Skip to content

Pectoralis Major Rupture

Pectoralis major tendon rupture and repair (corpus-synthesised).

Overview

Surgical repair is the definitive treatment for clinical pectoralis major ruptures, offering superior strength and functional outcomes compared to nonoperative management [1, 3, 6, 7]. This benefit extends to both acute and chronic presentations, with no statistically significant difference in outcomes between the two operative groups [3]. Early anatomic repair is particularly critical for total and near-total ruptures to achieve optimal results [4], and is the treatment of choice for complete acute ruptures in athletes [9]. While early intervention is preferred, successful repair remains feasible even 13 years after the initial injury [2].

The procedure is associated with a complication rate of 14.21% [6, 7] but can be performed safely with low re-rupture rates [5]. Early surgical repair combined with an accelerated rehabilitation protocol reliably restores shoulder function and strength, facilitating an early return to sports and functional activity [10]. In specific populations, such as military service members, repair using intramedullary suture anchors yields high rates of return to duty, high patient satisfaction, and superior patient-reported outcomes [17]. Total ruptures in athletes demonstrate significantly better outcomes with surgical treatment based on the Bak criteria compared to nonoperative care [8].

Anatomy & Pathophysiology

The distal pectoralis major tendon exhibits a 'U' shape comprised of an anterior layer (clavicular head and, to a lesser extent, sternal head) and a posterior layer (sternal head) that fuse proximal to the distal tendon attachment on the humerus [13]. The humeral insertion consists of a unilaminar fibrocartilaginous enthesis [24]. Ultrasound provides fresh insights on the role of evaluating pectoralis major anatomy and tendon attachment to bone [27].

Classification: A contemporary injury classification system for pectoralis major tears includes injury timing, injury location, and standardized terminology addressing tear extent to reflect musculotendinous morphology [21]. A new classification of pectoralis major injury has been proposed specifically for isolated tears of the sternocostal head [18].

Diagnostic Testing: The Pectoralis Major Index (PMI) technique is a simple, quantifiable, and accurate clinical diagnostic test for structurally significant pectoralis major tears [12].

Surgical Timing and Outcomes: Anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes [9]. Early surgical repair of distal pectoralis major tendon ruptures combined with an accelerated rehabilitation protocol provides reliable restoration of shoulder function and strength [10]. Surgical repair of pectoralis major tears results in significant improvements in shoulder function [22]. Surgical repair of pectoralis major tendon ruptures can be successfully performed 13 years after the initial injury [2]. A statistically significant decrease in player performance was observed after surgically treated pectoralis major tears, though this difference was no longer seen after stratification by position type and draft selection [29].

Biomechanical Repair Constructs: A locking whipstitch of the pectoralis major tendon over a length of 6 cm provides superior biomechanical properties at time zero compared to 2 cm or 4 cm lengths [23]. Augmentation of pectoralis major tendon repair with an acellular dermal matrix significantly increases the ultimate load to failure compared to standard repair [26]. Augmentation of pectoralis major tendon repair with an acellular dermal matrix achieves biomechanical properties equivalent to the native tendon [26]. Repair constructs utilizing larger caliber suture and suture tape provide a measurable improvement in construct strength versus traditional pectoralis major repair techniques [28]. The cortical button repair method for pectoralis major tendon ruptures may be associated with better long-term pain and functional outcomes compared to the transosseous tunnel repair method [30].

Classification

Surgical Outcome Classification: Surgical repair provides superior results compared to conservative treatment for patients with a clinical diagnosis of pectoralis major rupture in terms of regaining strength and functional outcome [1]. Operative treatment for acute or chronic pectoralis major ruptures yields significantly better outcomes than nonoperative treatment [3]. There is no statistically significant difference in outcomes between acute and chronic operative groups for pectoralis major ruptures [3]. Early surgical treatment via anatomic repair provides the best results for total and near-total ruptures of the pectoralis major muscle [4]. Total ruptures of the pectoralis major muscle exhibit better outcomes with surgical treatment than with nonoperative treatment in athletes based on the Bak criteria [8]. Anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes [9]. Surgical repair of pectoralis major tendon ruptures can be performed safely with a low re-rupture rate and low risk of complications [5].

Anatomic Morphology: The distal pectoralis major tendon exhibits a 'U' shape comprised of an anterior layer (clavicular head and, to a lesser extent, sternal head) and a posterior layer (sternal head) that fuse proximal to the distal tendon attachment on the humerus [13].

