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黏液囊肿

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Mucous cysts – common bumps near finger joints, often linked to arthritis, and treatment options.

Updated Jun 2026
一幅手绘插图，显示了指尖关节靠近指甲处的小囊肿。
拇指黏液囊肿：一种起源于手指或拇指末端磨损关节的小型充满液体的肿块。 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

您可能会注意到手指顶部有一个小而硬的肿块，通常位于远端指间关节附近。这个肿块是一种黏液囊肿。它摸起来通常像皮下的一颗小豌豆。如果您的皮肤较薄，您可能能清楚地看到它。囊肿可能会使覆盖其上的皮肤看起来发亮或紧绷。在某些情况下，它可能导致指甲呈现波浪状或脊状生长模式。

囊肿周围的区域可能会感到压痛或酸痛。按压手指或弯曲手指时可能会感到疼痛。日常活动可能会变得困难。拿取物品、打字或抓握工具时可能会疼痛。您可能会发现扣纽扣或拉上夹克拉链很困难。有些人报告说，夜间或长时间使用手部后疼痛会加重。如果您将手放在身下休息，不适感可能会干扰睡眠。

您的外科医生会检查囊肿并评估其对手指活动的影响。疼痛通常源于潜在的关节改变，而不仅仅是肿块本身。如果骨赘（骨刺）仍然存在，仅切除囊肿可能无法缓解疼痛。您的外科医生可能会讨论切除骨赘，以帮助减轻对关节和皮肤的压力。这种方法有助于皮肤更好地愈合，并降低囊肿复发的可能性。

在许多情况下，治疗骨赘会导致囊肿完全消退。您可能不需要复杂的手术。单纯切除囊肿联合骨赘切除术的复发率极低。甚至更微创的选项，如仅切除骨赘，在大多数情况下也能实现完全消退。如果需要皮瓣，患者对疤痕的满意度很高。您很可能对外观感到满意，并愿意再次接受该手术。

您的外科医生会根据您的具体需求制定计划。目标是缓解疼痛并恢复功能。大多数患者发现，治疗后，他们的手指感觉更舒适，外观也更好。一旦主要问题得到解决，皮肤具有良好的恢复潜力。您可以预期，在仔细护理伤口的情况下，恢复过程将是顺利的。

实际发生了什么

黏液囊肿是一种形成于手指上的小型充满液体的囊袋。它通常出现在手指尖端附近，靠近甲床。囊肿位于关节囊的上方，关节囊是包裹在关节周围以保持其稳定的坚韧纤维性套筒。

其根本原因是关节的退行性关节炎。随着软骨——覆盖在骨头末端的光滑涂层——发生退化，身体会尝试修复损伤。这一过程通常会形成骨赘，也称为骨刺。这些是从关节表面向外生长的细小粗糙的额外骨性突起。

可以将关节囊想象成一个垫片或密封件。当骨刺摩擦这个密封件时，会刺激组织。这种刺激导致关节滑膜渗出滑液，滑液是保持关节顺畅运动的天然润滑剂。液体通过关节囊的薄弱部位渗出，形成你在皮肤上看到的可见隆起。

由于囊肿与关节相连，其中充满了相同的润滑液。液体的压力可能导致囊肿上方的皮肤变薄且脆弱。在某些情况下，囊肿可能会压迫附近的神经或影响甲母质，甲母质是指位于甲上皮下方、负责生长指甲的组织。这种压力会导致你在指甲上看到的沟槽或脊状突起。

仅切除囊肿往往会导致其复发，因为骨刺仍然存在。骨刺会继续刺激关节滑膜，导致更多液体渗出。要打破这一循环，必须处理潜在的骨刺。当骨刺被移除时，刺激停止，关节滑膜得以愈合。这就是为什么治疗骨骼与治疗囊肿本身同样重要。

我们能采取的措施

您的治疗过程通常从简单的自我护理和专业指导开始。您可以尝试让手指休息，并避免对囊肿施加压力的活动。物理治疗有助于维持关节的活动度，并保持周围肌肉的力量。这种方法旨在通过非侵入性手段减少刺激并改善功能。您应给予保守治疗充分的尝试时间，以观察症状是否缓解。许多患者发现，通过调整日常习惯并遵循温和的锻炼计划，即可获得足够的缓解，从而避免进一步干预。

