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皮质类固醇和糖皮质激素注射

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What cortisone injections do, when they help, how long the effect lasts, and the risks of repeated injections for shoulder, elbow, wrist and hand conditions.

Updated Aug 2026
一支将皮质类固醇注射到肩部前方的注射器。
皮质类固醇注射可以缓解关节或肌腱的炎症，从而减轻疼痛并支持康复。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到髋部、踝部、手部或肩部疼痛。这种疼痛通常源于磨损性关节炎或发炎的组织。例如，踝关节骨关节炎会导致僵硬和酸痛，使行走变得困难。在手部，扳机指或软组织问题可能使简单的动作变得疼痛。当您弯曲拇指或抓握物体时，可能会感到尖锐的疼痛。

疼痛常在特定时间加剧。许多人发现疼痛在醒来后、活动后或夜间加重。侧卧于患侧可能会特别不适。日常任务可能会变得具有挑战性。您可能难以完成将手伸到背后扣上胸罩或将衬衫塞进裤子里的动作。提重物或打开罐子等简单动作可能会引发不适。

您可能会想知道休息是否有帮助。虽然休息可以提供暂时的缓解，但疼痛往往会随着活动而复发。如果您接受过皮质类固醇注射，您可能会注意到缓解持续时间的变化。与低剂量选项相比，高剂量注射通常能提供更长时间的缓解。有些人需要比其他人更早地进行重复注射。在某些情况下，例如拇指关节炎，注射可能无法避免日后需要手术。

重要的是要知道，并非所有治疗方法对每个人都有效。例如，将皮质类固醇与透明质酸混合使用可能比单独使用类固醇更能缓解踝部疼痛。然而，对于扳机指，在类固醇中加入利多卡因可能不会使手术过程中的疼痛产生明显差异。同样，腕管松解术前的注射不会增加感染风险，但可能无法预防术后支柱区疼痛。

您的外科医生将帮助您了解预期情况。他们会考虑您的具体症状和病史。如果注射后疼痛持续存在，手术可能是一个选择。例如，对于皮质类固醇注射后疼痛的拇指腕掌关节骨关节炎，两种手术方式均适用。重复注射通常是安全的，不会影响后续松解手术的效果。

倾听您身体的声音。如果疼痛干扰睡眠或日常活动，请与您的外科医生沟通。他们可以调整您的治疗方案。您可能需要不同类型的注射或转诊进行手术。目标是减轻疼痛并改善您的功能。您值得在没有不适的情况下活动并享受日常生活。

实际发生了什么

炎症是身体对损伤或磨损的自然反应。炎症会将化学物质输送到受损区域以启动愈合过程，但这些化学物质也可能刺激附近的神经。这种刺激会导致疼痛、肿胀和僵硬。当这一过程发生在关节内或肌腱周围时，会干扰正常活动。

皮质类固醇是强效抗炎药物。当注射到受影响区域时，它们可以抑制这种过度活跃的免疫反应。它们并不能治愈潜在的结构损伤，例如磨损的软骨或撕裂的组织。相反，它们通过减轻引起疼痛的肿胀和化学刺激来发挥作用。这种缓解使您能够更舒适地活动，并参与物理治疗。

在某些情况下，如踝关节骨关节炎，将皮质类固醇与透明质酸联合使用比单独使用类固醇能提供更好的镇痛效果。透明质酸起到润滑剂的作用，帮助关节面平滑滑动。对于扳机指等病症，注射液中可能包含利多卡因以在手术过程中使该区域麻木，尽管主要益处来自类固醇随时间推移减轻炎症。

您的外科医生也可能使用这些注射来管理术前或术后的疼痛。例如，腕管松解术前的注射不会增加感染风险。术后，支柱注射（pillar injections）对于预防拇指基部的疼痛无效。然而，对于手部疾病，与低剂量选项相比，高剂量曲安奈德注射通常能提供更持久的缓解，并减少重复注射或手术的需求。

重复注射通常是安全的，不会加重病情或使未来的手术复杂化。无论您患有髋部问题、肩部撕裂还是拇指关节炎，目标都是一致的：减轻炎症以提高生活质量。这种方法有助于您在身体解决根本原因的同时维持功能。

预期情况

您的症状可能会反复发作，而非保持不变。皮质类固醇注射带来的缓解是暂时的。它有助于在愈合或等待其他治疗起效期间控制疼痛。它并不能治愈根本问题。大多数人会发现疼痛会在一段时间内得到缓解，但可能会复发。

