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Neurovascular Anatomy

Hand neurovascular anatomy: variations (median artery, DCBUN), nerve loops, and implications for nerve/vascular repair & transfers.

53 citationsUpdated Oct 2026
Illustration: Neurovascular Anatomy

Overview

The neurovascular anatomy of the upper extremity encompasses a complex microvascular system within human nerves that is analogous to experimental animal models [4]. The structure and function of intraneural microvessels are directly related to trauma, edema formation, and nerve function, where temporary or permanent interference with intraneural microcirculation may cause disturbances in nerve function [27]. A comprehensive understanding of the peripheral nervous system includes nerve fiber classification, receptor types, blood supply, and pharmacological agents affecting nerve function [6]. This global view extends from peripheral receptors to the somatosensory cortex [55]. Knowledge of anatomical variations, such as the penetration of a proper digital nerve by a common digital artery, is clinically relevant during operations in the vicinity of the nerve and when repairing nerve injuries [2, 7].

Clinicians must recognize symptomatic neural loops as a rare anatomic variation and diagnostic challenge of exclusion, considering microvascular decompression if other etiologies are absent [8]. Vascular insufficiency of the upper extremity requires a thorough understanding of vascular anatomy, diagnostic modalities, and medical and surgical management options, with promising advances continuing in its treatment [15]. Significant advances have also been made in the pathogenesis and genetics of vascular anomalies relevant to the upper limbs, with classification systems, diagnosis, and treatment remaining areas of focus [57].

Reference texts provide comprehensive, highly detailed, and readable anatomy for the upper extremity, including the nail bed, skin, fascia, compartments, palmar spaces, digits, and neurovascular structures [5, 50]. Hand anatomy, diagnosis, and treatment principles emphasize the balance between restoring function and maintaining aesthetic appearance [53]. A critical overview of upper extremity peripheral nerve injuries is provided by an analysis of median, radial, and ulnar nerve injuries presenting to US emergency departments [21]. The design and outcome measures of peripheral nerve basic science research are important for hand surgeons to understand for potential clinical translation [49].

Osseous Anatomy

The human peripheral nerves possess a microvascular system analogous to the intraneural system observed in experimental animals [4]. Vascular integrity is maintained during specific surgical maneuvers; for instance, the median nerve at the wrist may be advanced while retaining its vascular connection and blood supply from the radial artery [13]. In the distal digital segment, the size of the vessels at each level permits microvascular anastomosis [29].

Anatomical variations and constancies characterize the digital and ulnar nerve territories. Serial histologic sections of 20 ulnar nerves revealed broad individual variations in the number and diameter of the fascicles at all levels [14]. Conversely, the direct small branches of the proper digital nerve of the fingers exhibit anatomical constancy [35]. The levels of division of the different branches of the ulnar nerve were precisely determined by an analysis of variations in the areas of muscular innervation [33, 34].

Comparative studies of wrist vasculature indicate that anatomical dissections and radionucleotide flow studies of the ulnar and radial arteries failed to demonstrate any difference between the anatomical dimensions of these vessels [24]. Regarding sympathetic nerve morphology, the distal adrenergic nerves were morphologically normal in appearance after perivascular sympathectomy [40].

Ligaments and Joint Capsule

The thumb trapeziometacarpal joint ligaments exhibit a distinct innervation pattern that supports a proprioceptive function in addition to their biomechanical importance [54]. This sensory distribution is characterized by an abundance of nerve endings located within the dorsal ligaments [54]. In contrast, the anterior oblique ligament contains little to no innervation [54].

Muscles and Tendons

The abductor digiti minimi and flexor digiti minimi brevis muscles possess 1 major and 2 minor vascular pedicles [63].

Neurovascular Anatomy

Digital Neurovascular Anatomy

In Dupuytren’s disease, the neurovascular bundle exhibits a spiralling pattern [1]. To prevent injury during surgery, surgeons must identify and dissect the neurovascular bundle proximally and distally throughout its course [1]. Hand surgeons must also recognize the existence of digital neural loop penetrations to prevent iatrogenic damage, as these structures may be damaged if not carefully identified at operation [3]. Penetration of a proper digital nerve by a common digital artery represents an underrecognized anatomic variation that can cause neurovascular symptoms [7]. Clinicians must be aware of this anatomic variation and consider microvascular decompression if other etiologies are absent [8].

The blood supply of the digital nerve depends strictly on the artery/vein pedicle of which it is a satellite [42]. Ubiquitous connections exist between the vasa vasorum and the vasa epineurium along the digital pedicle [42].

