Skip to content

Nerve Tests and Conduction Studies

What nerve conduction studies and EMG are, why they are done for carpal tunnel and other nerve problems, what to expect, and how accurate they are.

Overview

Nerve conduction studies serve as a measure of impaired nerve function and the best available indicator of overall disease severity in carpal tunnel syndrome, with some prognostic value for surgical outcome [1]. In diabetic and non-diabetic carpal tunnel syndrome, distal motor latency and median nerve cross-sectional area are associated with each other and with clinical symptoms [10]. Ultrasound is a valid alternative confirmatory test compared with electrodiagnostic studies for detecting ulnar neuropathy at the elbow [2]. It can confirm nerve integrity and identify indirect effects of surgery, supporting the integration of electrodiagnostic and ultrasound experts into orthopaedic teams for diagnosis and rehabilitation [4].

There is severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%) [9]. When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, additional testing such as electrodiagnostic studies or ultrasound may increase the probability of identifying actual median neuropathy that can benefit from surgery [3]. Regardless of the result of additional tests, carpal tunnel release may still be offered for mild-to-moderate idiopathic median neuropathy [12].

For ulnar neuropathy, ulnar nerve motor nerve conduction velocity at the upper arm should be measured alongside routine assessment of motor nerve conduction velocity at the elbow and forearm, especially in clinically severe cases considering surgery [6]. Radiological and electrodiagnostic insights into suprascapular nerve dysfunction are key predictors of poor functional outcomes in shoulder hemiarthroplasty, highlighting the importance of perioperative nerve preservation strategies and postoperative neurological assessments [5]. Electromyography does not show adequate effectiveness in the diagnosis of suprascapular nerve lesions caused by rotator cuff tear in a rat model, underscoring the need for surgeons to carefully evaluate suprascapular nerve integrity in such cases [13].

How It Works

Diagnostic Utility: Nerve conduction studies serve as the best available indicator of overall disease severity in carpal tunnel syndrome [1] and possess prognostic value for surgical outcome [1]. Electrodiagnostic studies or ultrasound increase the probability of identifying actual median neuropathy that may benefit from surgery when signs and symptoms suggest mild-to-moderate disease [3]. Distal motor latency and median nerve cross-sectional area (CSA) are associated with each other and with clinical symptoms in carpal tunnel syndrome [10]. There is a significant association between increasing median nerve cross-sectional area and increasing electrodiagnostic severity at the distal wrist crease [16].

Alternative Imaging: Ultrasound is a valid alternative confirmatory test compared with electrodiagnostic studies for detecting ulnar neuropathy at the elbow [2]. As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow [14]. Ultrasound confirms nerve integrity and identifies indirect effects of surgery [4].

Ulnar Nerve Specifics: Ulnar nerve motor nerve conduction velocity (MNCV) at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery [6]. Compound muscle action potential amplitude is predictive of functional outcomes after in situ decompression of the ulnar nerve [7]. Other conventional electrodiagnostic parameters are not predictive of functional outcomes after in situ decompression of the ulnar nerve [7].

Double-Crush Syndrome: Patients with double-crush syndrome demonstrate unique electrodiagnostic findings compared to carpal tunnel syndrome-only patients, including shorter sensory nerve onset and peak latencies [15]. Patients with double-crush syndrome demonstrate different patterns of wrist and elbow motor nerve conduction compared to carpal tunnel syndrome-only patients [15].

Suprascapular Nerve: Perioperative nerve preservation strategies and postoperative neurological assessments are important for suprascapular nerve dysfunction, which is a key predictor of poor functional outcomes in shoulder hemiarthroplasty [5].

Multidisciplinary Integration: Electrodiagnostic and ultrasound experts should be integrated into orthopaedic teams for diagnosis and rehabilitation [4].

Therapeutic Monitoring: Chitosan phonophoresis demonstrates significant improvements in nerve conduction, pain reduction, and enhancement of hand function for mild to moderate cubital tunnel syndrome [8].

Trends: The overall and preoperative electrodiagnostic study usage for carpal tunnel syndrome has been decreasing since at least 2014 [11].

What the Evidence Shows

Diagnostic Utility and Prevalence: Nerve conduction studies serve as the best available indicator of overall disease severity in carpal tunnel syndrome [1]. They also possess prognostic value for surgical outcome in this condition [1]. However, severe discordance exists between clinical estimates of mild-to-moderate carpal tunnel syndrome prevalence (73%) and findings from electrodiagnostic studies and ultrasound (51%) [9]. Electrodiagnostic studies and ultrasound may increase the probability of confirming actual median neuropathy that can benefit from surgery when signs and symptoms suggest mild-to-moderate disease [3]. Distal motor latency and median nerve cross-sectional area are associated with each other and with clinical symptoms in carpal tunnel syndrome [10]. Ultrasound serves as a valid alternative confirmatory test compared with electrodiagnostic studies for detecting ulnar neuropathy at the elbow [2]. It can also confirm nerve integrity and identify indirect effects of surgery in median neuropathy cases [4].