缓解持续的时间取决于注射部位以及您所患的疾病。在某些情况下，例如手部软组织问题，较高剂量的类固醇可提供更长时间的缓解，并可能延缓手术的需要。在其他部位，如髋部或肩部，注射不会改变您的长期预后。无论是否进行注射，十年后手术或自然愈合后的最终结果往往相似。

您在注射过程中或注射后不久可能会感到一些疼痛。如果您的外科医生在类固醇中使用了利多卡因等局部麻醉药，您在手术过程中可能会感到疼痛减轻。这种舒适感是真实的，但它可能不会改变您在随后几周内的感受。在某些关节（如踝关节）中，将类固醇与另一种称为透明质酸的液体结合使用，比单独使用类固醇能更好地缓解疼痛。

在某些部位（例如腕管综合征的腕部）重复注射是安全的。这些重复治疗不会增加您的感染风险，也不会使未来的手术更加困难。然而，在手术前进行的注射并不能加速您的恢复，也不能改善术后力量和活动范围。手术前一年内注射的时机不会改变您的成功率。

如果您拇指或踝关节患有骨关节炎，注射可以帮助您在一段时间内控制疼痛。如果疼痛变得难以忍受，手术仍然是后续的良好选择。您应预期注射只是您工具箱中的一种工具。它帮助您度过艰难的日子，但如果关节磨损进展，它并不能替代长期管理或最终手术的必要性。

Reviewed by Kieran Hirpara · 13 June 2026.

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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

  • Response to intra-articular corticosteroid injection was not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome [1].
  • The combination of corticosteroid and hyaluronic acid injection is more effective than corticosteroid alone in relieving pain in ankle osteoarthritis [2].
  • Preoperative corticosteroid injection at all studied timepoints was not associated with an increased risk of postoperative deep infection after carpal tunnel release [3].
  • There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone for trigger finger, but that difference may not be clinically relevant [4].
  • Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms after carpal tunnel release surgery [5].
  • High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery for soft tissue pathology of the hand [6].
  • Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [7].
  • Both surgical procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections [8].
  • Repeated corticosteroid injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release [9].

How It Works

  • Response to intra-articular corticosteroid injection is not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome [1].
  • Combination of corticosteroid and hyaluronic acid injection is more effective than corticosteroid alone in relieving pain in ankle osteoarthritis [2].
  • Preoperative corticosteroid injection at all studied timepoints is not associated with an increased risk of postoperative deep infection after carpal tunnel release [3].
  • There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant [4].
  • Repeated corticosteroid injections are safe in the treatment of carpal tunnel syndrome and do not affect the morbidity of subsequent release [9].
  • Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis [11].
  • Both corticosteroid injections and conservative treatments are effective in treating heel spurs, with corticosteroid injections recommended as the preferred option due to higher patient satisfaction [12].
  • Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release [15].
  • Posterior approach, women, and history of preoperative corticosteroid injection are identified as the strongest risk factors for postoperative greater trochanter bursitis injection or postoperative soft tissue injection in total hip arthroplasty [18].
  • A dose-dependent relationship exists between pre-operative corticosteroid injections and post-operative complications following total shoulder arthroplasty, with increasing numbers of injections correlated with higher risks of prosthetic loosening, stiffness, revision surgery, and new rotator cuff disease [19].

What the Evidence Shows

Preoperative Injections and Surgical Outcomes

  • Response to preoperative intra-articular corticosteroid injection for hip arthroscopy in femoroacetabular impingement syndrome was not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates [1].
  • Timing of a single preoperative corticosteroid injection within 1 year prior to rotator cuff repair was not associated with increased risk of repair failure, nor did it significantly affect patient-reported outcomes, range of motion, or strength [7].
  • Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release for chronic plantar fasciopathy [15].

Comparative Efficacy and Treatment Alternatives

  • Platelet-rich plasma (PRP) has superior midterm efficacy compared to corticosteroids for improving pain and functional impairment in tendinopathy [20].
  • In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12 weeks compared to intra-articular corticosteroid injections [21].
  • Corticosteroid injections are recommended as the preferred option over conservative treatments for heel spurs due to higher patient satisfaction, although both are effective [12].

Injection Technique and Safety

  • Repeated corticosteroid injections for carpal tunnel syndrome are safe and do not affect the morbidity of subsequent release [9].
  • Postoperative corticosteroid injection is a viable treatment for postoperative stiffness after rotator cuff repair and may serve as a safer alternative to arthroscopic capsular release, particularly in high-risk patients such as those with osteoporosis or at risk of axillary nerve injury [16].