Intraneural Vascularization and Physiology

Peripheral nervous system anatomy encompasses nerve fiber classification, receptor types, blood supply, and pharmacological agents affecting nerve function [6].

Forearm and Median Nerve Vascularization

It may be possible to advance the median nerve at the wrist while retaining the vascular connection and blood supply from the radial artery [13]. This advancement may maintain the vascularity of the nerve at the common site of nerve repair in the distal forearm [13]. Funicular plexus formation and interchange takes place in the nerves of the human forearm [18]. These funicular connections are not of such a degree as to preclude operative procedures such as intraneural neurolysis, fascicular nerve repair, and interfascicular nerve grafting [18].

Vascular Dynamics and Injury

In a rat model of immediate and delayed repairs, nerve blood flow decreased approximately 50% with substantial recovery in 30 minutes after 8% elongation [16]. In the same model, 15% elongation produced approximately an 80% reduction in nerve blood flow with minimal recovery [16]. Combined nerve and artery injuries caused the most significant alterations in hand vascularity [20]. Median nerve and associated artery injuries caused the most disabling symptoms [20].

Biomechanics and Function

Nerve Tension and Blood Flow

In models of immediate and delayed nerve repairs, 8% elongation decreased nerve blood flow by approximately 50% in both proximal and distal segments, with substantial recovery occurring within 30 minutes [16]. In contrast, 15% elongation produced an approximately 80% reduction in nerve blood flow with minimal recovery [16]. Peripheral nerves possess sufficient reparative properties to adjust biomechanically to moderate gaps [56]. It remains to be determined if the return of nerve function parallels the mechanically adaptive findings observed in response to tension [56].

Compression and Ischemia Effects

Small amounts of compression applied for short durations mechanically deformed the ulnar nerve, influencing the nerve conduction response in a non-ischaemic manner [23]. Acute compression of a nerve may cause persistent impairment of intraneural microcirculation due to mechanical injury to blood vessels [25]. Preconditioning of neural tissue by ischemic parameters makes nerves more susceptible to mechanical stimuli and injury [62].

Vascular Anatomy and Supply

Human peripheral nerves present a microvascular system analogous to the intraneural system of experimental animals [4]. Tissues with low metabolic rates, such as tendons and nerves, are supplied by fewer small vessels and a disproportionate number of large vessels compared to metabolically active tissues [61]. A constant identifiable vascular pedicle to the median nerve exists in the distal forearm [10]. A dissection technique for the median nerve in the distal forearm enables adequate mobilization while preserving vascularity and achieving tensionless repair [10]. Anatomical dissections and radionucleotide flow studies failed to demonstrate any difference between the anatomical dimensions of the ulnar and radial arteries at the wrist [24]. The size of vessels at each level of the distal digital segment permits microvascular anastomosis [29].

Neurovascular Bundle Relationships

The neurovascular bundle in Dupuytren’s disease spirals, requiring surgeons to identify and dissect it proximally and distally throughout its course to prevent injury [1]. Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury [9]. In muscle transfer, the neurovascular pedicle vessels are the predictable limiting factor for translation due to their shorter length compared to the nerve [59].

Trauma and Injury Risk

Nerve injury after ballistic trauma to the upper extremity is common, with vascular injury and fractures associated with a higher risk of nerve injury [22].

Common Sites of Injury

In Dupuytren’s disease, the neurovascular bundle spirals, requiring surgeons to identify and dissect it proximally and distally throughout its course to prevent injury [1]. Anatomical landmarks and data can predict the position of palmar cutaneous branches of the proper digital nerves to facilitate safer surgical dissection in this context [12]. Recognition of anatomical details and variations of the ulnar nerve is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury [17].

Trauma and Acute Injury: Early exploration of supracondylar fractures allows direct visualization of the extent of neurovascular injury and immediate intervention [26]. In cases of avulsion and crush injury, there is widespread damage to arteries distant to the injury field [32]. Penetrating injury to vessels should be thoroughly explored and repaired [37]. Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist in an effort to optimize outcomes [38].

Athletic Injuries: Most nerve lesions sustained by athletes are best described as neuropraxias, which is the mildest form of nerve injury denoting a conduction block where all nerve elements remain in continuity [44].