如果自我护理效果不佳，您的外科医生可能会建议药物治疗以控制疼痛和炎症。皮质类固醇注射是治疗此类囊肿的常见选择。掌侧皮质类固醇注射便于针头准确且一致地置入关节。与其他技术相比，该方法最大限度地减少了潜在的软组织损伤和感染风险。注射有助于缓解驱动囊肿生长的炎症。虽然证据强调了这种方法的安全性和便捷性，但重要的是要理解，注射通常仅用于管理症状，而非永久去除囊肿。效果会持续一段时间，但潜在的退行性关节炎仍然存在。您和您的外科医生将决定这种暂时缓解是否足够，或者是否需要采取进一步措施。

当保守治疗达到极限，且囊肿引起持续性疼痛、畸形或功能障碍时，会考虑手术治疗。您的外科医生将讨论针对您具体病例的最佳手术方案。目标是去除囊肿并解决根本原因，这通常是关节炎引起的骨赘（骨刺）。去除这些骨赘至关重要，因为它能显著降低囊肿复发的几率。某些技术涉及连同小块皮瓣一起切除囊肿以确保适当愈合，而其他技术则主要关注骨骼。您的外科医生将选择一种方法，在低复发率和良好的手部美容效果之间取得最佳平衡。

预期情况

黏液囊肿是小的、充满液体的肿块，通常出现在手指或拇指的远端关节附近。它们与该关节的退行性关节炎密切相关。由于囊肿源于这种潜在的关节改变，如果未解决根本原因，囊肿本身可能会持续存在或复发。然而，经过适当治疗，预后通常非常良好。

您的外科医生可能会建议切除囊肿以及引起囊肿的任何骨赘（骨刺）。这种方法可以极罕见地消除黏液囊肿的复发。如果您的外科医生选择使用局部推进皮瓣的技术，复发率仅为1.4%。在某些情况下，您的外科医生可能仅切除骨赘而不取出囊肿。这种侵入性较小的方法在大多数情况下可实现完全缓解。无论软组织的具体计划如何，您的外科医生都会切除骨赘以防止囊肿复发。

您可以对结果感到高度满意，尤其是关于疤痕的外观。许多患者表示他们会再次接受该手术。所使用的外科技术旨在简单可靠。例如，某些方法允许在不增加指甲基质风险的情况下去除变薄的皮肤。其他方法使用皮肤移植，提供令人满意的美容效果，同时具有可接受的复发率。即使是复杂的病例，如囊肿生长在指神经内部，也能取得成功的结果。

如果不治疗，囊肿可能会持续存在或增大，可能导致皮肤变薄并增加感染风险。通过同时处理囊肿和潜在的关节炎，您的外科医生旨在提供持久的解决方案。大多数患者发现手术后手指的外观和感觉都更好。目标不仅是去除肿块，还要防止其复发。您可以期待一个直接的恢复过程，重点在于保护手术部位，同时让关节愈合。

何时就医

若发现手指靠近指甲处有小肿块，请咨询全科医生。若囊肿引起持续疼痛且休息后未缓解，请要求专科医生评估。若出现关节无力或不稳，请及时就医。注意是否有卡顿或关节不稳感。若症状影响睡眠或工作，请联系您的外科医生。该区域症状突然加重也需进行检查。早期评估有助于预防并发症。您的外科医生可讨论切除囊肿及骨赘等方案。该方法通常满意度高且复发率低。治疗根本原因有助于皮肤自然恢复。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

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Evidence & references

Overview

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
  • Much of the management or recommendations for mucous cysts is based on expert opinion [1].
  • Total dorsal capsulectomy alone is a simple treatment for mucous cysts that does not lead to any recurrence [2].
  • Excision of the cyst combined with complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
  • Osteophyte excision without cyst excision may be a good treatment choice for mucous cysts of the finger, providing a less invasive method with complete resolution in most cases [5].
  • Osteophyte removal results in a low cyst recurrence rate, indicating it should be undertaken regardless of the surgeon's plan for the soft tissues [13].
  • The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
  • The use of a Wolfe graft for mucous cysts is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
  • Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again [9].
  • A surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients [10].
  • Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
  • Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].

Anatomy & Pathophysiology

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
  • Much of the management or recommendations for mucous cysts is based on expert opinion [1].
  • Mucous cysts are associated with marginal osteophytes at the distal interphalangeal joint [3].
  • The primary pathology in mucous cysts involves osteophytes, and removal of these osteophytes allows for skin recovery potential [20].
  • Ultrasound is a powerful modality for evaluating pathologic conditions in the hand and wrist [16].
  • Ultrasound provides a cost-effective and expedient alternative or adjunct to MRI for hand and wrist evaluation [16].
  • Ultrasound is best used when there is a specific clinical question regarding a well-localized abnormality [16].
  • Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
  • Subungual keratoacanthoma may show locally aggressive behaviour but does not metastasize [14].

