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肩峰下减压术

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Rehabilitation after isolated arthroscopic subacromial decompression — early movement, staged strengthening and return to activity.

Updated Jun 2026
插图：一个人仰卧，双手举着一根棍子朝向天花板。
肩峰下减压术后早期数周的辅助性过头运动。 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。

本方案适用于基兰·希尔帕拉（Kieran Hirpara）医生在罗克汉普顿 Mater 私人医院进行的单纯性关节镜下肩峰下减压术（肩成形术，伴或不伴滑囊切除）术后的康复。请在首次物理治疗就诊时携带此页面或其 PDF 文件，以确保康复过程协调一致。您的物理治疗师将根据您肩关节的恢复情况，通过以下阶段为您个体化推进康复进程。

重要提示： 肩峰下减压术常与肩袖修复术联合进行。本方案仅适用于单纯性肩峰下减压术。如果您的手术同时包含了肩袖修复，请遵循肩袖修复方案；修复后的肌腱会要求更慢的康复节奏。

如果您对术后伤口有任何疑虑，请联系诊室。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。

预期情况

肩峰下减压术通过磨削肩峰（肩部的骨性顶盖）的下表面并切除发炎的滑囊，为肩袖肌腱创造更多空间。无需修复需要保护的组织，因此早期康复的重点在于活动而非休息：从第一天起肩部即可安全活动，早期活动可防止其在恢复过程中变得僵硬。

您醒来时佩戴的悬吊带仅用于舒适，并不起保护作用。请尽可能少佩戴并尽早停用：大多数人会在头几天内不再佩戴悬吊带，且已发表的方案要求最迟在两周内完全停用。佩戴悬吊带期间请勿驾驶。

您的锻炼计划包含三种类型的活动，物理治疗师将根据每个阶段指导适用类型：

  • 主动活动范围： 无需辅助或帮助即可进行的活动。
  • 主动辅助活动范围： 使用另一只手臂或物体辅助移动手臂。
  • 被动活动范围： 完全放松，使用另一只手臂或外力完成 100% 的工作。

简要概览：

  • 第一阶段 — 早期活动 — 大约前两周
  • 第二阶段 — 恢复活动范围并开始力量训练 — 第 2–6 周
  • 第三阶段 — 力量强化 — 第 6–12 周
  • 第四阶段 — 恢复全面活动 — 第 12 周以后

在早期几周内，肩部通常表现为酸痛而非脆弱，部分人可能会感到不适长达六周。已发表的指南表明，大多数人在大约三个月时疼痛会有明显改善，且症状可持续改善长达一年。以下周数范围仅为典型情况而非固定标准；您的物理治疗师将根据肩部的活动情况推进康复进度，而非依据日历时间。

第一阶段 — 早期活动（第0–2周）

手术中常使用神经阻滞，因此术后数小时内手臂可能感到麻木；请在麻醉效果消退前开始服用止痛药。在前两周内，目标简明：控制疼痛和肿胀，并在舒适范围内恢复肩部活动。定期使用冰敷以缓解疼痛。立即开始活动手部、腕部和肘部，在舒适允许的情况下加入钟摆练习和辅助性手臂运动，并将手臂用于正常的轻度日常活动，如洗漱、穿衣和进食。在进行锻炼和物理治疗预约前，请服用止痛药。本手术为关节镜手术，通常通过两个或三个小穿刺伤口完成，并使用粘合条闭合；保持伤口干燥直至愈合，通常需要10–14天。从事办公室工作的人员通常在两周内即可复工；一旦脱离悬吊带并能舒适地控制车辆（包括执行紧急制动），即可恢复驾驶，这通常发生在术后1至3周之间。

致物理治疗师：

目标

  • 控制疼痛和肿胀
  • 重建无痛活动范围（从辅助主动活动逐步过渡到主动活动）
  • 预防肌肉萎缩，并开始重建动态稳定性
  • 实现轻度日常生活活动的独立

管理措施

  • 定期使用冷疗以缓解疼痛和肿胀；在锻炼和治疗前给予镇痛
  • 从第1天开始进行肘部、腕部、手部、颈部和胸椎的活动范围练习
  • 钟摆练习；在肩胛平面进行滑轮或棍棒辅助主动上举；外展30–45°时开始进行外旋和内旋
  • 在舒适允许的情况下，逐步过渡到主动活动范围
  • 坐姿下肩胛骨定位；姿势意识训练
  • 次最大等长收缩（屈曲、伸展、外展、外旋和内旋）及轻柔的节奏性稳定训练
  • 从第2周开始：如有帮助，锻炼前使用热敷；将旋转练习进展至外展90°；使用弹性管进行外旋和内旋，手臂置于体侧