Surgical Anatomy

Anatomical variations and specific neural structures dictate safe operative corridors and repair techniques across multiple regions. In the hand, knowledge of anatomical variations is useful during operations in the vicinity of the posterior interosseous nerve and when repairing nerve injuries [2]. Neural loop penetrations in the palm may be damaged if not carefully identified at operation, making it important for hand surgeons to recognize these structures [3]. All palm operations must be done with great care to visualize and protect unusual anatomical structures [19]. A dissection technique enables adequate mobilization of the median nerve while preserving vascularity and achieving tensionless repair [10]. Successful nerve repair requires proper identification of the neural zone of injury, meticulous nerve handling, and fine microsurgical repair [31].

Palmar Neurovascular Zones: The Berrettini communicating branches are positioned consistently in the palm [19]. A high-risk zone in the palm fully contains seven of the 12 Berrettini communicating connections [19]. Awareness of the high-risk zone for Berrettini communicating branches can help reduce the risk of iatrogenic nerve injury [19]. The central area of the palm contains a triangular zone which is poorly vascularized [45]. Ulnar-based cutaneous nerves to the palm were found within the zone of incision in 16 of 25 specimens [48]. Ulnar-based cutaneous nerves to the palm are not necessarily preserved by longitudinal palmar incisions in the axis of the ring finger [48]. Identifying and carefully managing dual radial digital nerves in the right ring finger ensured a successful surgical outcome without neurologic compromise [47].

Dorsal and Peripheral Approaches: A definable zone over the dorsal skin exists for surgical incisions where no major branch of the superficial branch of the radial nerve or dorsal branch of the ulnar nerve passes [11]. Recognition of anatomical details and variations is essential for accurate diagnosis and surgical decompression of the ulnar nerve to avoid iatrogenic injury [17]. In the lower extremity, a 'high and inside' approach that remains superior to the superior border of the peroneus brevis tendon is anatomically safe [28]. This approach may decrease the chance of intraoperative nerve injury and irritation postoperatively [28].

