Using Free Vascularized Fibular Head Graft Following Intralesional Excision for Campanacci Grade 3 Giant Cell Tumors Involving the Articular Surface of the Distal Radius. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.09.036

[22] Pathological fracture of the trapezoid secondary to an intraosseous ganglion. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413497867

[25] A literature review of carpal tunnel syndrome and its association with body mass index, wrist ratio, wrist to palm ratio, and shape index. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.03.002

[26] Treatment and Outcomes of 4,973 Unicameral Bone Cysts. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00159

[28] Osteochondrolipoma of the Hand. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.05.024

[29] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > DIAGNOSIS OF DISORDERS OF THE HAND.

[30] Atypical Pleomorphic Lipomatous Tumor of the Right Hand Mimicing Venous Malformation. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.04.015

[31] The effect of surgical factors on recurrence of tendon sheath giant cell tumours. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934231222401

[32] Green S Operative Hand Surgery. Indication for Wrist Surgery.

[33] Green S Operative Hand Surgery. PROLIFERATIVE TENOSYNOVITIS > Rheumatoid Arthritis.

[35] Green S Operative Hand Surgery. BOX 59.1 Ganglions of the Hand and Wrist > Carpmetacarpal Boss.

[38] Green S Operative Hand Surgery. Which Patients to Operate? What Method?.

[39] Campbell S Operative Orthopaedics 4 Volume Set. THUMB CARPODNETACARPAL ARTHRODESIS WITH KIRSCHNER WIRE OR BLADE-PLATE FIXATION > SYNOVITIS OF THE WRIST.

[43] Green S Operative Hand Surgery. BOX 59.1 Ganglions of the Hand and Wrist > Osteoid Osteoma.

[44] Green S Operative Hand Surgery. BOX 59.1 Ganglions of the Hand and Wrist > Operative Treatment > Dorsal Wrist Ganglion.

[45] Aaos Comprehensive Orthopaedic Review 3. Arthritides of the Hand and Wrist* > I. Primary Osteoarthritis.

[46] Tachdjian S Pediatric Orthopaedics From The Texas Scottish Rite Hospital For Children E Book. Wrist Involvement.

[47] Intra-articular Synovial Ganglion of the Wrist. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.05.007

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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.