Prognostic Indicators: In cubital tunnel syndrome, electrodiagnostic severity does not predict short- to midterm outcomes of cubital tunnel release surgery [17]. Patient-reported preoperative disease severity may predict the expected postoperative change in ulnar nerve functional improvement, while electrodiagnostic studies may not have prognostic value for these patients [17]. Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, predicts functional outcomes after in situ decompression of the ulnar nerve [7].

Technical Considerations and Trends: The overall and preoperative usage of electrodiagnostic studies for carpal tunnel syndrome has been decreasing since at least 2014 [11]. For clinically severe cubital tunnel syndrome cases considering surgery, ulnar nerve motor nerve conduction velocity at the upper arm should be measured alongside routine assessment at the elbow and forearm [6]. Insights from electrodiagnostic studies and ultrasound are important for perioperative nerve preservation strategies and postoperative neurological assessments in suprascapular nerve dysfunction [5].

Therapeutic Monitoring: Chitosan phonophoresis demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function for mild to moderate cubital tunnel syndrome [8]. EMG-driven robotic treatment with 15 sessions of rehabilitation suggests that improvement in hand recovery may be possible for chronic stroke patients nine years after stroke [18].

Practical Considerations

Electrodiagnostic Studies: Nerve conduction studies serve as a measure of impaired nerve function and are the best available indicator of overall disease severity in carpal tunnel syndrome [1]. They hold prognostic value for surgical outcome in this condition [1]. However, overall and preoperative usage for carpal tunnel syndrome has been decreasing since at least 2014 [11]. For mild-to-moderate median neuropathy where surgery is considered, electrodiagnostic studies may increase the probability of identifying actual neuropathy benefitting from surgery [3]. In ulnar neuropathy, compound muscle action potential amplitude, but not other conventional parameters, predicts functional outcomes after in situ decompression [7]. For clinically severe cases considering surgery, ulnar nerve motor nerve conduction velocity (MNCV) at the upper arm should be measured alongside routine assessment at the elbow and forearm [6].

Ultrasound: Ultrasound is a valid alternative confirmatory test compared with electrodiagnostic studies for detecting ulnar neuropathy at the elbow [2]. It has comparable sensitivity and specificity to nerve conduction studies in patients two or more standard deviations above or below the mean age for carpal tunnel syndrome presentation [19]. Ultrasound can confirm nerve integrity and identify indirect effects of surgery [4].

Diagnostic Discordance and Integration: There is severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%) [9]. Electrodiagnostic studies and ultrasound experts should be integrated into orthopaedic teams for diagnosis and rehabilitation [4].

Suprascapular Nerve Assessment: Suprascapular nerve dysfunction is a key predictor of poor functional outcomes in shoulder hemiarthroplasty [5]. Perioperative nerve preservation strategies and postoperative neurological assessments are important for this dysfunction [5]. Surgeons should carefully evaluate suprascapular nerve integrity in cases of rotator cuff tear [13]. Electromyography does not show adequate effectiveness in diagnosing suprascapular nerve lesions caused by rotator cuff tear in a rat model [13].

Therapeutic Monitoring: Chitosan phonophoresis demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function for mild to moderate cubital tunnel syndrome [8].