Key Evidence

  • [L4] Surgeons should identify and dissect the neurovascular bundle proximally and distally throughout its course to prevent injury. [1] (10.1177/1753193409349855)
  • [L4] Knowledge of anatomical variations is useful during operations in the vicinity of the nerve and when repairing nerve injuries. [2] (10.1054/jhsb.2000.0399)
  • [L5] If neural loop penetrations are not carefully identified at operation they may be damaged and therefore it is important for hand surgeons to recognize the existence of these structures. [3] (10.1016/s0266-7681(99)90019-0)
  • [L5] The human nerves present a microvascular system analogous to the intraneural system of experimental animals. [4] (10.1016/s0363-5023(79)80102-1)
  • [Paper] The book 'Surgical Anatomy of the Hand & Upper Extremity' is described as a comprehensive, highly detailed, and readable text that provides user-friendly, portable, and clinically relevant anatomy for the upper extremity. [5] (10.1197/j.jht.2003.10.013)
  • [L5] The patient presented with neurovascular symptoms due to penetration of a proper digital nerve by a common digital artery, which is described as the first clinically relevant description of this underrecognized anatomic variation. [7] (10.1016/s0363-5023(96)80325-x)
  • [Case_report] Symptomatic neural loops are a rare, diagnostic challenge and diagnosis of exclusion; clinicians must be aware of this anatomic variation and consider microvascular decompression if other etiologies are absent. [8] (10.1016/j.jhsa.2012.07.012)
  • [L5] Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. [9] (10.1016/j.jhsa.2013.12.004)
  • [L2] The study established the presence of a constant identifiable vascular pedicle to the median nerve in the distal forearm and developed a dissection technique that enables adequate mobilization while preserving vascularity and achieving tensionless repair. [10] (10.1016/s0363-5023(09)60086-1)
  • [L5] A definable zone over the dorsal skin for surgical incisions exists where no major branch of the superficial branch of the radial nerve or dorsal branch of the ulnar nerve passes. [11] (10.1016/j.jhsa.2005.12.021)
  • [Textbook] Anatomical landmarks and data can predict the position of these branches to facilitate safer surgical dissection. [12] (10.1007/978-3-642-22697-7_33)
  • [L5] This cadaveric study suggests that it may be possible to advance the median nerve at the wrist while retaining the vascular connection and blood supply from the radial artery, and so maintain the vascularity of the nerve at the common site of nerve repair in the distal forearm. [13] (10.1016/j.jhsa.2012.03.028)
  • [L5] Serial histologic sections of 20 ulnar nerves revealed broad individual variations in the number and diameter of the fascicles at all levels. [14] (10.1016/s0363-5023(85)80119-2)
  • [L5] Vascular insufficiency of the upper extremity requires a thorough understanding of vascular anatomy, diagnostic modalities, and medical and surgical management options, with promising advances continuing to be made in treatment. [15] (10.1016/j.jhsa.2010.06.011)
  • [Paper] In both the proximal and distal segments of the divided nerve in models of immediate and delayed repairs, the nerve blood flow decreased approximately 50% with substantial recovery in 30 minutes after 8% elongation, whereas 15% elongation produced approximately an 80% reduction in blood flow with minimal recovery. [16] (10.1016/0363-5023(92)90316-h)
  • [L5] Recognition of these anatomical details and variations is essential for accurate diagnosis and surgical decompression to avoid iatrogenic injury. [17] (10.1016/j.hcl.2007.05.001)
  • [L5] Our study confirms and amplifies Sunderland's findings: although it is true that funicular plexus formation and interchange takes place in the nerves of the human forearm, these connections are not of such a degree as to preclude operative procedures such as intraneural neurolysis, fascicular nerve repair, and interfascicular nerve grafting. [18] (10.1016/s0363-5023(80)80035-9)
  • [L5] The Berrettini communicating branches were positioned consistently, and a high-risk zone in the palm was defined that fully contained seven of the 12 connections; awareness of this zone can help reduce the risk of iatrogenic nerve injury, though all palm operations must be done with great care to visualize and protect unusual anatomical structures. [19] (10.1177/17531934221095401)
  • [L4] Combined nerve and artery injuries caused the most significant alterations in hand vascularity, and median nerve and associated artery injuries caused the most disabling symptoms. [20] (10.1016/s0363-5023(79)80031-3)
  • [L4] This study provides a critical overview of upper extremity peripheral nerve injuries. [21] (10.1016/j.jht.2026.02.012)
  • [L4] Nerve injury after ballistic trauma to the upper extremity is common, with vascular injury and fractures associated with a higher risk of nerve injury. [22] (10.1016/j.jhsa.2021.03.020)
  • [Paper] Small amounts of compression applied for short durations mechanically deformed the nerve which subsequently influenced the nerve conduction response in a non-ischaemic manner. [23] (10.1016/0266-7681(91)90143-c)
  • [L4] Anatomical dissections and radionucleotide flow studies of the ulnar and radial arteries at the wrist failed to demonstrate any difference between the anatomical dimensions of these vessels. [24] (10.1016/s0266-7681(05)80060-9)
  • [Paper] It is concluded that acute compression of a nerve may cause persistent impairment of intraneural microcirculation due to mechanical injury to blood vessels. [25] (10.1016/s0363-5023(81)80003-2)
  • [L4] Early exploration of supracondylar fractures allows direct visualization of the extent of neurovascular injury and immediate intervention. [26] (10.1177/17531934231201925)
  • [L5] The article reviews the structure and function of intraneural microvessels and the pathophysiology of intraneural edema, emphasizing that temporary or permanent interference with intraneural microcirculation may cause disturbances in nerve function. [27] (10.2106/00004623-197557070-00011)
  • [L5] A 'high and inside' approach that remains superior to the superior border of the peroneus brevis tendon is anatomically safe and may decrease the chance of intraoperative nerve injury and irritation postoperatively. [28] (10.1177/0363546512448320)
  • [L5] The size of the vessels at each level permits microvascular anastomosis. [29] (10.1016/0266-7681(88)90129-5)
  • [L5] Successful nerve repair requires proper identification of the neural zone of injury, meticulous nerve handling, and fine microsurgical repair. [31] (10.1016/j.jhsg.2024.01.026)
  • [L4] The findings of this study support that there is widespread damage to arteries distant to the injury field in cases of avulsion and crush injury. [32] (10.1142/s2424835518500261)
  • [L5] The levels of division of the different branches were precisely determined by an analysis of variations in the areas of muscular innervation. [33] (10.1016/0266-7681_85_90007-5)
  • [L5] The levels of division of the different branches were precisely determined by an analysis of variations in the areas of muscular innervation. [34] (10.1016/0266-7681(85)90007-5)
  • [L5] In this study, we verified the anatomical constancy of the direct small branches of the proper digital nerve. [35] (10.1177/1558944716660555jj)
  • [L4] Penetrating injury to vessels should be thoroughly explored and repaired. [37] (10.1016/s0363-5023(87)80158-2)
  • [L3] Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist in an effort to optimize outcomes. [38] (10.1177/1558944719866865)
  • [Paper] The distal adrenergic nerves were morphologically normal in appearance after the perivascular sympathectomy. [40] (10.1016/0266-7681(91)90008-c)
  • [L5] The blood supply of the digital nerve depends strictly on the artery/vein pedicle of which it is a satellite, with ubiquitous connections between the vasa vasorum and the vasa epineurium along the digital pedicle. [42] (10.1016/0266-7681(92)90189-9)
  • [L5] Most nerve lesions sustained by athletes are best described as neuropraxias, which is the mildest form of nerve injury denoting a conduction block where all nerve elements remain in continuity. [44] (10.1016/s0278-5919(05)70256-8)
  • [L5] The central area of the palm contains a triangular zone which is poorly vascularized. [45] (10.2106/00004623-195436060-00012)
  • [L4] Identifying and carefully managing this anatomic variant ensured a successful surgical outcome without neurologic compromise. [47] (10.1016/j.jhsg.2025.100906)
  • [L5] Our finding that the ulnar-based cutaneous nerves to the palm were found within the zone of incision in 16 of 25 specimens indicates that these nerves are also not necessarily preserved by longitudinal palmar incisions in the axis of the ring finger. [48] (10.1016/s0363-5023(96)80017-7)
  • [L5] The purpose of this article is to provide an overview of the importance of the design and outcome measures of peripheral nerve basic science research, for hand surgeons to understand for potential clinical translation. [49] (10.1016/j.jhsa.2021.02.016)
  • [L5] The thumb trapeziometacarpal joint ligaments had an abundance of nerve endings in the dorsal ligaments but little to no innervation in the anterior oblique ligament, inferring a proprioceptive function of these ligaments in addition to their biomechanical importance. [54] (10.1016/j.jhsa.2011.12.038)
  • [Paper] The paper presents a global view of nerves and their function, covering topics from peripheral receptors to the somatosensory cortex. [55] (10.1016/s0894-1130(12)80286-9)
  • [Paper] Peripheral nerves have sufficient reparative properties to adjust biomechanically to moderate gaps; however, it remains to be determined if return of function parallels these mechanically adaptive findings. [56] (10.1016/s0363-5023(80)80037-2)
  • [L5] This article aims to provide an update on vascular anomalies relevant to the upper limbs, focusing on significant advances in pathogenesis and genetics, classification systems, diagnosis and treatment. [57] (10.1177/1753193418808130)
  • [L5] In muscle transfer, the neurovascular pedicle vessels are the predictable limiting factor for translation due to their shorter length compared to the nerve. [59] (10.1016/j.jse.2014.07.001)
  • [L5] Tissues with low metabolic rates, such as tendons and nerves, are supplied by fewer small vessels and a disproportionate number of large vessels compared to metabolically active tissues. [61] (10.2106/00004623-196143080-00010)
  • [Paper] This study provides the first concrete evidence that the preconditioning of neural tissue by ischemic parameters makes nerves much more susceptible to mechanical stimuli/injury. [62] (10.1016/s0363-5023(09)60085-x)
  • [L5] The dissections and the microangiography of the muscles revealed 1 major and 2 minor pedicles. [63] (10.1016/j.jhsa.2004.06.001)