Risks and Adverse Events

  • Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis, although the incidence rates of these outcomes vary notably [11].

Health Disparities

  • Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis [13].
  • Minority demographics were less likely to receive a corticosteroid injection or undergo surgical repair for rotator cuff disease despite matching on medical comorbidities and smoking status [14].

Methodological Notes

  • Methodological concerns regarding a trial comparing platelet-rich plasma to corticosteroid injections include the lack of ultrasound examination to assess inflammation and degeneration, the absence of Kellgren-Lawrence grade distribution data, and the potential confounding effect of lidocaine in corticosteroid preparations [10].

Practical Considerations

  • Response to preoperative intra-articular corticosteroid injection is not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome [1].
  • Dual intra-articular injections of corticosteroid and hyaluronic acid are more effective than single corticosteroid injection alone in relieving pain in ankle osteoarthritis [2].
  • High-dose triamcinolone injections outperform low-dose injections across most metrics, including estimated time of relief, rate of repeat injection, and rate of surgery, for soft tissue pathology of the hand [6].
  • Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair does not significantly affect failure rates, patient-reported outcomes, range of motion, or strength [7].
  • Both corticosteroid injections and conservative treatments are effective in treating heel spurs, but corticosteroid injections are recommended as the preferred option due to higher patient satisfaction [12].
  • Minority demographics are less likely to receive a corticosteroid injection or undergo surgical repair for rotator cuff disease despite matching on medical comorbidities and smoking status [14].
  • Platelet-rich plasma injections are inferior to corticosteroid injections for short-term pain relief, suggesting that expectations regarding the clinical utility of PRP should be tempered [17].

Key Evidence

  • [L2] Response to intra-articular corticosteroid injection was not associated with differences in 10-year patient-reported outcomes, achievement of clinically significant outcomes, or reoperation rates. [1] (10.1016/j.arthro.2025.07.013)
  • [L1] The combination of corticosteroid and HA injection is more effective than corticosteroid alone in relieving pain in ankle OA. [2] (10.1186/s12891-025-08488-0)
  • [L3] Preoperative corticosteroid injection at all studied timepoints was not associated with an increased risk of postoperative deep infection, a divergence from existing literature. [3] (10.5435/jaaos-d-25-00317)
  • [L2] There is a statistically significant difference in pain during and shortly after injection when using a steroid with lidocaine versus steroid alone, but that difference may not be clinically relevant. [4] (10.1016/j.jhsa.2024.05.016)
  • [L1] Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms. [5] (10.1186/s12891-025-09393-2)
  • [L4] High-dose triamcinolone injections outperformed low-dose injections across most metrics including estimated time of relief, rate of repeat injection, and rate of surgery. [6] (10.1016/j.jhsa.2025.09.014)
  • [L2] Timing of a single preoperative corticosteroid injection within 1 year of rotator cuff repair did not significantly affect failure rates, patient-reported outcomes, range of motion, or strength, suggesting that one injection before repair does not strongly influence outcomes. [7] (10.1016/j.jseint.2026.101632)
  • [L4] Both procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections. [8] (10.1016/j.jhsa.2026.01.024)
  • [L3] Repeated injections were found to be safe in the treatment of carpal tunnel syndrome and did not affect the morbidity of subsequent release. [9] (10.1177/17531934251396629)
  • [L5] The letter highlights methodological concerns regarding the original trial, specifically the lack of ultrasound examination to assess inflammation and degeneration, the absence of Kellgren-Lawrence grade distribution data, and the potential confounding effect of lidocaine in corticosteroid preparations. [10] (10.1016/j.arth.2025.05.006)
  • [L5] Risks of intra-articular hip corticosteroid injections include rapidly progressive osteoarthritis, osteonecrosis, femoral head collapse, insufficiency fracture, and worsening osteoarthritis, although the incidence rates of these outcomes vary notably. [11] (10.1016/j.asmr.2025.101169)
  • [L3] Both corticosteroid injections and conservative treatments were effective in treating heel spurs; however, corticosteroid injections are recommended as the preferred option due to higher patient satisfaction. [12] (10.1186/s12891-025-08648-2)
  • [L3] Minority demographics have lower odds of receiving corticosteroid injections for the treatment of hand osteoarthritis. [13] (10.1016/j.jhsg.2025.100837)
  • [L3] Minority demographics were less likely to receive a corticosteroid injection or undergo surgical repair for rotator cuff disease despite matching on medical comorbidities and smoking status. [14] (10.1016/j.jse.2026.01.015)
  • [L3] Patients who experienced temporary improvement after local corticosteroid injection had better clinical outcomes following endoscopic plantar fascia release. [15] (10.1186/s12891-025-08816-4)
  • [L5] Current findings suggest that corticosteroid injections may serve as a safer alternative to arthroscopic capsular release, particularly in high-risk patients such as those with osteoporosis or at risk of axillary nerve injury. [16] (10.1016/j.arthro.2025.04.021)
  • [L1] Based on these findings, expectations regarding the clinical utility of PRP should be tempered. [17] (10.1016/j.arth.2025.03.013)
  • [L3] Posterior approach, women, and history of preoperative corticosteroid injection were identified as the strongest risk factors for postoperative greater trochanter bursitis injection or postoperative soft tissue injection. [18] (10.1016/j.arth.2025.03.045)
  • [L2] A dose-dependent relationship exists between pre-operative corticosteroid injections and post-operative complications following total shoulder arthroplasty, with increasing numbers of injections correlated with higher risks of prosthetic loosening, stiffness, revision surgery, and new rotator cuff disease. [19] (10.1016/j.jse.2026.01.024)
  • [L1] PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its midterm efficacy is superior to that of corticosteroids. [20] (10.1186/s12891-025-08566-3)
  • [L1] In patients with adhesive capsulitis, suprascapular nerve blocks provide greater pain relief at 3-4, 6-7, and 12 weeks, greater improvements in shoulder function at 12 weeks, and greater active abduction at 12 weeks, compared to intra-articular corticosteroid injections. [21] (10.1016/j.jse.2025.05.037)