Classification

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
  • Much of the management or recommendations for mucous cysts is based on expert opinion [1].
  • Total dorsal capsulectomy alone is a simple treatment for mucous cysts that does not lead to any recurrence [2].
  • Excision of the cyst combined with complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
  • Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
  • Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger, providing a less invasive method with complete resolution in most cases [5].
  • The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
  • The use of a Wolfe graft is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
  • Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].
  • Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again [9].
  • A surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients [10].
  • There is a statistically significant difference in recurrence rates between Type I giant cell tumours of the tendon sheath (0%) and Type II tumours (38%) [11].
  • Recurrence in Type II giant cell tumours of the tendon sheath is likely due to undetected satellite lesions or incomplete excision [11].
  • Incomplete excision of a granular cell nerve tumor can lead to recurrence [12].
  • Osteophyte removal results in a low cyst recurrence rate [13].
  • Osteophyte removal should be undertaken regardless of the surgeon's plan for the soft tissues [13].

Clinical Presentation

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
  • Much of the management or recommendations for mucous cysts is based on expert opinion [1].
  • Malignant natural-killer cell neoplasms can present as a mucous cyst on the distal interphalangeal joint of the finger [4].
  • Eccrine porocarcinomas can present as a hand cyst [8].
  • Subungual keratoacanthoma may present as a condition masquerading as flexor tenosynovitis in the finger [14].
  • Ultrasound is a powerful modality for the evaluation of pathologic conditions in the hand and wrist [16].
  • Ultrasound provides a cost-effective and expedient alternative and/or adjunct to MRI for hand and wrist evaluation [16].
  • Ultrasound is best used when there is a specific clinical question regarding a well-localized abnormality in the hand or wrist [16].

Investigations

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
  • Much of the management of mucous cysts is based on expert opinion [1].
  • Pathohistological analysis is useful when doubts arise about the initial diagnosis of a benign tumorous lesion [4].
  • Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].
  • Ultrasound is a powerful modality for evaluation of pathologic conditions in the hand and wrist [16].
  • Ultrasound provides a cost-effective and expedient alternative and/or adjunct to MRI [16].
  • Ultrasound is best used when there is a specific clinical question regarding a well-localized abnormality [16].

Treatment

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies, and much of what is done or recommended is based on expert opinion [1].
  • Total dorsal capsulectomy alone is a simple treatment for mucous cysts that does not lead to any recurrence [2].
  • Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
  • Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger, providing a less invasive method with complete resolution in most cases [5].
  • Osteophyte removal results in a low cyst recurrence rate, indicating that it should be undertaken regardless of the surgeon's plan for the soft tissues [13].
  • The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
  • Use of Wolfe graft is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
  • Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again [9].
  • A surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients [10].
  • Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].

Complications

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies, with many recommendations based on expert opinion [1].
  • Total dorsal capsulectomy alone for mucous cysts did not lead to any recurrence [2].
  • Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
  • Osteophyte excision without cyst excision may provide complete resolution in most cases [5].
  • The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
  • Use of a Wolfe graft provides satisfactory cosmesis with acceptable recurrence rates [7].
  • Surgical excision with a local advancement skin flap demonstrates a low recurrence rate of 1.4% and high patient satisfaction regarding the scar [9].
  • A surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients [10].
  • Incomplete excision can lead to recurrence of granular cell nerve tumors [12].
  • Type II giant cell tumors of the tendon sheath have a 38% recurrence rate, likely due to undetected satellite lesions or incomplete excision [11].
  • Malignant natural-killer cell neoplasms can present as mucous cysts on the distal interphalangeal joint [4].
  • Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
  • Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].

Recovery

  • Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
  • Much of the treatment for mucous cysts is based on expert opinion [1].
  • Total dorsal capsulectomy alone is a simple treatment for mucous cysts that does not lead to any recurrence [2].
  • Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
  • Osteophyte excision without cyst excision may be a good treatment choice for mucous cysts of the finger, providing a less invasive method with complete resolution in most cases [5].
  • The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
  • The use of a Wolfe graft is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
  • Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again [9].
  • Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
  • Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].
  • Incomplete excision can lead to recurrence in granular cell nerve tumors [12].