注意事项

  • 在舒适范围内活动：不要强行或过度拉伸；以疼痛为指引
  • 悬吊带仅用于舒适；在最初几天内逐渐减少使用，并在两周内停用
  • 佩戴悬吊带期间禁止驾驶
  • 禁止提重物、禁止举过头顶、禁止突然发力动作
  • 术后六周内避免通过患侧手臂从椅子或床上撑起：肩峰已被变薄，在其重塑期间应避免强力负荷

进展标准

  • 疼痛通过简单镇痛药得到良好控制
  • 肿胀消退，伤口愈合或正在愈合且无异常
  • 辅助主动活动舒适，主动活动恢复至肩高以下

第二阶段 — 恢复活动范围并开始力量训练（第2–6周）

本阶段旨在恢复剩余的活动范围，并开始重建力量。您的锻炼将从辅助运动过渡到在所有方向上主动活动手臂，大多数已发表的方案预计在六至八周时达到完全或接近完全的活动范围。力量训练从轻柔开始：首先不使用负重，然后使用弹力带和非常轻的哑铃来锻炼肩袖和肩胛骨肌肉。许多人发现运动前热敷和运动后冰敷有帮助。中度活动（低于肩高的轻重量 lifting）通常在此阶段变得可行，但需在物理治疗师的指导下进行。

致您的物理治疗师：

目标

  • 在大约第6–8周时，在所有平面上实现完全或接近完全的主动活动范围
  • 恢复并改善肩袖和肩胛骨的力量
  • 使肩肱节律和神经肌肉控制正常化
  • 继续缓解疼痛

管理方案

  • 在所有平面上进展活动范围，包括向后背部的内旋，配合轻柔的后关节囊拉伸
  • 根据指征进行盂肱关节松动术（向下滑动、后向滑动和前向滑动）
  • 等张训练计划，最初无负重（肩关节上举、俯卧划船、俯卧水平外展、俯卧伸展至中立位、侧卧外旋、外展至90°），在无痛且控制良好的重复训练一周后，增加轻重量（约0.5–1公斤）
  • 使用弹力管进行外旋和内旋；随着舒适度允许，逐渐进展到更高位置的外旋训练
  • 肩胛骨神经肌肉控制及下斜方肌训练；躯干、核心及下肢 conditioning
  • 上肢耐力训练；根据偏好，训练前热敷，训练后冰敷

注意事项

  • 避免在引起疼痛的撞击范围内进行负重训练；锻炼可能会感到困难，但不应重现术前疼痛
  • 在未实现无痛之前，不要针对冈上肌或三角肌中部进行负重训练；如果引发静息痛或夜间痛，请避免此类训练
  • 继续避免通过患侧手臂支撑起身，并在六周内避免提重物或过头举重

进阶标准

  • 完全且无痛的活动范围，仅有轻微压痛
  • 手动测试显示肩袖力量约为4/5，且肩胛骨控制良好

第三阶段——强化训练（第6–12周）

随着活动度的恢复，重点转向力量、耐力和控制能力。抗阻训练从弹力带过渡到负重，练习变得更加动态，包括对于重返运动的人群，开始进行受控的增强式训练，并逐步恢复训练。游泳通常从大约六周开始恢复（先蛙泳，自由泳在感觉舒适时进行），中等负荷工作（肩部高度以下的轻体力劳动）通常在六周时即可胜任。间歇性重返运动计划通常在达到力量标准后的第10–12周开始。

给物理治疗师：

目标

  • 提高肩复合体的力量、爆发力和耐力
  • 优化神经肌肉控制、本体感觉和运动模式（避免耸肩代偿）
  • 为逐步重返运动和从事重体力劳动做准备

管理措施

  • 进展等张训练方案：等长收缩 → 弹力带 → 负重；肩袖、三角肌和肩胛稳定肌群进行2–3组，每组8–12次重复
  • 引入离心抗阻训练、闭链练习和节律性稳定训练；包括负重和四点跪位在内的本体感觉训练
  • 增强式训练：双手练习（胸前传球、左右侧投掷）逐渐过渡到单手练习（对墙运球、投掷练习），在阶段末期进行
  • 若达到标准，在第10–12周开始间歇性运动计划
  • 继续核心肌群和体能训练；根据需要应用冷疗

注意事项

  • 练习应具有挑战性，但基本无痛；任何引发静息痛或夜间痛的动作应停止
  • 重体力劳动和持续的过头负荷需等待至大约三个月时

进阶标准

  • 无痛的主动活动范围完全恢复（与健侧大致相等）
  • 力量接近健侧（文献标准显示，达到70%可进入动态训练，接近90%可重返运动）
  • 渐进负荷下无疼痛或压痛