References

[1] No Difference in Responders and Nonresponders to Preoperative Intra-articular Corticosteroid Injection Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome at 10 Years: A Matched Analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.013

[2] Dual intra-articular injections of corticosteroid and hyaluronic acid versus single corticosteroid injection for ankle osteoarthritis: a randomized comparative trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08488-0

[3] Ipsilateral Preoperative Corticosteroid Injection and Timing Not Associated With Postoperative Deep Infection After Carpal Tunnel Release. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00317

[4] Corticosteroid Injection With and Without Local Anesthetic for the Treatment of Trigger Finger: A Randomized Clinical Trial. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.05.016

[5] “Intraoperative pillar corticosteroid injection”: does it improve clinical outcomes after carpal tunnel release surgery? A double-blind, randomized controlled study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09393-2

[6] Efficacy of Low-Dose Versus High-Dose Corticosteroid Injections for Soft Tissue Pathology of the Hand. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.09.014

[7] Timing of corticosteroid injection within 1 year prior to rotator cuff repair was not associated with increased risk of repair failure. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101632

[8] Do Preoperative Intra-Articular Steroid Injections Affect the Choice of Surgical Procedures for Thumb Carpometacarpal Osteoarthritis?. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.024

[9] The safety and cost of repeated corticosteroid injections for carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251396629

[10] Letter Regarding "Platelet-Rich Plasma Injections Are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial". The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.006

[11] Risks of Intra‐articular Hip Corticosteroid Injections Include Rapidly Progressive Osteoarthritis and Femoral Head Collapse in Patients With and Without Pre‐existing Osteoarthritis: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101169

[12] Comparison of corticosteroid injections and conservative treatments for heel spurs. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08648-2

[13] Underutilization of Hand Corticosteroid Injections and Arthroplasty for Minority Demographics. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100837

[14] Minority groups are less likely to undergo surgical fixation or receive a corticosteroid injection for rotator cuff disease: a large database study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.015

[15] Does local steroid injection have a prognostic value for endoscopic plantar fascia release in chronic plantar fasciopathy?. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08816-4

[16] Editorial Commentary:

                Postoperative Corticosteroid Injection Is a Viable Treatment for Postoperative Stiffness After Rotator Cuff Repair. *Arthroscopy*. 2025. DOI: 10.1016/j.arthro.2025.04.021

[17] Platelet-Rich Plasma Injections Are Inferior to Corticosteroid Injections for Short-Term Pain Relief: A Prospective, Double-Blinded, Randomized Controlled Trial. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.03.013

[18] Does Surgical Approach in Total Hip Arthroplasty Affect Postoperative Corticosteroid Injection Requirements?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.03.045

[19] Pre-operative corticosteroid injections are associated with a dose-dependent risk for complications following anatomic and reverse total shoulderarthroplasty. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.024

[20] Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08566-3

[21] Intra-articular corticosteroid injection vs. suprascapular nerve block for adhesive capsulitis: a systematic review and meta-analysis of level I randomized controlled trials. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.05.037

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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.