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[48] The cutaneous innervation of the palm: An anatomic study of the ulnar and median nerves. The Journal of Hand Surgery. 1996. DOI: 10.1016/s0363-5023(96)80017-7

[49] Peripheral Nerve Basic Science Research—What Is Important for Hand Surgeons to Know?. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.016

[50] Chapter 23 Anatomy of the Hand and Wrist. 2019.

[53] 9. Hand Surgery. 2013.

[54] Innervation Patterns of Thumb Trapeziometacarpal Joint Ligaments. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.038

[55] From the Periphery to the Somatosensory Cortex — A Global View of Nerves and Their Function. Journal of Hand Therapy. 1993. DOI: 10.1016/s0894-1130(12)80286-9

[56] The biomechanical responses to tension in a peripheral nerve. The Journal of Hand Surgery. 1980. DOI: 10.1016/s0363-5023(80)80037-2

[57] Vascular anomalies of the upper limb. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418808130

[59] The neurovascular anatomy of the teres major muscle. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.07.001

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[62] Ischemic Nerves are more Susceptible to Mechanical Injury. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60085-x

[63] The vascular anatomy of the abductor digiti minimi and the flexor digiti minimi brevis muscles. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2004.06.001

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

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

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

Creative Commons Attribution-NonCommercial 4.0 International Public License

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

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.