第四阶段 — 恢复全面活动（第12周起）

最终阶段是逐步恢复重体力劳动、 overhead 任务和运动。重体力或重复性举重以及肩部以上高度的持续工作通常在约三个月后恢复。重返竞技运动（尤其是 overhead 运动）基于是否达到特定标准，而非日历时间：无痛的全范围活动，力量接近对侧，以及对专项训练的信心。肩部在此阶段之后通常仍会持续改善；已发表的指南指出，改善可持续长达一年。

为您物理治疗师：

目标

  • 逐步恢复重体力劳动、 overhead 活动和运动
  • 长期维持活动范围、力量和协调性

管理

  • 继续强化训练计划，根据耐受情况推进健身房和专项运动训练
  • 继续进行间歇性运动计划，分阶段恢复投掷和其他 overhead 运动
  • 根据需要自我管理关节囊拉伸和维护性练习

注意事项

  • 进展仍以症状为指导；如果疼痛复发，减少负荷，恢复舒适的活动范围并重新建立

进展标准

  • 无痛的全范围活动
  • 力量和功能测试满意（根据已发表的回归运动标准，约为对侧的90%）
  • 临床复查满意

术后方案

上述阶段改编自已发表的关节镜下肩峰下减压术康复方案及患者指导，来源包括：OrthoIndy、Sports Surgery New York、Gundersen Health System Sports Medicine、Twin Cities Orthopedics、Oxford University Hospitals NHS Foundation Trust 和 Royal Berkshire NHS Foundation Trust。周数范围为典型值而非固定值，您的持续康复由您的物理治疗师根据您肩部的恢复情况，与诊所合作进行个体化指导。本页面与诊所的一般康复建议配合使用；请参阅术后疼痛管理和伤口护理。关于手术本身及其治疗的疾病，请参阅肩峰下减压术。本方案背后的证据（包括其与肩峰下手术试验证据的契合情况）在证据部分进行了总结，可从本页面顶部下载 PDF 版本。

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Arthroscopic Subacromial Decompression (Acromioplasty) — Post-operative Rehabilitation

Topic scope: Post-operative rehabilitation after isolated arthroscopic subacromial decompression (ASD / acromioplasty ± bursectomy). When a decompression is performed together with a rotator cuff repair, the repaired tendon sets the (slower) pace and the rotator-cuff-repair protocol takes priority — this page is for the isolated decompression.

Defining principle of this rehab: a subacromial decompression shaves bone and clears bursa — it repairs nothing that needs protecting. So (like a debridement, and unlike a cuff repair or stabilisation) the rehab is an early-movement pathway: a short sling for comfort only, weaned within days, motion and normal light use from day one, and a rapid return of range and function. The aim is to settle the post-operative flare and keep the shoulder moving while it quiets down — rehabilitation, not rest, does the work.

A. THE PROCEDURE & ITS EVIDENCE CONTEXT (important)

Arthroscopic subacromial decompression removes the subacromial bursa and shaves the under-surface of the acromion to "make room" for the rotator cuff, on the impingement model of subacromial pain.

The efficacy of the bony decompression itself is one of the most debated questions in shoulder surgery, and the rehabilitation context cannot be stated honestly without it:

  • CSAW (Beard et al, Lancet 2018; n=313, 3-arm) — a placebo-controlled surgical RCT. Decompression gave no clinically important benefit over arthroscopy-only (placebo) surgery, and both surgical arms were only marginally better than no treatment — a difference below the pre-specified minimal clinically important threshold.
  • FIMPACT (Paavola et al, BMJ 2018) — a second placebo-controlled RCT: no benefit of ASD over diagnostic arthroscopy, and neither was superior to a structured exercise programme at 2 years.
  • Cochrane review (Karjalainen et al, 2019) — high-certainty evidence that subacromial decompression provides little or no clinically important benefit over placebo for pain, function, or quality of life.

The practical consequence is that structured exercise/physiotherapy is first-line for subacromial pain, and ASD is now a selective operation — reserved for patients who have failed an adequate non-operative programme or who have a specific mechanical lesion. This does not make a well-selected decompression valueless, but it explains why the post-operative emphasis is on early movement and rehabilitation, which is what reliably drives recovery.

B. POST-OPERATIVE PHASED TIMELINE (isolated decompression)

A nerve block is commonly used (numb arm for some hours — start analgesia before it wears off). Keyhole wounds; desk-based work commonly resumes within ~2 weeks.