Key Evidence

  • [L5] Nerve conduction studies should be understood not as a test that determines the diagnosis but as a measure of impaired nerve function, serving as the best available indicator of overall disease severity with some prognostic value for surgical outcome. (10.1177/17531934231191685)
  • [L4] Ultrasound is a valid alternative confirmatory test compared with electrodiagnostic studies in detecting ulnar neuropathy at the elbow. (10.1016/j.jhsa.2023.08.014)
  • [L3] When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as EDS or US, to increase the probability of actual median neuropathy that can benefit from surgery. (10.1097/corr.0000000000002751)
  • [L4] Ultrasound confirmed nerve integrity and identified indirect effects of surgery, supporting the integration of electrodiagnostic and ultrasound experts into orthopaedic teams for diagnosis and rehabilitation. (10.1097/corr.0000000000002972)
  • [L3] These findings highlight the importance of perioperative nerve preservation strategies and postoperative neurological assessments. (10.1016/j.jse.2025.07.001)
  • [L3] Ulnar nerve MNCV at the upper arm should be measured alongside routine assessment of MNCV at the elbow and forearm, especially in clinically severe cases considering surgery. (10.1177/17585732241293360)
  • [L2] Compound muscle action potential amplitude, but not other conventional electrodiagnostic parameters, was predictive of functional outcomes after in situ decompression of the ulnar nerve. (10.1016/j.jhsa.2022.10.008)
  • [L1] This approach demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function. (10.1016/j.jht.2024.02.006)
  • [L5] There is a severe discordance between the estimated prevalence of mild-to-moderate carpal tunnel syndrome based on clinical signs and symptoms (73%) versus electrodiagnostic studies and ultrasound (51%), calling into question whether clinicians can confidently diagnose patients with mild-to-moderate CTS. (10.1097/corr.0000000000002822)
  • [L4] Distal motor latency and median nerve CSA were not only associated with each other, but also with clinical symptoms. (10.1186/s12891-023-06881-1)
  • [L3] The overall and preoperative electrodiagnostic study usage for carpal tunnel syndrome has been decreasing since at least 2014, predating the 2016 AAOS CPG, reflecting the rapid implementation of evidence into practice. (10.1016/j.jhsa.2022.09.019)
  • [L5] No matter the result of the additional tests, we probably would have offered carpal tunnel release. (10.1097/corr.0000000000003036)
  • [L5] This underscores the need for surgeons to carefully evaluate suprascapular nerve integrity in such cases. (10.1186/s12891-025-09195-6)
  • [L2] As the severity of ulnar neuropathy at the elbow increases, the CSA of the ulnar nerve correspondingly increases at the elbow. (10.1016/j.jhsa.2024.12.004)
  • [L3] Patients with double-crush syndrome (DCS) demonstrated unique electrodiagnostic findings, including shorter sensory nerve onset and peak latencies and different patterns of wrist and elbow motor nerve conduction compared to CTR-only patients. (10.5435/jaaos-d-24-00056)
  • [L3] There was a significant association between increasing cross-sectional area and increasing electrodiagnostic severity. (10.1177/15589447211066349)
  • [L3] Patient-reported preoperative disease severity may predict the expected postoperative change in ulnar nerve functional improvement, and EDS may not have prognostic value for patients undergoing cubital tunnel decompression. (10.1016/j.jse.2024.01.055)
  • [L5] The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients. (10.1016/j.jht.2021.04.022)
  • [L4] Ultrasound has comparable sensitivity and specificity to NCS in patients two or more standard deviations above or below the mean age for presentation of CTS. (10.1016/j.jhsg.2024.01.008)

References

[1] Use of nerve conduction studies in carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231191685

[2] Diagnosis of Ulnar Neuropathy at the Elbow Using Ultrasound — A Comparison to Electrophysiologic Studies. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2023.08.014

[3] Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002751

[4] Letter to the Editor: Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000002972

[5] Radiological and electrodiagnostic insights into suprascapular nerve dysfunction: a key predictor of poor functional outcomes in shoulder hemiarthroplasty. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.001

[6] Clinical significance of upper arm motor nerve conduction velocity in cubital tunnel syndrome. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241293360

[7] Electrodiagnostic Predictors of Outcomes After In Situ Decompression of the Ulnar Nerve. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.10.008

[8] Effectiveness of chitosan phonophoresis on ulnar nerve conduction velocity, pain relief, and functional outcomes for mild to moderate cubital tunnel syndrome: A double-blind randomized controlled trial. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2024.02.006

[9] CORR Insights®: Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002822

[10] Characteristics of diabetic and non-diabetic carpal tunnel syndrome in terms of clinical, electrophysiological, and Sonographic features: a cross-sectional study. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06881-1

[11] Has the Use of Electrodiagnostic Studies for Carpal Tunnel Syndrome Changed After the 2016 American Academy of Orthopaedic Surgeons Clinical Practice Guideline?. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.09.019

[12] Reply to the Letter to the Editor: Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003036

[13] Electromyography does not show adequate effectiveness in diagnosis of suprascapular nerve lesions caused by rotator cuff tear in rat model. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09195-6

[14] Association of Ultrasound and Electrodiagnostic Studies in Patients Evaluated for Ulnar Neuropathy. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.004

[15] Preoperative Electrodiagnostic Study Findings Differ Between Patients With Double-crush Syndrome and Carpal Tunnel Syndrome: A Propensity Matched Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00056

[16] Ultrasound Measurements of the Median Nerve at the Distal Wrist Crease Correlate With Electrodiagnostic Studies. HAND. 2022. DOI: 10.1177/15589447211066349

[17] Electrodiagnostic severity does not predict short- to midterm outcomes of cubital tunnel release surgery. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.01.055

[18] The effect of Electromyography (EMG)-driven Robotic Treatment on the recovery of the hand Nine years after stroke. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2021.04.022

[19] The Diagnostic Utility of Ultrasound and Electrodiagnostic Studies in The Young and Old. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.01.008

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

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.