Diagnostic and Injury Classification Systems: The Pectoralis Major Index (PMI) technique is a simple, quantifiable, and accurate clinical diagnostic test for structurally significant pectoralis major tears [12]. MRI is accurate for diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, tendon-bone, and G3 tears [16]. A new classification of pectoralis major injury has been proposed specifically for isolated tears of the sternocostal head [18]. A contemporary injury classification system for pectoralis major tears includes injury timing, injury location, and standardized terminology addressing tear extent to reflect musculotendinous morphology [21].

Other Considerations: Steer wrestlers represent a unique cohort of pectoralis major rupture case studies [11].

Clinical Presentation

Surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes, providing superior strength and functional outcomes compared to nonoperative management [1][3][6][7][8][9]. Early anatomic repair yields the best results for total and near-total ruptures, with outcomes for acute and chronic operative groups showing no statistically significant difference [3][4]. While loss of strength is not complete with conservative treatment, operative repair is essential to restore complete function and contour, particularly in young athletes [15]. Repair can be successfully performed even 13 years after the initial injury, though early intervention with anatomic repair and accelerated rehabilitation protocols reliably restores shoulder function, strength, and allows for an early return to sports [2][10].

Diagnostic accuracy is supported by MRI, which is particularly effective for identifying acute, tendon-bone, and G3 tears [16]. The Pectoralis Major Index (PMI) serves as a simple, quantifiable, and accurate clinical test for structurally significant tears [12], while the Cruciform Test offers a simple, reproducible indicator of both rupture and successful repair [19]. Anatomically, the distal tendon exhibits a 'U' shape with anterior (clavicular and sternal heads) and posterior (sternal head) layers that fuse proximal to the humeral attachment [13]. Prognosis is unrelated to patient age or rupture location [20].

Complications following surgical repair occur in 14.21% of cases, though the procedure remains safe with low re-rupture and complication rates [5][6][7]. Steer wrestlers represent a unique cohort for case studies [11]. In rare instances of compartment syndrome, prompt recognition and decompression followed by delayed tendon repair can result in a successful return to normal function [14].

Investigations

Plain radiography: No specific plain radiographic signs or indications are supported by the provided evidence base for pectoralis major rupture.

MRI: MRI is accurate for diagnosing the tear grade and location of pectoralis major tendon ruptures [16]. It is particularly accurate for diagnosing acute, tendon-bone, and G3 tears of the pectoralis major tendon [16].

Other Considerations: The Pectoralis Major Index (PMI) technique is a simple, quantifiable, and accurate clinical diagnostic test for structurally significant pectoralis major tears [12]. The Cruciform Test is a simple and reproducible diagnostic tool with potential as a clinical indicator of pectoralis major rupture [19] and has potential as a clinical indicator of successful pectoralis major repair [19]. Anatomically, the distal pectoralis major tendon has a 'U' shape comprised of an anterior layer (clavicular head and, to a lesser extent, sternal head) and a posterior layer (sternal head) [13]. The anterior and posterior layers of the distal pectoralis major tendon fuse proximal (medial) to the distal tendon attachment on the humerus [13]. Surgical repair provides superior results in regaining strength and functional outcome for patients with a clinical diagnosis of pectoralis major rupture [1]. Patients treated operatively for acute or chronic pectoralis major ruptures fare significantly better than those treated nonoperatively [3], with repair resulting in significantly superior outcomes compared with nonoperative treatment [6, 7]. Early surgical treatment by anatomic repair yields the best results for total and near-total ruptures of the pectoralis major muscle [4]. Anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes [9]. Surgical repair of the ruptured pectoralis major muscle is important to restore complete function and contour, especially in young athletes [15], though loss of strength is not complete in conservative treatment [15]. Surgical repair can be successfully performed 13 years after the initial injury [2], and there is no statistically significant difference in outcomes between acute and chronic operative groups [3]. Surgical repair can be performed safely with a low re-rupture rate and low risk of complications [5], with a complication rate associated with pectoralis major tendon repair of 14.21% [6, 7]. Prompt recognition and decompression of pectoral/upper arm compartment syndrome followed by delayed pectoralis major tendon repair can result in a successful return to normal function [14]. Steer wrestlers represent a unique cohort of pectoralis major rupture case studies [11].

Treatment

Non-Operative

Conservative management of pectoralis major rupture results in incomplete restoration of strength [15]. Operative treatment yields significantly superior functional outcomes and strength recovery compared to nonoperative care for both acute and chronic ruptures [3, 6, 7]. In athletes specifically, total ruptures demonstrate better outcomes with surgical intervention based on the Bak criteria [8].

Operative

Indications: Surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes [9]. Early anatomic repair provides the best results for total and near-total ruptures [4]. Surgical intervention is critical to restore complete function and contour, particularly in young athletes [15].