Key Evidence

  • [L4] The scientific data regarding mucous cysts consist almost entirely of retrospective studies, and much of what is done or recommended is based on expert opinion. [1] (10.1016/j.jhsa.2010.01.029)
  • [L4] A total dorsal capsulectomy alone was a simple treatment for mucous cysts and did not lead to any recurrence. [2] (10.1016/j.jhsa.2014.03.004)
  • [L4] Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence. [3] (10.2106/00004623-197355030-00013)
  • [L5] This case emphasizes the utility of a pathohistological analysis in cases where doubts arise about the initial diagnosis of a benign tumorous lesion. [4] (10.1007/s00402-008-0794-4)
  • [L4] Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger, providing a less invasive method with complete resolution in most cases. [5] (10.1177/1753193413478549)
  • [L4] It allows excision of the cyst and thinned skin with no added risk to the nail matrix. [6] (10.1016/j.jhsa.2017.03.013)
  • [L4] The technique is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates. [7] (10.1177/1753193408103498)
  • [L4] Prompt recognition and appropriate treatment are critical because eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal. [8] (10.1016/j.jhsa.2016.07.112)
  • [L4] Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again. [9] (10.1177/1753193413508540)
  • [L4] A new surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients. [10] (10.2106/00004623-197254070-00008)
  • [L3] The study found a statistically significant difference in recurrence rates between Type I tumours (0%) and Type II tumours (38%), with recurrence in Type II likely due to undetected satellite lesions or incomplete excision. [11] (10.1054/jhsb.2000.0522)
  • [Case_report] The author notes that while the true recurrence rate is unknown, incomplete excision can lead to recurrence. [12] (10.1016/j.jhsa.2009.05.011)
  • [Commentary] The article shows that osteophyte removal results in a low cyst recurrence rate, indicating that it should be undertaken regardless of the surgeon's plan for the soft tissues. [13] (10.1177/1753193413510663)
  • [L4] Subungual keratoacanthoma may show locally aggressive behaviour but does not metastasize. [14] (10.1177/1753193409360605)
  • [L5] Ultrasound is a powerful modality for evaluation of pathologic conditions in the hand and wrist, providing a cost-effective and expedient alternative and/or adjunct to MRI, best used when there is a specific clinical question regarding a well-localized abnormality. [16] (10.1016/j.jhsa.2009.02.010)
  • [L5] The authors of the original study believe that extensive damage to the skin is unnecessary and that the skin has recovery potential once the main problem (osteophytes) is removed, favoring a less invasive approach over techniques requiring skin flaps. [20] (10.1177/1753193414546443)

References

[1] Mucous Cysts. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.01.029 [2] Total Dorsal Capsulectomy for the Treatment of Mucous Cysts. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.03.004 [3] Marginal Osteophyte Excision in Treatment of Mucous Cysts. The Journal of Bone & Joint Surgery. 1973. DOI: 10.2106/00004623-197355030-00013 [4] Malignant Natural-Killer cell neoplasm presenting as a mucous cyst on the distal interphalangeal joint of the finger. Archives of Orthopaedic and Trauma Surgery. 2008. DOI: 10.1007/s00402-008-0794-4 [5] Osteophyte excision without cyst excision for a mucous cyst of the finger. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413478549 [6] The Zitelli Bilobed Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Cohort of 33 Cases. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.013 [7] Use of Wolfe Graft for the Treatment of Mucous Cysts. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408103498 [8] Eccrine Porocarcinoma Presenting as a Hand Cyst. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.112 [9] A reliable surgical treatment for digital mucous cysts. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413508540 [10] Etiology and Treatment of the So-Called Mucous Cyst of the Finger. The Journal of Bone & Joint Surgery. 1972. DOI: 10.2106/00004623-197254070-00008 [11] Giant Cell Tumours of Tendon Sheath: Classification and Recurrence Rate. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0522 [12] Granular Cell Nerve Tumor in the Hand: Case Report. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.05.011 [13] Commentary on Lee et al. Osteophyte excision without cyst excision for a mucous cyst of the finger. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193413510663 [14] Metastases to the finger masquerading as flexor tenosynovitis. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193409360605 [16] Ultrasound of the Hand and Wrist. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.010 [20] Re: Lee HJ, Kim PT, Jeon IH, et al. Osteophyte excision without cyst excision for a mucous cyst of the finger. J Hand Surg Eur. 2014, 39: 258–61. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414546443

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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.

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