Phase Window Sling ROM / use Strengthening Notes
I — Early movement Week 0–2 Comfort only, off within days (gone by ≤ 2 wk) Hand/elbow immediately; pendulums + assisted motion as comfort allows; normal light daily use from day 1 — Settle pain/swelling; ice; analgesia before exercise. No driving while in sling (typically back ~1–3 wk once out of sling + safe emergency stop)
II — Restore range / start strength Week 2–6 Off Progress to full active ROM all planes Begin gentle cuff + scapular strengthening Range comfortable below shoulder height; most daily activity resumed
III — Strengthening Week 6–12 Off Full Progressive cuff/scapular loading, band → light weight Heavier and overhead loading built gradually
IV — Return to full activity Week 12 + Off Full Advanced/sport-specific Full unrestricted activity typically ~3 months

There is no construct-protection branch in the isolated decompression — the only branch is if a rotator cuff repair was also done, which converts recovery to the protected cuff-repair pathway.

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Does the bony decompression add anything? Two placebo-controlled RCTs (CSAW, FIMPACT) and a Cochrane review say it adds little or nothing over placebo or exercise for subacromial pain. Strong (RCT/SR). → exercise-first, selective surgery.
  2. Decompression added to a cuff repair — multiple RCTs show no added benefit of routine acromioplasty at the time of arthroscopic cuff repair. Moderate–strong.
  3. The post-operative rehab protocol itself — consensus/expert (institutional protocols), no defining rehab RCT; phase timings are typical, not trial-derived. Weak/consensus.

(Patient-facing note: the efficacy debate belongs in this clinician evidence section, not the patient protocol page — surfaced here for the surgeon's awareness.)

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (RCT / SR): ASD provides little/no benefit over placebo surgery or exercise (CSAW Lancet 2018; FIMPACT BMJ 2018; Cochrane Karjalainen 2019); no benefit of added acromioplasty at cuff repair.
  • MODERATE: early-motion rehabilitation after isolated decompression (institutional cohorts / consensus protocols, consistent ~3-month recovery).
  • WEAK / CONSENSUS: the specific phase/timeline structure of the post-op protocol.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Is acromioplasty justifiable? Orthop Traumatol Surg Res. 2019. DOI: 10.1016/j.otsr.2019.10.002
  • Indications for Arthroscopic Subacromial Decompression: a Level V evidence clinical guideline. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.06.012
  • The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness rotator cuff tears. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.11.022
  • Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty (RCT). Am J Sports Med. 2014. DOI: 10.1177/0363546514529091
  • A comparative study of arthroscopic débridement versus repair for Ellman grade I partial cuff tears. J Shoulder Elbow Surg. 2020. DOI: 10.1016/j.jse.2020.03.006

Landmark trials / reviews (URLs)

  • Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): placebo-controlled 3-group RCT. Lancet. 2018. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32457-1/fulltext
  • Paavola M, et al. (FIMPACT) Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled trial. BMJ. 2018;362:k2860. https://www.bmj.com/content/362/bmj.k2860
  • Karjalainen TV, et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Syst Rev. 2019. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005619.pub3/full

Published rehab protocols (basis for the phase structure)

  • Kendall C. Arthroscopic Subacromial Decompression Physical Therapy Protocol. OrthoIndy. https://www.orthoindy.com/wp-content/uploads/Arthroscopic-Subacromial-Decompression.pdf
  • Strauss EJ. Rehabilitation Protocol: Arthroscopic Subacromial Decompression / Distal Clavicle Excision. Sports Surgery New York. https://www.sportssurgerynewyork.com/pdf/arthroscopic-subacromial-decompression-distal-clavicle-excision-rehab-protocol.pdf
  • Gundersen Health System Sports Medicine. Subacromial Decompression / Acromioplasty Rehabilitation Program. https://www.gundersenhealth.org/sites/default/files/2022-06/Sports-Medicine-Protocol-Subacromial-Decompression-Acromioplasty.pdf
  • Meisterling RC. Arthroscopic Subacromial Decompression Rehabilitation. Twin Cities Orthopedics. https://tcomn.com/wp-content/uploads/2016/06/Arthroscopic-Subacromial-Decompression-Rehabilitation.pdf
  • Scott-Dempster C, Harper J. Outpatient Post-operative Physiotherapy Guidelines: Sub-Acromial Decompression. Oxford University Hospitals NHS FT. https://www.ouh.nhs.uk/media/zidppie2/sub-acromial-decompression.pdf
  • Royal Berkshire NHS FT. Arthroscopic subacromial decompression and/or ACJ excision: discharge advice. https://www.royalberkshire.nhs.uk/media/smegtn3c/arthroscopic-subacromial-decompression-and-or-acromioclavicular-joint-excision-discharge-advice_jul24.pdf

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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.