Surgical Approach / Technique: Anatomic surgical repair is the preferred technique for complete acute ruptures [9]. Early surgical repair combined with an accelerated rehabilitation protocol reliably restores shoulder function and strength [10]. This approach also facilitates an early return to sports and functional activity [10]. Repair can be successfully performed even 13 years after the initial injury [2].

Implant Selection: Repair using intramedullary suture anchors demonstrates high rates of return to duty, patient satisfaction, and patient-reported outcomes [17].

Complications: Surgical repair is associated with a 14.21% complication rate [6, 7]. Despite these risks, repair can be performed safely with a low re-rupture rate and low risk of complications [5].

Outcomes: Patients treated operatively for acute or chronic ruptures fare significantly better than those treated nonoperatively [3]. There is no statistically significant difference in outcomes between acute and chronic operative groups [3]. Surgical treatment of acute ruptures results in high levels of return to work and sport [25].

Complications

General Complications: Surgical repair of pectoralis major tendon ruptures is associated with a low risk of complications [5] and a low re-rupture rate [5]. However, the overall complication rate for pectoralis major tendon repair is reported at 14.21% [6, 7].

Compartment Syndrome: Compartment syndrome secondary to acute pectoralis major tendon rupture is a documented complication [14]. Prompt recognition and decompression of pectoral/upper arm compartment syndrome followed by delayed pectoralis major tendon repair can result in a successful return to normal function [14].

Other Considerations: No evidence provided for infection, aseptic loosening, instability, periprosthetic fracture, thromboembolism, patellar/extensor-mechanism issues, stiffness/arthrofibrosis, nerve palsy, wound complications, or polyethylene wear.

Recovery

Surgical outcomes: Surgical repair provides superior results in terms of regaining strength and functional outcome compared to conservative treatment for patients with a clinical diagnosis of pectoralis major rupture [1]. Operative treatment for acute or chronic pectoralis major ruptures results in significantly better outcomes than nonoperative treatment [3]. Pectoralis major tendon repair results in significantly superior outcomes compared with nonoperative treatment [6, 7]. Total ruptures of the pectoralis major muscle exhibit better outcomes with surgical treatment than with nonoperative treatment in athletes based on the Bak criteria [8]. Early surgical treatment by anatomic repair yields the best results for total and near-total ruptures of the pectoralis major muscle [4]. There is no statistically significant difference in outcomes between acute and chronic operative groups for pectoralis major ruptures [3].

Rehabilitation protocol: Early surgical repair of distal pectoralis major tendon ruptures combined with an accelerated rehabilitation protocol provides reliable restoration of shoulder function and strength [10]. This approach allows for an early return to sports and functional activity [10]. Surgical repair of pectoralis major tendon ruptures can be performed safely with a low re-rupture rate and low risk of complications [5]. Pectoralis major tendon repair is associated with a 14.21% complication rate [6, 7]. Prompt recognition and decompression of pectoral/upper arm compartment syndrome followed by delayed pectoralis major tendon repair can result in a successful return to normal function [14].

Functional milestones: The prognosis of pectoralis major rupture is related neither to the age of the patient nor to the location of the rupture [20]. Among military personnel, Army soldiers and junior officer/enlisted rank are at the highest risk of pectoralis major tendon ruptures [31]. Among military personnel, junior personnel are at the highest risk of being unable to return to duty after surgical treatment [31].

Key Evidence

  • [L3] We therefore conclude that, in a patient with the clinical diagnosis of rupture of the pectoralis major, surgical repair will give the best results in terms of regaining strength and functional outcome. (10.1136/bjsm.35.3.202)
  • [L4] Repair of a pectoralis major muscle rupture was successfully performed 13 years after the initial injury. (10.1177/03635465000280021901)
  • [L3] Patients treated operatively for acute or chronic pectoralis major ruptures fared significantly better than those treated nonoperatively, with no statistically significant difference in outcomes between acute and chronic operative groups. (10.1177/03635465000280012701)
  • [L4] Early surgical treatment by anatomic repair gives the best results in the treatment of total and near-total ruptures of the pectoralis major muscle. (10.1177/0363546503261137)
  • [L4] Surgical repair of pectoralis major tendon ruptures can be performed safely with a low re-rupture rate and low risk of complications. (10.1177/2325967117s00242)
  • [L1] Pectoralis major tendon repair resulted in significantly superior outcomes compared with nonoperative treatment, with an associated 14.21% complication rate. (10.1177/2325967119900813)
  • [L1] Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. (10.1177/2325967120s00411)
  • [L2] Total ruptures of the pectoralis major muscle exhibit better outcomes with surgical treatment than with nonoperative treatment based on the Bak criteria in athletes. (10.1177/0363546513506556)
  • [L4] In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes. (10.2147/oajsm.s9066)
  • [L4] Early surgical repair of distal pectoralis major tendon ruptures and an accelerated rehabilitation protocol provide reliable restoration of shoulder function and strength, allowing an early return to sports and functional activity. (10.1007/s00264-006-0171-2)
  • [L4] Steer wrestlers represent a unique cohort of pectoralis major rupture case studies. (10.1155/2013/987910)
  • [L2] The PMI technique is a simple, quantifiable, and accurate clinical diagnostic test for structurally significant pectoralis major tears. (10.1177/2325967113516729)
  • [L5] New anatomic descriptions of the distal pectoralis major tendon detail a ' U ' shape of the distal tendon comprised of anterior layer (the clavicular head and, to a lesser extent, the sternal head) and posterior layer (the sternal head), which fuse proximal (i.e., medial) to the distal tendon attachment on the humerus. (10.1007/s00256-014-1990-7)
  • [L4] Our case demonstrates that prompt recognition and decompression of pectoral/upper arm compartment syndrome, followed by delayed pectoralis major tendon repair, can result in a successful return to normal function. (10.1016/j.jse.2014.10.023)
  • [L3] MRI is accurate for diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, tendon-bone, and G3 tears. (10.1016/j.jse.2015.08.037)
  • [L4] Repair of the pectoralis major tendon ruptures using intramedullary suture anchors has high rates of return to duty, patient satisfaction, and patient-reported outcomes. (10.1016/j.jse.2024.04.029)
  • [L4] The authors propose a new classification of pectoralis major injury and present a biomechanically sound repair technique for isolated tears of the sternocostal head with favorable outcomes. (10.1016/j.jse.2019.11.024)
  • [L4] The Cruciform Test is a simple and reproducible diagnostic tool that has potential as a clinical indicator of both pectoralis major rupture and successful repair. (10.1177/17585732211058457)
  • [L1] The prognosis is related neither to the age of the patient nor to the location of the rupture. (10.1007/s001670050197)
  • [L4] A contemporary injury classification system is proposed that includes injury timing, injury location, and standardized terminology addressing tear extent to more accurately reflect the musculotendinous morphology of PM injuries and better inform surgical management, rehabilitation, and research. (10.1016/j.jse.2011.04.035)
  • [L3] Patients undergoing repair of the PMM are expected to have significant improvements in function of the shoulder. (10.1177/2325967119s00252)
  • [L5] A locking whipstitch of the PM tendon over a length of 6 cm provides superior biomechanical properties at time zero compared to 2 cm or 4 cm lengths. (10.1016/j.jse.2025.01.045)
  • [L5] The PM tendon humeral insertion consists of a unilaminar fibrocartilaginous enthesis. (10.1016/j.jse.2019.12.020)
  • [L5] Surgical treatment of acute ruptures is superior to nonsurgical treatment and results in improved functional outcomes and high levels of return to work and sport. (10.5435/jaaos-d-21-00541)
  • [L5] Augmentation of pectoralis major tendon repair with an acellular dermal matrix significantly increases the ultimate load to failure compared to standard repair and achieves biomechanical properties equivalent to the native tendon. (10.1016/j.jse.2019.09.020)
  • [L4] Fresh insights are provided on the role of US in evaluating PM anatomy and tendon attachment to bone. (10.1007/s00590-014-1451-y)
  • [L5] Repair constructs with larger caliber suture and suture tape provide a measurable improvement in construct strength versus traditional PM repair techniques in a biomechanical model. (10.1177/0363546517716175)
  • [L4] Although we found a statistically significant decrease in player performance after surgery, this difference was no longer seen after players were stratified by position type and draft selection. (10.1016/j.asmr.2022.07.009)
  • [L4] The cortical button repair method for pectoralis major tendon ruptures may be associated with better long-term pain and functional outcomes as reported on the American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand surveys compared to the transosseous tunnel repair method, but further investigation is needed. (10.1016/j.xrrt.2026.100742)
  • [L3] Among military personnel, Army soldiers and junior officer/enlisted rank were at highest risk of pectoralis major tendon ruptures, and junior personnel were at highest risk of being unable to return to duty after surgical treatment. (10.1177/0363546516637177)

References

[1] Pectoralis major tears: comparison of surgical and conservative treatment. British Journal of Sports Medicine. 2001. DOI: 10.1136/bjsm.35.3.202

[2] Delayed Repair of a Ruptured Pectoralis Major Muscle. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280021901

[3] Rupture of the Pectoralis Major Muscle. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280012701

[4] Rupture of the Pectoralis Major Muscle. The American Journal of Sports Medicine. 2004. DOI: 10.1177/0363546503261137

[5] Surgical Treatment of Pectoralis Major Tendon Ruptures: A Retrospective Review of 134 Patients Tendon Ruptures. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00242

[6] Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967119900813

[7] Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-Analysis of Operative and Nonoperative Treatment. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00411

[8] Clinical Considerations for the Surgical Treatment of Pectoralis Major Muscle Ruptures Based on 60 Cases. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513506556

[9] Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal. Open Access Journal of Sports Medicine. 2010. DOI: 10.2147/oajsm.s9066

[10] Rupture of the pectoralis major muscle: Surgical treatment in athletes. International Orthopaedics. 2006. DOI: 10.1007/s00264-006-0171-2

[11] Retrospective Review of Pectoralis Major Ruptures in Rodeo Steer Wrestlers. Advances in Orthopedics. 2013. DOI: 10.1155/2013/987910

[12] Utility of the Pectoralis Major Index in the Diagnosis of Structurally Significant Pectoralis Major Tears. Orthopaedic Journal of Sports Medicine. 2013. DOI: 10.1177/2325967113516729

[13] Pectoralis major tears: anatomy, classification, and diagnosis with ultrasound and MR imaging. Skeletal Radiology. 2014. DOI: 10.1007/s00256-014-1990-7

[14] Compartment syndrome secondary to acute pectoralis major tendon rupture. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.10.023

[15] Rupture of Pectoralis Major Muscle: A CASE REPORT AND REVIEW OF LITERATURE.. The Journal of Bone and Joint Surgery. American Volume. 1970.

[16] Accuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.037

[17] Pectoralis major tendon rupture repairs using intramedullary suture anchors shows high patient-reported outcomes in military service members. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.04.029

[18] Isolated tears of the sternocostal head of the pectoralis major muscle: surgical technique, clinical outcomes, and a modification of the Tietjen and Bak classification. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.024

[19] The ‘Cruciform Test’: A diagnostic tool to detect pectoralis major rupture. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211058457

[20] Rupture of the pectoralis major: a meta‐analysis of 112 cases. Knee Surgery, Sports Traumatology, Arthroscopy. 2000. DOI: 10.1007/s001670050197

[21] A systematic review and comprehensive classification of pectoralis major tears. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.04.035

[22] Return to Sport and Exercise Following Repair of the Pectoralis Major Tendon. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00252

[23] Pectoralis major tendon tears: a biomechanical study to analyze the influence of intratendinous suture distance on repair stability. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.01.045

[24] Pectoralis major tendon and enthesis: anatomic, magnetic resonance imaging, ultrasonographic, and histologic investigation. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.020

[25] Pectoralis Major Rupture: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-00541

[26] Acellular dermal matrix augmentation significantly increases ultimate load to failure of pectoralis major tendon repair: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.09.020

[27] Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years. European Journal of Orthopaedic Surgery & Traumatology. 2014. DOI: 10.1007/s00590-014-1451-y

[28] Pectoralis Major Repair: A Biomechanical Analysis of Modern Repair Configurations Versus Traditional Repair Configuration. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517716175

[29] Surgically Treated Pectoralis Major Tears Impact the Play and Performance of National Football League Athletes. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.07.009

[30] Pectoralis major tendon repair outcomes: comparison of transosseous tunnel and cortical button fixation techniques. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100742

[31] Incidence Rate and Results of the Surgical Treatment of Pectoralis Major Tendon Ruptures in Active-Duty Military Personnel. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546516637177

Creative Commons BY-NC 4.0

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

Attribution-NonCommercial 4.0 International

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

Using Creative Commons Public Licenses

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

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

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

Creative Commons Attribution-NonCommercial 4.0 International Public License

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

Section 1 -- Definitions.

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

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

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

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

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

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

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

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

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

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

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

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

Section 2 -- Scope.

a. License grant.

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

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

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

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

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

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

5. Downstream recipients.

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

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

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

b. Other rights.

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

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

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

Section 3 -- License Conditions.

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

a. Attribution.

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

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

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

ii. a copyright notice;

iii. a notice that refers to this Public License;

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

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

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

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

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

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

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

Section 4 -- Sui Generis Database Rights.

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

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

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

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

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

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

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

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

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

Section 6 -- Term and Termination.

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

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

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

2. upon express reinstatement by the Licensor.

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

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

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

Section 7 -- Other Terms and Conditions.

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

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

Section 8 -- Interpretation.

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

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

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

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

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

Creative Commons may be contacted at creativecommons.org.